Breasts
- are paired mammary glands that lie over the
muscles of the anterior chest wall, anterior to
the pectoralis major and serratus anterior
muscles. Depending on their size and shape,
the breasts extend vertically from the second
to the sixth rib and horizontally from the
sternum to the mid-axillary line
-The male and female breasts are similar until
puberty, when female breast tissue enlarges
in response to the hormones estrogen and
progesterone, which are released from the
ovaries.
Female breast-is an accessory reproductive
organ with two functions: to produce and
store milk that provides nourishment for
new-borns and to aid in sexual stimulation.
Male breasts have no functional capability.
Breasts are divided into four quadrants by
drawing horizontal and vertical imaginary
lines that intersect at the nipple. The upper
outer quadrant, which extends into the
axillary area, is referred to as the tail of
Spence. Most breast tumors occur in this
quadrant
A projection of breast tissue from this
quadrant extends into the axilla, called the
axillary tail of Spence
External Breast Anatomy
Nipple- located in the center of the breast,
contains the tiny openings of the lactiferous
ducts through which milk passes.
Areola –surrounds the nipple (generally 1 to
2 cm radius) and contains elevated sebaceous
glands (Montgomery glands) that secrete a
protective lipid substance during lactation.
Hair follicles commonly appear around the
areola. Smooth muscle fibers in the areola
cause the nipple to become more erectile
during stimulation
The nipple and areola typically have darker
pigment than the surrounding breast. Their
color ranges from dark pink to dark brown,
depending on the person’s skin color. The
amount of pigmentation increases with
pregnancy, then decreases after lactation. It
does not, however, entirely return to its
original coloration
During embryonic development, a milk line
or ridge extends from each axilla to the groin
area. It gradually atrophies and disappears as
the person grows and develops. However, in
some clients, supernumerary nipples or other
breast tissue may appear along this “milk
line”
Internal Breast Anatomy
Female breasts consist of three types of
tissue: glandular, fibrous, and fatty
(adipose)
Glandular tissue constitutes the functional
part of the breast, allowing for milk
production. Glandular tissue is arranged in 15
to 20 lobes that radiate in a circular fashion
from the nipple. Each lobe contains several
lobules in which the secreting alveoli (acini
cells) are embedded in grape-like clusters.
Mammary ducts from the alveoli converge
into a single lactiferous duct that leaves each
lobe and conveys milk to the nipple. The
slight enlargement in each duct before it
reaches the nipple is called the lactiferous
sinus. The milk can be stored in the
lactiferous sinus (or ampullae) until
stimulated to be released from the nipple.
The lateral nodes drain most of the arms, and
the central nodes receive drainage from the
anterior, posterior, and lateral lymph nodes.
A small proportion of the lymph also flows
into the infraclavicular or supraclavicular
lymph nodes or deeper into nodes within the
chest or abdomen.

The fibrous tissue provides support for the

glandular tissue largely by way of bands
called Cooper’s ligaments (suspensory
ligaments). These ligaments run from the
skin through the breast and attach to the deep
fascia of the muscles of the anterior chest
wall.

Fatty tissue is the third component of the

breast. The glandular tissue is embedded in
the fatty tissue. This subcutaneous and
retromammary fat provides most of the
substance to the breast, determining the size
and shape of the breasts. The functional
capability of the breast is not related to size
but rather to the glandular tissue present.
The amount of glandular, fibrous, and fatty
tissue varies according to various factors
including the client’s age, body build,

nutritional status, hormonal cycle, and

whether she is pregnant or lactating.

