Breast and Lymphatic Systems Flashcards
Breast structures and function
Function: Paired mammary glands that produce and store breastmilk
Structures:
- Lobes/lobules (glandular tissue): produce breastmilk
- Lactiferous ducts: carry breastmilk to nipple
- Montgomery glands: secrete oil and aroma during breastfeeding (on areola)
- Nipple & areola
- Tail of Spence: breast tissue that extends into axilla
- Cooper’s ligament: provides structure for breast tissue
- Pectoralis major and serrates anterior muscles
- Lymph nodes
- Supernumerary nipples: extra nipples that may appear along the embryonic “milk line”
Lymphatic system
Drains cellular waste/debris and recirculates interstitial fluid
Primary locations: axilla, sternum, and breast
CC/COLDSPA
Breast or axillary lumps/swelling/mass/rash/scaling?
Change in size/shape?
Pain/tenderness?
Nipple tenderness/pain/discharge (especially blood)?
Tender breasts with menses?
Breast redness/warmth/dimpling (may be d/t malignant tumor)
Medications: discharge s/t prescribed meds. that treat endocrine disorders (HTN, antidepressants, antipsychotic, ERT)
Males: can also have breast/lympathic concerns/symptoms
PMHX
Age of menarche/menopause?
Pregnancies/children and breastfeeding or nulliparity
Breast CA/biopsy/surgeries/implants/augmentation or reduction?
Mastitis or breast access?
Women who have fibrocystic breasts will often have lumps that increase in size 1-2 weeks prior to menses (and diminish during/after menses)
FHX
First and second-degree relatives diagnosed with breast CA
Lifestyle and health practice & BSE
Recent changes during BSE? (however, mammogram is “gold standard”)
Contraception use/hormonal therapy: can cause irregular menstrual cycles and breast tenderness
Nutrition and diet (and caffeine intake)
Alcohol use
Exercise
ROS
Head-to-toe
Breast augmentation/implants and breast reduction
Location of augmentation/implants:
- Subglandural placement: on top of chest wall
- Submuscular placement: underneath chest wall
Breast reduction: wedge of extra skin and breast tissue is excised and brought together; may result in nipple scar, but permits ability to breastfeed
Mastitis
An inflammatory infection of the breast tissue; symptoms can progress from localized (pain, swelling) to systemic (malaise, fever, flu)
Occurs more often in lactating women, but also non-breastfeeding women
S/S: Breast pain, swelling, redness, fever, enlargement, changed nipple sensation, discharge, itching, tenderness, breast lump
Breast abscess
A painful build-up of pus in the glands caused by an infection; breast become hard, tender
A complication of mastitis
Mammogram screenings for breast CA
Screening of choice; variating factors:
- Age
- Dense breast
- Individuals with higher than average risk factors (alcohol intake, FHX)
Males: Gynecomastia (increased breast tissue); breast CA is rare and usually not diagnosed until late stages
Non-modifiable risk factors
Gender (female)
Increasing age (older clients may notice a decrease in size/firmness of breast d/t decreased estrogen)
Genetics
Race/ethnicity
PMHX
FHX (5-10% breast CA are hereditary; related to BRCA1/BRCA2 genes)
Increasing density/consistency
Early menses (prior to 12 yrs. of age d/t prolonged exposure to progesterone)
Chest radiation exposure
Lifestyle/modifiable risk factors
Breastfeeding (decreases risk for breast CA; increased risk >30 yrs. of age)
Oral contraceptives (estrogen)
Menopausal HT
Alcohol consumption
Excess weight/obesity
Limited physical exercise
Diet
BSE and regular mammogram screening
Night work
Smoking/second-hand
Physical assessment preparation
Prep the pt: Provide privacy to undress and front-snap gown
Equipment: Cm. ruler, small pillow, gloves, specimen slide, BSE pt handout, chaperone
Physical assessment
Techniques: INSPECTION & PALPATION (vertical/wedge/circular; depth: light/medium/deep)
Anatomic landmarks: breast quadrants, tail of Spence
Positioning: Sitting, hands on hips, hands over head, leaning forward, clenching hands, supine with pillow under shoulder
General routine screening:
- Inspect breast and nipple size/symmetry/color/texture, superficial venous pattern, dimpling
- Palpate for texture/elasticity, tenderness/temperature
- Pt demonstrates BSE
Focused speciality assessment:
- Inspect and palpate axilla and lymph nodes
- Palpate breast for masses, nipples for discharge, mastetcomy or lumpectomy site for redness/lesions/lumps/swelling/tenderness
Inspection
Compare breast size/shape/color/texture, bilaterally
Nipple and areola position/direction/discharge, bilaterally (pregnant women have enlarged nodule-like breast, darkened nipples)
Axilla color/lesion/rashes
Superficial venous patterns
Dimpling
Palpation
Use flat pads of three fingers to palpate
Breast: Consistency/masses/tenderness/nodules, skin texture/elasticity/temp.
Assess lumps for: Location, size, shape, consistency, mobility, tenderness, distinctness
Nipple: Elasticity/masses/tenderness, discharge (milk discharge with breastfeeding compared to brown discharge with mastitis)
Lymph nodes: Axillary, epitrochlear, clavicular; Normal: No palpable nodes OR 1-2 small, discreet, non-tender, movable nodes in central area (enlarged, hard, fixed axillary nodes indicate malignancy)
Palpation of male breasts
Inspect and palpate breasts, areolas, nipples, axilla; Normal: No swelling, nodules, ulcerations
Gynecomastia; younger males d/t pubertal hormones
Clinical warning signs of breast CA
S/S:
- Redness
- Swelling or enlargement
- Pain or itchiness
- Thickened, ridged, or dimpled skin
- Swelling of lymph nodes in axilla or below collarbone
- Inverted or retracted nipple
Ex.: Clinical manifestations of breast CA: Irregular, firm lumps; orange peel-like appearance; dimpling and nipple retraction
Breast mass characteristics
Size/shape/anatomical position
Mobility
Consistency
Temp.
Tenderness
Delimitation
Redness
Older adult considerations
Breast are pendulous (d/t increase in fatty tissue; assess by leaning forward), less firm, granular, smaller in size
Smaller, flatter nipples less erect on stimulation
Possible lumpectomy or mastectomy (and removal of lymph nodes with CA)
Additional abnormalities
- Fibroadenomas: non-cancerous breast lumps that are round, firm, well-defined, singular, mobile (seldom tender); occur most often in women 15-35 yrs. of age
- Fibrocystic lesions: benign breast lesions that may be multiple in number, firm, rubbery, elliptical or round, mobile; often bilateral and tender just before menses
- Peau d’ orange: pigskin-like appearance found in metastatic breast disease; caused by breast edema from blocked lymph node (indicative of advanced CA)
- Paget’s disease: areas over the areola that are red, scaly, crust-like, ulcerous
- Acanthosis nigricans: can be associated with an internal malignancy (polycystic ovarian syndrome, hirsutism, obesity, irregular periods, infertility, ovarian cysts, early-onset T2DM)
Other: Benign breast disease, retracted nipple/breast tissue, dimpling, mastitis
BSE
Should be conducted 5-7 days following menses with light/medium/deep palpation pressures
General BSE:
- Examine in shower
- Examine in mirror with arms down, up, on hips
- Stand and press fingers on breast in an up/down or circular approach
- Lie supine and palpate
- Palpate nipple for discharge
