Assessment of the Breast and the Axilla

1. ASSESSMENT OF THE
AXILLA AND THE BREAST
SAPHAN C. AGABA
UGANDA CHRISTIAN UNIVERSITY

2. LEARNING OBJECTIVES
By the end of the unit, learners will be able to:
• Discuss the history questions pertaining to male and female breast and
Genitalia assessment.
• Perform a breast examination including axillary nodes and interpret
findings.
• Discuss components of a genital exam on a male or female.
• Review components of a comprehensive reproductive history.
• Document findings.
• List the changes in breast, male & female
• genitalia that are characteristics of aging process.

3. FEATURES OF THE BREAST
• Location-- chest
wall
• Axillary tail of Spence
• Nipple and areola

4. Internal Features
• Glandular tissue
– Lobes, lobules, and
alveoli
– Lactiferous ducts and
sinuses
• Fibrous tissue
– Suspensory ligaments or
Cooper’s ligaments –
Adipose tissue

5. THE 4 QUADRANTS
The
quadrants
play an
important
role in
localizing
and
examining
the breasts

6. LYMPHATICS
• Axillary nodes – Central
• – Pectoral (anterior)
– Subscapular (posterior) – Lateral
Drainage patterns

7. HEALTH HISTORY/SUBJECTIVE DATA
• History of Breast Disease and or Surgery
• Lumps or thickening
• Discharge
• Rash
• Swelling/Trauma
• Pain
• Does pt. perform self breast exam monthly
• Axillary tenderness, lumps swelling, rash

8. PHYSICAL EXAM/OBJECTIVE DATA
Inspection-
• patient sitting, disrobed to waist, Arms aside
• Note symmetry, size and shape
• Skin normally smooth and even in color.
• Observe the axillary and supra clavicular areas for
any bulging, discoloration or edema
• Nipples- symmetrical? Flat? Inverted?
• Discharge? Bleeding?

9. Inspect with Arms Above
the Head
Inspect with Arms place on the hips
Inspect with patient leaning forward
SCREEN FOR
RETRACTIONS

10. PALPATION OF THE BREASTS
•Palpation is best performed when the
breast tissue is flattened.
•The patient should be supine.
•Palpate the rectangular area extending from
the clavicle to the inframammary fold or bra
line, and from the midsternal line to the
posterior axillary line and well into the axilla
to ensure that you examine the tail of the
breast.

11. PALPATION OF THE BREASTS
• A thorough examination takes at least 3 minutes for each
breast.
• Use the pads of the 2nd, 3rd, and 4th fingers, keeping the
fingers slightly flexed.
• It is important to be systematic.
• The vertical strip pattern is currently the best validated
technique for detecting breast masses.
• Palpate in small, concentric circles applying light, medium,
and deep pressure at each examining point.
• Press more firmly to reach the deeper tissues of a large
breast. Examine the entire breast, including the periphery,
tail, and axilla.

12. PALPATION OF THE BREASTS
• Three Methods for systematic examination of the
breast:
1. Vertical strips:
• In this technique, you are breaking the breast into a
series of vertical strips, each of which is evaluated
sequentially, moving lateral to medial.
• Start at the clavicle, adjacent to the axilla.
• Move your hand down in a vertical line until you've
reached the area below the breast.
• Actual palpation technique is as described above.

13. PALPATION OF THE BREASTS Cont’d
• Then move a bit more medially, and examine while traveling up
towards the top of the breast.
• When you reach the clavicle, move medially and repeat until you've
evaluated the entire breast.
• There is a "tail" of breast tissue that extends from the lateral aspect of
the structure towards the axilla. Make sure that you palpate this
region as well.

14. PALPATION OF THE BREASTS Cont’d
• The breast is a comma shaped organ with its tail extending upwards
into the axilla.
• All of the breast tissue needs to be systematically palpated.

15. NOTE THE FOLLOWING AS YOU PALPATE
• Consistency of the tissues.
• Tenderness ---- may occur prior to menses.
• Nodules. Palpate carefully for any lump or mass that is
qualitatively different from or larger than the rest of the
breast tissue.
• This is sometimes called a dominant mass that may be
pathologic when evaluated by mammogram, aspiration, or
biopsy.

16. Inspect and Palpate Axillae
•While patient is sitting, lift and support the arm so
patient’s muscles are relaxed
•Use the right hand to palpate left axillae
•Reach fingers high into axillae
•Move fingers firmly down in four directions:
•– Down the chest wall, along the anterior and
posterior borders of axillae and around the inner
aspect of the arm
•Move arm through ROM to have access to areas.

17. Examine
Lymphnodes for;
-Size
-Consistence
-Fixation

18. Bimanual Breast Palpation
• For pendulous breasts
• Patient sitting, leaning
forward
• Support inferior part of
breast with one hand.
• Use other hand to palpate
breast tissue against
supporting hand.

19. THE NIPPLES
• Performed after breast
palpation.
• Palpate nipple, noting any
indurations or mass.
• Use thumb and forefinger to
apply gentle pressure to note
any discharge.

20. BREAST SELF EXAM (BSE) INSTRUCTIONS
• LYING IN SUPINE
1. Lie down with a pillow under your right
shoulder, Place your right arm behind
your head.
2. Use the finger pads of the three middle
fingers on your left hand to feel for lumps
in the right breast. Make overlapping,
dime-sized circular motions to feel the
breast tissue.

21. BREAST SELF EXAM (BSE) INSTRUCTIONS
3. Apply three levels of pressure in each spot: light, medium, and firm,
using firmer pressure for tissue closest to the chest and ribs.
• A firm ridge in the lower curve of each breast is normal.
• If you’re not sure how hard to press, talk with your health care
provider, or try to copy the way the doctor or nurse does it

22. BREAST SELF EXAM (BSE) INSTRUCTIONS
4. Examine the breast in an up-and-down or “strip” pattern.
Start at an imaginary straight line under the arm, moving up and
down across the entire breast, from the ribs to the collarbone, until you
reach the middle of the chest bone (the sternum).
Remember how your breast feels from month to month.
• 5. Repeat the examination on your left breast, using the finger pads of
the right hand.
• 6. If you find any masses, lumps, or skin changes, see your clinician
right away.

23. BREAST SELF EXAM (BSE) INSTRUCTIONS
• While Standing
• While standing in front of a mirror with
your hands pressing firmly down on your
hips, look at your breasts for any changes
of size, shape, contour, or dimpling, or
redness or scaliness of the nipple or
breast skin

24. BREAST SELF EXAM (BSE) INSTRUCTIONS
• . The pressing down on the hips position
contracts the chest wall muscles and
enhances any breast changes.
• Examine each underarm while sitting up or
standing and with your arm only slightly
raised so you can easily feel in this area.
• Raising your arm straight up tightens the
tissue in this area and makes it harder to
examine

25. The Male Breast
• Examination can be abbreviated but not omitted.
• Inspect the chest wall noting skin surface and any lumps or swelling.
• Palpate nipple area for lumps or enlargement.
• Normal male breast has a flat disc of
• undeveloped breast tissue beneath the
• nipple. Should be even without any nodules

26. Documenting the Breasts and Axillae
Examination
• Breasts symmetric, firm and smooth without nodules
or masses. Nipples without discharge. No axillary
adenopathy or abnormal skin color