LYMPH NODES -The major axillary

lymph nodes consist of the anterior
(pectoral), posterior (subscapular), lateral
(brachial), and central (mid-axillary)
nodes.
The anterior nodes drain the anterior chest
wall and breasts.
The posterior chest wall and part of the arms
are drained by the posterior nodes.
 Assessment Normal Findings Deviations from Normal
Inspect the breasts for size, Females: rounded shape; Recent change in breast size;
symmetry, and contour or shape slightly unequal in size; swellings; marked asymmetry
while the client is in a sitting generally symmetric
position Males: breasts even with the
chest wall; if obese, may be
similar in shape to female
breasts
Inspect the skin of the breast for  Skin uniform in color (like  Localized discolorations or
localized discolorations or skin of abdomen if not hyperpigmentation
hyperpigmentation, retraction or tanned) Skin smooth and  Retraction or dimpling
dimpling, localized hyper vascular intact (result of scar tissue or an
areas, swelling or edema. ❶  Diffuse symmetric invasive tumor)
❶ A lesion causing retraction of horizontal or vertical  Unilateral, localized hyper
the skin. vascular pattern in light- vascular areas (associated
skinned people with increased blood flow)
 Striae (stretch marks);  Swelling or edema
moles and nevi appearing as pig skin or
orange peel due to
exaggeration of the pores
Emphasize any retraction by having
the client:
• Raise the arms above the head.
• Push the hands together, with
elbows flexed. ❷
• Press the hands down on the hips.
❸

Inspect the areola area for size,
shape, symmetry, color, surface
characteristics, and any masses or
lesions.
 Irregular
Inspect the nipples for size, shape,
position, color, discharge, and
lesions
 No discharge, except from
 Inversion of one or both
Palpate the axillary, subclavicular,
and supraclavicular lymph nodes
❹ while the client sits with the
arms abducted and supported on
the nurse’s forearm. See discussion
on palpation of clavicular lymph
nodes in Skill 30-10. Use the flat
surfaces of all fingertips to palpate
the four areas of the axilla:
 The edge of the greater
pectoral muscle (musculus
pectoralis major) along the
anterior axillary line
Round or oval and bilaterally Any asymmetry, mass, or
the same lesion
Color varies widely, from
light pink to dark brown
placement of
sebaceous glands on the
surface of the areola
(Montgomery’s tubercles)
Round, everted, and equal in Asymmetrical size and color
size; similar in color; soft and Presence of discharge, crusts,
smooth; both nipples point or cracks
in same direction (out in Recent inversion of one or
young women and men, both nipples
downward in older women)
pregnant or breast-feeding
females
nipples that is present from
puberty
No tenderness, masses, or Tenderness, masses, or
nodules nodules
  The thoracic wall in the
midaxillary area
 The upper part of the
humerus
 The anterior edge of the
latissimus dorsi muscle
along the posterior axillary
line.

Palpate the breast for masses, No tenderness, masses, Tenderness, masses, nodules,
tenderness, and any discharge from nodules, or nipple discharge or nipple discharge
the nipples. Palpation of the breast If you detect a mass, record the
is generally performed while the following data:
client is supine. a) Location: the exact
Rationale: In the supine position, location relative to the
the breasts flatten evenly against quadrants and axillary
the chest wall, facilitating tail, or the clock ❺
palpation. For clients who have a and the distance from
history of breast masses, who are at the nipple in
high risk for breast cancer, or who centimeters
have pendulous breasts, b) Size: the length, width,
examination in both a supine and a and thickness of the
sit-ting position is recommended mass in centimeters. If
 If the client reports a breast you can determine the
lump, start with the discrete edges, record
“normal” breast to obtain this fact
 baseline data that will serve
as a comparison to the
reportedly involved breast
 To enhance flattening of
the breast, instruct the
client to abduct the arm
and place her hand behind
her head. Then place a
small pillow or rolled towel
under the client’s shoulder.
 For palpation, use the
palmar surface of the
middle three fingertips
(held together) and make a
gentle rotary motion on the
breast
 Choose one of three
patterns for palpation:
 a. Hands-of-the-clock or
spokes-on-a-wheel ❺
 b. Concentric circles ❻
 c. Vertical strips pattern.
❼
c) Shape: whether the
mass is round, oval,
lobulated, indistinct, or
irregular
d) Consistency: whether
the mass is hard or soft
e) Mobility: whether the
mass is movable or
fixed.
f) Skin over the lump:
whether it is reddened,
dimpled, or retracted.
g) Nipple: whether it is
displaced or retracted
h) Tenderness: whether
palpation is painful
Palpate the areolae and the nipples No tenderness, masses, Tenderness, masses, nodules,
for masses. Compress each nipple nodules, or nipple discharge or nipple discharge
to determine the presence of any
discharge. If discharge is present,
milk the breast along its radius to
identify the discharge-producing
lobe. Assess any discharge for
amount, color, consistency, and
odor. Note also any tenderness on
palpation