Breast and Axillae Flashcards
Breast nodules are often bilateral or unilateral?
bilateral and can occur throughout the breast
when does nodularity of the breast increase?
possibly before menses
is uneven breast tissue normal or abnormal
normal
extra nipples along the “milk line” that present as a small nipple/areola
supernumerary nipples
what node is most likely to be palpable
central nodes
node that is in the center of the axilla in the axillary fat, midway between A and P axillary fold
Central nodes
node located between the pectoralis minor and major muscles
Rotter’s nodes
where does the central nodes drain into
into the infraclavicular and supraclavicular nodes
where do most lymphatic vessels of the breast drain into?
the axillary nodes
what 3 groups drain into the central nodes? are they palpable
- pectoral (anterior)
- subscapular (posterior)
- lateral (humeral or deep)
no they are not palpable
small nipple and areola overlaying a thin disc of undeveloped breast tissue consisting of primarily ducts
the male breast
a benign breast enlargement caused by a proliferation of a palpable glandular tissue
gynecomastia
how big is the glandular tissue in gynecomastia?
> 2cm in size
what causes gynecomastia?
- increased estrogen
- decreased testosterone
- medications (spironolactone)
- Klinefelter syndrome
- antipsychotics
common/concerning symptoms of the breast
- breast lump
- discomfort or pain
- nipple discharge
accumulation of subareolar fat
pseudogynecomastia (man boobs)
what should be asked for pts with breast lump or mass?
- location
- how long has it been there
- any variation in size or with menstraution
- any dimpling of the skin?
- family history
MC breast mass for age 15-25 years?
fibroadenoma
smooth, rubbery, round, mobile and nontender breast mass
fibroadenoma
MC breast mass in age 25-50
Cyst, fibrocystic changes, cancer
mass that is soft/firm, round, mobile, tender
cysts
mass that is nodular and rope like
fibrocystic change
mass that is irregular, firm, mobile/fixed
cancer
MC masses in pregnant/lactating patients
- lactating adenomas
- cysts
- mastitis
- cancer
Breast pain that fluctuates with hormone changes from menstrual cycle
cyclic mastalgia
breast pain related to an internal injury or anatomical change
non-cyclic mastaglia
breast pain that is felt in the breast but originates from another location
Extramammary mastalgia
what type of pain NEEDS diagnostic imaging
focal
a discharge of milk containing fluid unrelated to pregnancy or lactation
galactorrhea
what is the MC cause of galactorrhea
hyperprolactinemia
when is nipple discharge more likely to be pathologic?
- blood/serous
- unilateral
- spontaneous
- with a mass
- arising from a single duct
- > 40yo
When is the best time to do a breast exam in female patients that are still menstruating
5-7 days after onset of menstruation
what are the 4 positions of breast exams
- arms at the side
- arms over the head
- hands pressed against the hips
- leaning forward
why do we do 4 different positions for breast exam
b/c certain positions can bring out dimpling or retraction
thickening of the skin and prominent pores of the breast
Peau d’orange
what does peau d’orange suggest?
breast cancer
Nipple that points inward and is depressed below the areolar surface but can be moved out from the sulcus
inverted nipple
what is a benign variant of nipple shape that can cause difficulty with breastfeeding
inverted nipple
nipple that is pulled inward and is tethered by an underlying duct
retracted nipple
what can a retracted nipple suggest?
possible underlying cancer
what nipple variation may be depressed, flat, broad, or thickened?
retracted nipple
how should the patient be positioned for a breast exam
- lying supine with their hand on their forehead
what is the area borders of a breast exam
rectangular area from the clavicle to the inframammary fold and from the midsternal to the posterior axilla
what pattern should the breast be examined in?
verticle strip pattern
small circles at each examining points w varying pressure
how to describe the location of a mass
by quadrant of the clock with cm from the nipple
how should the size of a mass be described
cm
how should the shape of a mass be described?
- round
- cystic
- disc-like
- irregular contour
how should the consistency of a mass be described
soft, firm, hard
how should the boundary of a mass be described
delimitation
well circumscribed or not
what are you palpating the nipple for?
thickening and elasticity
firm disc of glandular enlargement, often tender
gynecomastia
soft, fatty enlargement of breast from obesity
pseudogynecomastia
normal nodes are
soft
small
non tender
how to palpate for the axillae
sunder the axillae
what should you inspect a mastectomy scar for
- masses
- unusual noduality
- inflammation
- infection
should you palpate the mastectomy scar?
yes, gently
where should you palpate the breast post breast reconstruction
- breast tissue and incision lines
- pay attention to the upper/outter quadrant
- note any enlarged lymph nodes
what causes should be considered for bilateral nipple discharge?
- hyperthyroidism
- pituitary prolactinoma
- medications
not pregnancy
what causes should be considered for unilateral bloody discharge?
- intraductal papilloma
- ductal carcinoma in situ
- paget disease
what type of discharge is usually benign
- multiductal
- clear, green or black
- non bloody
what is the most common solid benign tumor?
Fibroadenoma
what can cause an increase in size of fibroadenoma
pregnancy or estrogen therapy
what can cause a fibroadenoma to regress
menopause
a fluid filled sac within the breast that is benign
breast cyst (common in middle aged women)
irregular or stellate shape with firm or hard consistency mass
cancer
what causes cysts that are tender/painful and palpable as nodular rope-like densities
fibrocystic changes
are fibrocystic changes benign
yes
painless, well circumscribed, round, mobile mass
fibroadenoma
what are the visible signs of breast cancer?
- retraction signs (contours, dimpling, deviation)
- edema of the skin
- thickened skin/enlarged pores
- paget disease
what is an uncommon form of breast cancer?
paget disease of the nipple
where is edema first seen as a sign of breast cancer
in the lower portion of the breast
scaly, eczema like lesion on the nipple that may weep, crust or erod with ulceration into the areola
paget disease of the nipple (starting)
how often is an in situ/invasive ductal/lobular carcinoma present in pagets disease
60%
what is the most important risk factor of female breast cancer
AGE
what are the other risk factors of female breast cancer?
- BRCA mutation
- dense breast tissue
- personal/family history
- early menarche (<12 yo) or late menopause (>55 yo)
- high dose radiation at a young age
what age should breast cancer screening be started?
age 40
how often should mammograms be conducted?
every 2 years (Biennial)
American cancer society says q1 year
why is dense tissue a risk factor for female breast cancer
- harder to detect
- more common in dense
what percentage of breast cancer is male pts
<1%
what are risk factors of male breast cancer?
- age
- radiation
- BRCA mutation
- Klinefelter syndrome
- testicular disorders
- family history
- alochol use
- cirrohsis
- diabetes
- obesity
when is male breast cancer typically found?
age 60-70
