Chapter 19—Breasts and Axillae
Assessment
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Structure and Function #1
 Landmarks
o
Identification strategies
 4 quadrants
 Breast structures
o
Nipple; areola; Montgomery
glands
o
Fibrous tissue: supportive
 Cooper ligaments
(connect to the tissue
surrounding the chest
muscles. These ligaments
maintain the shape and
structure of the breasts)
o
Glandular tissue: 15 to 20
lobes
 Each lobe: 20 to 40
lobules
 Acini cells: milkproducing; lactiferous
ducts
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Structure and Function #2
 Axillae and lymph nodes
o Lateral axillary (brachial) nodes
o Central axillary (midaxillary) nodes
o Posterior axillary (subscapular) nodes
o Anterior axillary (pectoral) nodes
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Lifespan Considerations
o Pregnancy
 Colostrum: first form of breastmilk that is released by
the mammary glands after giving birth. It's nutrientdense and high in antibodies and antioxidants to build a
newborn baby's immune system
o Tanner staging: sexual Maturity Rating (SMR), is an
objective classification system that providers use to
document and track the development and sequence of
secondary sex characteristics of children during
puberty.
o Menarche: the first menstrual period (usually ages of 10
and 16).
o Gynecomastia: breast gland tissue caused by an
imbalance of the hormones estrogen and testosterone,
that occurs in men.
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Tanner Staging
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Lifespan Considerations #2
Cultural variations and health disparities
o Environmental factors, socioeconomic
conditions, nutrition, access to preventive
healthcare influence timing of puberty
o Black or African American females almost
40% more likely to die from breast
cancer compared to White females
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Urgent Assessment
Conditions requiring further investigation
o New breast lump/Swelling
o Existing lump with changes
o Axillary lump
o Skin irritation or dimpling
o Nipple discharge
o Nipple retraction/inverted nipple
o Breast or nipple pain
o Breast cancer can mimic other inflammatory
conditions.
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Subjective Data #1
Breast discomfort, masses or lumps, nipple
discharge
Breast surgeries
Menstrual, pregnancy, and lactation history
Hormone replacement therapy, contraceptive use
that emits hormones
Personal history of breast trauma and self-care
behaviors
Family history of breast cancer, other breast
disease, confirmed BRCA1 or BRCA2 mutation
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Subjective Data #2
 Risk reduction and health promotion
o
Health goals
 Increase proportion of mothers who breastfeed.
 Reduce female breast cancer death rate by 10%.
 Reduce late-stage female breast cancer by utilizing genetic
counseling for at-risk for breast cancer.
 Breast self-examination (BSE)
 The best time to do a monthly breast self-exam is about
3 to 5 days after your period starts. Do it at the
same time every month. Your breasts are not as tender
or lumpy at this time in your monthly cycle.
 Mammograms: Women should get mammograms every
year. Women 55 and older can switch to a mammogram
ever other year.
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Objective Data #1
 Comprehensive physical assessment
o
Inspection
o
Palpation
 Patient supine with arm extended upward
 Palpate breasts with both the flat of your hand and fingers
 Follow systematically, in a circular pattern around the nipple
or along the radial lines (simulate a clock) or vertical segments
and feel the entire breast, including the tail near the axilla.
 Feel the areola and nipple for tenderness; nodules; nipple
palpation
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Objective Data #2
Comprehensive physical assessment—(cont.)
o Male breasts (still assess for breast cancer)
o Additional techniques
 Mammography, ultrasound, MRI, biopsy
o Genetic Testing: Certain mutations in the
BRCA genes make cells more likely to divide
and change rapidly, which can lead to cancer.
All women have BRCA1 and BRCA2 genes,
but only some women have mutations in
those genes. About 1 in every 500 women in
the United States has a mutation in either her
BRCA1 or BRCA2 gene.
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Critical Thinking
 Laboratory and diagnostic testing: mammography;
ultrasound
 Diagnostic reasoning: nursing diagnoses; outcomes;
interventions
o Outcomes (partial list)
 Patient returns to previous social involvement.
 Patient performs BSE monthly.
o Interventions (partial list)
 Teach BSE, encouraging monthly performance.
 Allow for privacy during breast examination.
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