4. Breast

The breast bud consists of breast tissue that is stimulated to grow by maternal estrogens and fatty tissue which is dependent upon fetal nutritional status. the examiner notes the size of the areola and the presence or absence of stippling (created by the developing papillae of Montgomery). The examiner then palpates the breast tissue beneath the skin by holding it between thumb and forefinger, estimating its diameter in millimeters, and selects the appropriate square on the score sheet.

Under- and over-nutrition of the fetus may affect breast size variation at a given gestation. Maternal estrogen effect may produce neonatal gynecomastia on the second to fourth day of extrauterine life.


-1 0 1 2 3 4 5
Breast imperceptable barely
flat areola
no bud
stippled areola
1-2 mm bud
raised areola
3-4 mm bud
full areola
5-10 mm bud

References :
Ballard JL, Khoury JC, Wedig K, et al: New Ballard Score, expanded to include extremely premature
infants. J Pediatrics 1991; 119:417-423.