Breast Disorders & Nursing Management –

A) Diagnostic Tests – Breast Self-Examination (BSE)

✅ Definition:

• A self-examination method to detect early breast lumps, changes, or abnormalities.

✅ Steps of Breast Self-Examination (BSE):

• 1. Visual Inspection (Standing in front of a mirror)
  • Look for skin changes, dimpling, nipple discharge, or retraction.
• 2. Palpation While Standing (Using fingers in a circular motion)
  • Check for lumps, hardness, thickened areas using the pads of three fingers.
• 3. Palpation While Lying Down
  • Place one hand behind the head and use the opposite hand to check the breast.
• 4. Check Axillary (Armpit) & Clavicular (Collarbone) Regions
  • Feel for swollen lymph nodes.

✅ Timing:

• Best time: 5-7 days after menstruation when breasts are least tender.

🔹 Competitive Exam Tip:

• BSE should be done monthly, after menstruation.
• Use the pads of three fingers for palpation.

B) Disorders of the Breast

1. Mastitis

✅ Definition:

• Inflammation of breast tissue, commonly seen in lactating women.

✅ Causes:

• Blocked milk ducts or bacterial infection (Staphylococcus aureus).

✅ Symptoms:

• Pain, redness, swelling, warmth in the breast.
• Fever, chills, flu-like symptoms.

✅ Treatment:

• Continue breastfeeding (Helps drain the breast).
• Warm compress & massage to relieve blockage.
• Antibiotics (Cephalexin, Dicloxacillin for bacterial infections).

🔹 Competitive Exam Tip:

• Mastitis is common in breastfeeding mothers & should not stop feeding.

2. Breast Abscess

✅ Definition:

• A localized pus-filled infection in the breast, often due to untreated mastitis.

✅ Symptoms:

• Painful, swollen lump, with pus formation.
• High fever, redness, fluctuant mass (Fluid-filled on palpation).

✅ Treatment:

• Incision & drainage (I&D) to remove pus.
• Antibiotics (Clindamycin, Amoxicillin-Clavulanate).

🔹 Competitive Exam Tip:

• A breast abscess requires drainage; antibiotics alone are insufficient.

3. Gynecomastia

✅ Definition:

• Enlargement of male breast tissue due to hormonal imbalance.

✅ Causes:

• Increased estrogen/Testosterone imbalance (Puberty, Aging).
• Drugs (Spironolactone, Cimetidine, Anabolic steroids).
• Chronic liver disease, Kidney failure.

✅ Symptoms:

• Breast enlargement, tenderness.
• Unilateral or bilateral growth.

✅ Treatment:

• Hormonal therapy (Tamoxifen for persistent cases).
• Surgical correction (Mastectomy in severe cases).

🔹 Competitive Exam Tip:

• Gynecomastia is common in pubertal boys and usually resolves on its own.

4. Tumors & Malignancy of the Breast

✅ Types of Breast Tumors:

• Benign Tumors: Fibroadenoma, Fibrocystic changes.
• Malignant Tumors: Invasive Ductal Carcinoma (Most common), Lobular Carcinoma.

✅ Risk Factors for Breast Cancer:

• Genetics (BRCA1, BRCA2 mutations).
• Early menarche (<12 years) & Late menopause (>55 years).
• Nulliparity (No pregnancy), Hormonal replacement therapy.
• Obesity, Alcohol consumption, Smoking.

✅ Clinical Features:

• Painless, hard lump with irregular borders.
• Nipple retraction, Peau d’Orange (Skin dimpling).
• Bloody nipple discharge.

✅ Diagnostic Tests:

• Mammography (Gold standard for women >40 years).
• Breast Ultrasound (For young women with dense breasts).
• Biopsy (Fine-needle aspiration or Core biopsy).

✅ Treatment:

• Surgery (Lumpectomy, Mastectomy).
• Radiotherapy, Chemotherapy (Tamoxifen for hormone-positive cancers).

🔹 Competitive Exam Tip:

• Peau d’Orange is a classic sign of inflammatory breast cancer.
• BRCA mutation carriers have a higher risk of breast & ovarian cancer.

C) Nursing Management of a Patient After Mastectomy

✅ Definition:

• Mastectomy is the surgical removal of one or both breasts (Unilateral or Bilateral).

✅ Post-Operative Nursing Care:

1. Immediate Post-Op Care (First 24-48 Hours)

• Monitor Vital Signs (BP, HR, Oxygen Levels).
• Pain Management (IV Opioids, NSAIDs).
• Monitor Drainage Tubes (Jackson-Pratt Drain) for Excessive Bleeding.
• Assess for Complications (Hematoma, Infection, Lymphedema).

2. Wound & Drain Care

• Keep surgical site clean & dry.
• Empty the drain every 8-12 hours & document output.
• Observe for signs of infection (Redness, Fever, Pus).

3. Prevention of Lymphedema

• Do NOT take BP or IV on the affected arm.
• Encourage arm elevation & gentle exercises to improve circulation.
• Wear compression garments (As prescribed).

4. Psychological & Emotional Support

• Encourage expression of feelings (Body Image Disturbance).
• Provide support groups & counseling.
• Explain reconstructive options (Breast Implants, Flap Surgery).

5. Rehabilitation & Home Care Advice

• Arm exercises (Wall climbing, Rope pulling) to prevent stiffness.
• Avoid heavy lifting & strenuous activity for 6-8 weeks.
• Educate on self-examination of the remaining breast.

🔹 Competitive Exam Tip:

• Avoid BP measurement & IV insertion in the affected arm to prevent lymphedema.
• Gentle arm exercises should begin 1-2 days post-op to prevent stiffness.

🛑 High-Yield Revision Table for Competitive Exams

Topic	Key Points
Best Time for BSE	5-7 days after menstruation
Common Cause of Mastitis	Staphylococcus aureus
Breast Abscess Treatment	Incision & Drainage (I&D)
Most Common Breast Cancer	Invasive Ductal Carcinoma
Key Sign of Breast Cancer	Peau d’Orange (Skin dimpling)
Gold Standard Diagnosis	Mammography
Common Post-Mastectomy Complication	Lymphedema
Avoid BP/IV on Affected Arm?	YES (To prevent lymphedema)