Chapter 17-Breast and Regional Lymphatics

Chapter 17-Breast and Regional Lymphatics

Identify appropriate history questions to ask regarding the breast examination
– Any hx of breast disease/
What type? how was it dx? when? treated?

-Family hx of breast disease? What ages?

Correlate changes in the female breast with normal developmental stages
Stage 1: Preadolescenct: only small, elevated nipple

Stage 2: Breast bud stage: small mound of breast and nipple develops; areola widens

Stage 3: Breast and areola enlarge; nipple is flush with breast surface

Stage 4: the areola and nipple form a secondary mound over the breast

Stage 5: Mature breast: only nipple protrudes; the areola is flush with breast contour

Describe the components of the breast examination
Subjective:
-Breast: Pain, Lump, Discharge, Rash, Swelling, Trauma, Hx of breast dx, srugery or radiation, medications, pt-centered
-Axilla: tenderness, lump, swelling, rash

Objective:
-Inspection: General appearance, skin, lymphatic drainage areas, nipple, maneuvers for screen retration
-Inspect and Palpate the Axilla
-Palpate breasts
-Teach breast self-examination

List points to include in teaching the breast self-examination
-Early detection of breast cancer is important, if cancer isn’t invasive, survival rate is 98%
-Explain correct techniques and rationales and expected findings
-Perform in front of mirror while disrobed
-Palpate in shower, then while laying supine

*Perform right after menstrual period (or familiar date once a month after menopause)

Explain significance of a supernumerary nipple or breast
-minute extra nipple along embryonic milk line
Differentiate bt the female and male examination procedures and findings
Male: can have abbreviate exam, but do not omit.
-can just combine with anterior thorax
-Gynecomastia–> benign breast growth in adolescent male
Discuss pathologic changes that may occur in the breast:
Benign breast disease
abscess
acute mastitis
fibroadenoma
cancer
paget disease
Benign breast disease: bilateral nodules; pain (dull, heavy and cyclic) Can make detecting cancerous lumps difficult

abscess: Packet of puss that feels hard, looks red, and is tender

acute mastitis: Inflammatory mass before abscess. Usually single quadrant, red, swollen, tender, hot and hard.
*usually with lactation bc of stasis or plugged duct*

fibroadenoma: solitary nontender mass that is solid, firm, rubbery, and elastic; round, oval, or lobulated; detected in late adolescence. Benign!

cancer: solitary, unilateral, nontender. solid, hard, dense, and fixed. Grows constantly

paget disease:
-early lesion has unilateral, clear, yellow discharge and dry, scaling crusts, friable @ nipple axex. Erythmatous halo on areola
-later lesions show nipple reddened, excoriated and ulcerated with bloody discharge and erythematous plaque surrounding nipple

List and describe the characteristics to consider when a mass is noted in the breast
Location: clock face
Size: width x length x thickness
Shape: oval, round, lobulated, or indistinct
Consistency: soft, firm, hard
Movable: freely or fixed?
Distinctness: solitary or multiple
Nipple: displaced or retracted
Note skin over lump: erythematous, dimpled, or retracted
Tenderness: tender on palpation
Lymphadenopathy: regional lymph nodes palpable?
Gynecomastia
benign growth of breast tissue, making it distinguishable from other tissues on chest wall.
Smooth, firm, movable disk
Temporary
*Adolescent boys
High-risk and moderate risk factors that increase the usual risk for breast cancer
Alcohol, physical exercise reduces, low income, lack of health insurance, geographic, culture and language barriers, racial bias
-Alcohol/western diet increases
-Mediterranean diet protective against
alveoli
smallest structures in the mammary gland
areola
darkened area surrounding the nipple
colostrum
thin, yellow fluid, precursor of milk, secreted for a few days after birth
cooper ligaments
syspensory ligaments; fibrous bands extending from the inner breast surface to the chest wall muscles
fibroadenoma
benign breast mass
galactorrhea
persistent white discharge of milk between nursing sessions or after weaning
intraductal papilloma
serosanguineous nipple discharge
inverted
nipples that are depressed or invaginated
lactiferous
conveying milk
mastalgia
pain in breast
mastitis
inflammation of the breast
montgomery glands
sebaceous glands in the areola that secrete protective lipid duringn lactation

-also called tubercles of Montgomery

paget disease
intraductal carcinoma in the breast
peau d’orange
orange peel appearance of breast due to edema
retraction
dimple or pucker on the skin
striae
atrophic pink, purple, or white linear streaks on the breasts, associated with pregnancy, excessive weight gain, or rapid growth during adolescence
supernumerary nipple
minute extra nipple along the embryonic milk line
tail of spence
extension of breast tissue into the axilla
thelarche
beginning of prepubertal breast development