breast and axillae Flashcards
anatomical location/boundaries of the female breast :
clavicle and ___ rib down to __ rib.
sternum to _____ ______.
overlies what muscles? what shape is this region?
Anterior thoracic wall Clavicle and 2nd rib down to 6th rib Sternum to midaxillary line Rectangular region Overlies pectoralis major and serratus anterior (at inferior)
extension of breast into the axillary fold is called what?
tail of spence
for descriptive purposes, how do you divide the breast? (2 ways)
4 quadrants (upper and lower, inner and outer) "clockface" w/ distance cm from nipple
three types of female breast tissue
- glandular
- fibrous connective
- adipose
what is the glandular tissue like?
(secretory tubuloalveolar glands/ducts)
Forms 15-20 septated lobes radiating around the nipple
Smaller lobules drain into milk-producing ducts and sinuses that open onto surface of breast at areola
what is the fibrous tissue like?
Structural support (fibrous bands, suspensory ligaments)
where is the adipose tissue usually?
Predominantly superficial and peripheral areas
as you get older, breast tissue is more _____
adipose (less dense)
what are the rounded elevations around the areola? (3 )
Sebaceous glands, sweat glands, accessory areolar glands
what does tactile stimulation do to the nipple? if this isnt happening what might be a cause?
Tactile stimulation = nipple smaller, firmer, more erect and areola puckers and wrinkles
-not happening? somthing blocking the smooth muscle contraction response like a tumor
Nipple and areola supplied by _____ ______ _______ to express milk
Sensory innervation triggers “letdown” due to what?
Nipple and areola supplied by smooth muscle for contraction to express milk
Sensory innervation triggers “letdown” due to neurohormonal stimulation from suckling
what does the female breast feel like?
Soft can be Granular, Nodular, “Lumpy”
- may or may not be pathologic
what is “physiologicl nodularity” of the breast?
normal nodularity feeling, Often bilateral and may increase prior to menses
what a supernumerary nipples?
extra nipples along the milk line
what is the male breast like?
Thin disc of undeveloped breast tissue consisting primarily of ducts
Minimal development due to lack of estrogen and progesterone stimulation
lymphatics of the breast, most drain where? which are most frequently palpable? where are these located?
- Most drain toward axilla
- Central nodes : Along chest wall, usually high and deep in axilla and midway between the anterior and posterior axillary folds
central nodes of the breast accept drainage from what three groups?
- pectoral nodes
- subscapular nodes
- lateral nodes
where do the central nodes drain TO?
supraclavicular and infraclavicular nodes
where are the pectoral nodes? what do they drain?
Pectoral nodes – anterior, lower border of pec major; drain ant. chest wall and much of breast
where are the subscapular nodes? what do they drain?
Subscapular nodes – posterior, along lateral border of scapula, deep in posterior axillary fold; drain posterior chest wall and portion of arm
where are the lateral nodes? what do they drain?
Lateral nodes – along upper humerus; drain most of arm
where are the internal mammary nodes?
near, along the sternum
when should women do self-breast exams?
5-7 days after onset of menses when estrogen stimulation is lowest (beginning of cycle). the way you can feel something that is ABNORMALLY tender or enlarged.
ACS and U.S. Preventive Health Services Task Force
Every ___-___ years for those in their ____.
(kind of confusing how Airey wrote this… not sure if its the combined guidelines..)
every 1-2 years, 40s.
Clinical Breast Exam (ACS Guidelines)
Every __ years from age ___ - ___
Yearly after age ___.
how is USPTF guidlines different?
every 3 years, age 20-40
yearly after age 40.
(USPTF says yearly after age 50)
does ACS recommend monthly self breast exam?
