EILEEN HAWKINS, MSN, ARNP

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EILEEN HAWKINS, MSN, ARNP
BREAST ASSESSMENT
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Brief Anatomy Review

• Breast Location
• Landmarks
• Composition

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Evaluation of Breast Complaints

• LMP, gravida, parity, breast feeding hx.
• Breast exams
• Mammography
• Medications, OTC, herbal
• PMH, F. Hx.
• Breast hx.

• Hormonal risk factors
• Thorough breast exam

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Common Breast Complaints

• Nipple discharge
• Breast pain
• Breast mass

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Nipple Discharge

• Duration, laterality
• Stimulation or spontaneous
• Lactation experience
• Color, consistency
• determine for occult blood
• Medications

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Differential Dx. of Nipple Discharge

• Fibrocystic condition
• Intraductal papilloma
• Infection
• Galactorrhea
• Duct ectasia

• Concern
• unilateral
• pink, bloody or nonmilky
• associated with a mass
• gt age 60

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Breast Pain History and Physical Exam

• Duration location
• Trauma
• Previous OR
• Associated lumps or nipple discharge
• Differentiate fibrocystic thickening from
  discrete mass

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Breast Pain Differentials

• Menstrually related
• Costochondral
• Trauma
• Unrelated causes
• Cancer

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Breast Mass History

• Age
• Menopausal status
• Duration
• Changes
• Previous masses biopsies
• F. Hx.
• PE location, shape, size, mobility

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Breast Mass Exam

• Inspection palpation
• Soft, smooth, movable often benign
• Hard, rough-edged, immobile suspicious

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Special Considerations

• Asymptomatic Women
• Premenopausal Women
• Lactating Women
• Mastectomy, augmentation, implant,
  reconstruction, lumpectomy
• Infants
• Adolescents

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Patient Education

• Teach and reinforce SBE
• Recommendations for clinical breast exams
• Guidelines for mammography

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• A 62 year old woman presents with a breast lump.
  She had first felt the lump about 2 yrs. ago and
  was afraid of breast CA because her mother and an
  older sister both had mastectomies for cancer.
  She denied smoking, has never had children,
  menopause at age 52. On breast exam you noted
  asymmetry of the breasts with dimpling and
  palpated a lump.
• How would you state your objective findings?
• What will you consider in your differential
  diagnosis?

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• A 32 year old woman presents with nipple
  discharge for several months.
• What specific questions will you ask?
• What objective findings will be important to
  document?
• What will you consider in your differential
  diagnosis?