Look for any change in size or shape; lumps or thickenings; any rashes or other skin irritations; dimpled or puckered skin; any discharge or change in the nipples (e.g. position or asymmetry). Inspect the breasts in all of the following positions:
1.1 Stand and face the mirror with your hands resting on the hips; then turn to the right and the left for a side view. This will allow you to observe for any flattening or dimpling on the peripheral areas of the breasts; repeatedly alternating the left and the right side aids in checking for lateral symmetry.
1.2 Bend forward from the waist and raise your arms over your head. With the breasts not resting or flattened on your chest wall, it will accentuate any changes in shape or size.
1.3 Still facing the mirror, raise both arms over your head to inspect for skin or nipple retraction. Such movements can cause the contraction of anterior chest muscles and stretch the breast ligament
1.3 Press your hands firmly down on your hips and again, look at your breasts for any changes of size, shape, contour, or dimpling. The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.
1.4 Check your nipples for discharge (fluid). Place your thumb and forefinger on the tissue surrounding the nipple and pull outward toward the end of the nipple. Look for any discharge. If discharge is present, milk the breast along its radii. Assess discharge for amount, color, consistency, and odor. Repeat on your other breast. The pressing motion pushes any fluid, if any, from the opening. Pulling on the nipple enables you to assess its elasticity and consistency. Milking the breast along its radii enables you to identify the lobe producing discharge.
2. Palpation: Lying Position
2.1 Place a pillow under your right shoulder and place the right hand behind your head. This position allows the breast tissue to spread evenly over the chest wall as thinly as possible, making it much easier to feel all the breast tissue. The shoulders can be elevated by a small pillow placed under them to allow the breasts to rest more symmetrically on the chest wall for more detailed and convenient examination.
2.2 Mark imaginary lines around the breast. Take the nipple as the central point, a horizontal line and a vertical line through the central point departs the breast into four quadrants. This makes it convenient to locate the lesion or masses if any.
2.3 Use the finger pads of the 3 middle fingers (held together) on your left hand to feel for lumps. The pads of the fingers are used because their concentration of nerve endings makes them highly sensitive to tactile discrimination.
2.4 Press the breast tissue against the chest wall firmly enough to know how your breast feels. A ridge of firm tissue in the lower curve of each breast is normal.
2.5 Use small, circular motions systematically all the way around the breast as many times as necessary until the entire breast is covered. Start and end at a fixed point to ensure that all breast surfaces are assessed.
2.6 The left breast should be palpated from the upper lateral quadrant, with a procedure of clockwise direction for thorough examination, The same procedure is adopted for palpation of the right breast with anti-clockwise direction. Pay particular attention to the upper outer quadrant area and the tail of Spence. About 50% of breast cancers develop in the upper outer quadrant area and in the tail of Spence.
2.7 Each quadrant is palpated superficially and then deeply, and the nipple is palpated finally.
Note: Vary the levels of the pressure as you palpate: Light superficial Medium mid-level tissue
Light palpation should always precede deeper palpation because heavy pressure on the fingertips can dull the sense of touch.
2.8 Repeat the steps on your left breast.
3. Palpation: Standing or Sitting
3.1 the steps are similar with that of palpating supine. Perform the examination while upright (sitting or standing) with one arm raised behind your head. This position makes it easier to check the area where a large percentage of breast cancers are found, the upper outer part of the breast and toward the armpit.
3.2 Palpate the axillary, subclavicular and supraclavicular lymph nodes. Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. The axilla, supraclavicular region and neck should be palpated carefully, to detect any enlargement of lymph nodes or other abnormalities; these areas are usually involved in inflammatory lesion. Raising your arm straight up tightens the tissue in this area and makes it very difficult to examine.
NORMAL AND ABNORMAL FINDINGS WHEN PERFORMING SELF-BREAST EXAMINATION ASSESSMENT NORMAL ABNORMAL SIGNIFICANCE
Size and Symmetry Breasts can be a variety of sizes and are somewhat round and pendulous. One breast may be larger than the other. A recent increase in size of one breast Inflammation or abnormal growth
Peau d orange appearance Results from edema which is seen in metastatic breast cancer Clients breasts should rise symmetrically with no sign of dimpling or retraction. Dimpling or retraction usually caused by malignant tumor that has fibrous strands attached to the breast tissue and fascia of the muscles. Usually caused by malignant tumor that has fibrous strands attatched to the breast tissue and fascia of the muscles
Color and Texture Color varies depending on the clients skin tone. Texture is smooth with no edema. Redness Associated with breast inflammation. Linear stretch marks may be seen during or after pregnancy or when there is significant weight loss.
Superficial Venous Pattern Veins radiate either horizontally and towards the axilla (transverse) or vertically with a lateral flare (longitudinal). Veins are more prominent during pregnancy. A prominent venous pattern
May occur as a result of increased circulation due to a malignancy. An asymmetric venous pattern May be due to malignancy.
ASSESSMENT NORMAL ABNORMAL SIGNIFICANCE
Areolas Areolas vary from dark pink to dark brown, depending on the clients skin tone. They are round and may vary in size. Small Montgomery tubercles are present. Peau d orange skin may be first seen in the areola. Results from edema which is usually seen in metastatic breast malignancy.
Red, scaly, crusty areas
Indicative of Pagets disease
Nipples Nipples are equally bilateral in size and are in the same location of each breast. Nipples are usually everted but they may be inverted or flat. Supernumerary Nipples may appear along the embryonic milk line.
A recently retracted nipple that was previously everted
May suggest malignancy Any type of spontaneous discharge should be referred for cytologic study and further evaluation.
Texture and Elasticity Smooth, firm, elastic tissue Older clients breasts may feel more granular
Thickening of tissues
May suggest underlying malignant tumor
Tenderness and Temperature A generalized increase in nodularity and tenderness may be a normal finding associated with the menstrual cycle or hormonal medication. Breasts should be a normal body temperature.
Painful breasts
Indicative of benign breast disease but can also be malignant.
Heat in the breast of women who have not just given birth or who are not lactating
Inflammation ASSESSMENT NORMAL ABNORMAL SIGNIFANCE
Presence of Masses No masses should be palpated. However, a firm ridge may normally be palpated at the lower base of the breasts. Malignant tumors are most often found in the upper outer quadrant of the breast. They are usually unilateral, irregular, poorly delineated borders. They are hard and nontender and fixed to underlying tissues.
Should be referred to cytologic study and further evaluation for management. Axillae
Inspection and Palpation No rash or infection noted.
No palpable nodes or one or two small (less than 1cm) discrete, nontender moveable nodes in the central area. Enlarged (greater than 1cm) lymph nodes may indicate infection of the hand or arm. May indicate infection of the hand or arm.
Large nodes that are hard or fixed to the skin may indicate an underlying malignancy.