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Breast & Axillae
Breast & Axilla Exam — MUST KNOW for NCLEX/Boards
Highest-yield red flags
Know these as possible malignancy until proven otherwise:
New unilateral nipple inversion/retraction, especially if nipple was not previously
inverted.
Unilateral prominent venous pattern on one breast.
Skin dimpling or retraction.
Peau d’orange: thick, pitted “orange peel” skin; concerning for inflammatory breast
cancer.
Inflammatory breast cancer: rapid breast redness, swelling, tenderness, warmth,
heaviness, skin color change.
Paget disease of nipple: eczema-like nipple/areola changes; associated with underlying
breast cancer.
Nipple discharge + pain/lump/hardness needs evaluation.
Supernumerary Nipples: Extra nipple tissue along: Milk line (midclavicular line)
appearance Often looks like: Hyperpigmented macule Small incomplete
nipple .Benign variation.
Breast exam sequence
1. Inspection = Patient Seated *Start seated. Inspect first. Then palpate supine.
2. Reinspect with position changes: Arms at sides
3. Step 2: Palpation = Patient Supine *Palpation ;Use light, medium, deep pressure. Chest
lymph nodes should not be palpable
Tail of Spence (MUST KNOW)
MUST KNOW
Never forget to palpate the:
Tail of Spence (axillary tail)
because: Accessory breast tissue can occur there. Breast cancer can occur there.
Tanner staging — breast development
, 2
Stage 1: preadolescent
Stage 2: breast bud/small breast development
Stage 3: continued enlargement
Stage 4: areola/papilla form secondary mound
Stage 5: adult breast
Teacher emphasized knowing stages 1–5.
Lymph drainage
75–90% of breast lymph drainage goes to the ipsilateral (same-side) axillary lymph
nodes
Therefore: Breast cancer commonly spreads to axillary nodes first. Always assess axillary lymph
nodes during breast exam.
Common terms to know
Fibrocystic changes: benign fluid-filled formations.
Fibroadenoma: benign tumor.
Fat necrosis: benign lump after injury/inflammation.
Intraductal papilloma: benign tumor causing nipple discharge.
Duct ectasia: benign duct condition causing discharge.
Galactorrhea: milk production not related to childbearing.
Mastitis: breast inflammation/infection.
Gynecomastia: male breast enlargement.
Premature thelarche
Breast tissue before age 8.
No other puberty signs: no pubic/axillary hair or menstruation.
Differentiate true breast bud from obesity/fat deposits by palpation.
Board Association
Possible precocious puberty evaluation
Gynecomastia
Male breast enlargement due to: ↓ Testosterone OR ↑ Estrogen .Causes Puberty Aging
Medications Marijuana/Cannabis use Hormonal imbalance .NCLEX Tip: Usually resolves in
adolescent males.
Galactorrhea
Breast & Axillae
Breast & Axilla Exam — MUST KNOW for NCLEX/Boards
Highest-yield red flags
Know these as possible malignancy until proven otherwise:
New unilateral nipple inversion/retraction, especially if nipple was not previously
inverted.
Unilateral prominent venous pattern on one breast.
Skin dimpling or retraction.
Peau d’orange: thick, pitted “orange peel” skin; concerning for inflammatory breast
cancer.
Inflammatory breast cancer: rapid breast redness, swelling, tenderness, warmth,
heaviness, skin color change.
Paget disease of nipple: eczema-like nipple/areola changes; associated with underlying
breast cancer.
Nipple discharge + pain/lump/hardness needs evaluation.
Supernumerary Nipples: Extra nipple tissue along: Milk line (midclavicular line)
appearance Often looks like: Hyperpigmented macule Small incomplete
nipple .Benign variation.
Breast exam sequence
1. Inspection = Patient Seated *Start seated. Inspect first. Then palpate supine.
2. Reinspect with position changes: Arms at sides
3. Step 2: Palpation = Patient Supine *Palpation ;Use light, medium, deep pressure. Chest
lymph nodes should not be palpable
Tail of Spence (MUST KNOW)
MUST KNOW
Never forget to palpate the:
Tail of Spence (axillary tail)
because: Accessory breast tissue can occur there. Breast cancer can occur there.
Tanner staging — breast development
, 2
Stage 1: preadolescent
Stage 2: breast bud/small breast development
Stage 3: continued enlargement
Stage 4: areola/papilla form secondary mound
Stage 5: adult breast
Teacher emphasized knowing stages 1–5.
Lymph drainage
75–90% of breast lymph drainage goes to the ipsilateral (same-side) axillary lymph
nodes
Therefore: Breast cancer commonly spreads to axillary nodes first. Always assess axillary lymph
nodes during breast exam.
Common terms to know
Fibrocystic changes: benign fluid-filled formations.
Fibroadenoma: benign tumor.
Fat necrosis: benign lump after injury/inflammation.
Intraductal papilloma: benign tumor causing nipple discharge.
Duct ectasia: benign duct condition causing discharge.
Galactorrhea: milk production not related to childbearing.
Mastitis: breast inflammation/infection.
Gynecomastia: male breast enlargement.
Premature thelarche
Breast tissue before age 8.
No other puberty signs: no pubic/axillary hair or menstruation.
Differentiate true breast bud from obesity/fat deposits by palpation.
Board Association
Possible precocious puberty evaluation
Gynecomastia
Male breast enlargement due to: ↓ Testosterone OR ↑ Estrogen .Causes Puberty Aging
Medications Marijuana/Cannabis use Hormonal imbalance .NCLEX Tip: Usually resolves in
adolescent males.
Galactorrhea