NO, just Promotes self-awareness
who would get an MRI instead of a mammogram? (maybe weeds)
High risk for breast CA, younger women, women with dense breasts, contralateral breast of women with newly diagnosed breast CA
more common lesion/mass in age 15-25? what is it like?
fibroadenoma: Usually smooth, rubbery, round, mobile, nontender
more common lesions/masses in age 25-50?
cyst, fibrocystic changes, cancer
lesion/mass in age over age 50? what is it like?
until proven otherwise… cancer: Irregular, firm, may be mobile or fixed to surrounding tissue
possible lesions/masses in pregnancy? (4)
Lactating adenomas, cysts, mastitis and cancer
what are cysts like?
Usually soft to firm, round mobile; often tender
what are fibrocystic changes like?
nodular and ropelike
who gets fibroadenomas and what are they like? (7 descriptors)
Age 15-25 (usually puberty and young adult) but up to age 55 Usually single firm Round, disc-like or lobular Well delineated Very mobile Usually nontender No retraction
who gets cysts and what are they like? (7 descriptors)
Age 30-50 with regression after menopause unless using estrogen tx Single or multiple ROUND Soft to firm (elastic) Well delineated Mobile Often tender No retraction
who gets fibrocystic changes and what are they like? (4 descriptors)
Ages 25-50 Nodular Ropelike Tender/Painful Benign
who gets cancer and what is it like? (7 descriptors)
Age 30-90 (Usually >50)
Usually single (May coexist with nodules)
Irregular or stellate
Firm/hard
No clear delineation from surrounding tissue
May be fixed to skin or underlying tissues
Usually NONTENDER
May have retraction
what is this likely? white star-shaped around a lump : “irregular infiltrating border”
cancer
4 signs of breast cancer
skin retraction,nipple retraction, contour changes, skin dimpling, skin edema, scaly nipple (paget’s disease)
what is skin retraction? what two things may be a cause other than breast cancer?
Fibrosis (scar tissue) shortening causes dimpling, contour changes, nipple retraction/deviation
May be due to fat necrosis or mammary duct ectasia (blockage)
what are abnormal skin contours?
Variation of normal convexity and compare bilaterally
nipple retraction: what does it look like?
Flattened or pulled inward
Broadened or thickened
Deviation if involvement radially asymmetric – typically toward underlying CA
breast skin edema is from what? how does it present? where is it often first seen?
Lymphatic blockade
Thick skin with enlarged pores
Peau d’orange sign- (lymphatics can’t drain)
Often first seen in lower portion of breast/areola
what is paget’s disease of the nipple? what can it present along with?
Uncommon form of Breast CA
- Scaly, eczema-like lesion may weep, crust, or erode
- dermatitis around areola
- May have breast mass: Can present with invasive CA or ductal carcinoma in situ
3 locations of breast implant (weeds)
sub-pectoral (partially under muscle), sub-muscular
(completely under muscle), subglandular (over muscle),
4 positions of pt for breast exam (kinda weeds)
Arms at sides
Arms overhead
Hands pressed against hips
Leaning forward
inspection of skin (kinda weeds)
Color and thickening Size and symmetry Contour Characteristic of nipple Size, shape, direction of nipple, rashes, ulcerations and discharge
palpation of skin: technique and area (weeds)
Systematically (circle, wedge or stripes)
Small concentric circles at each point
Apply light, medium and deep pressure
All of breast including periphery, tail and axilla
Lateral breast and medial breast
3 things you palpate breast tissue for (weeds)
Consistency of tissues
Tenderness
Nodules: location, size, shape, consistency, delimitation, tenderness, mobility
2 things you palpate nipple for (weeds)
Elasticity
Elicit discharge
palpation of the axilla (weeds)
Inspect skin for rash, infection, unusual pigmentation
Palpate central nodes first (against chest wall)
If suspicious, palpate other nodes: Pectoral, Lateral, Subscapular
nodes irregular to palpation: 3 characteristics, malignant if what?
Hard, irregular, tender
Malignancy if larger than 1 cm, firm or hard, matted together fixed to underlying structured or skin
