Breast & axillae Flashcards
What extends from the clavicle and 2nd rib down to 6th rib and from sternum across midaxillary line, and overlies the pectoralis major and part of serratus anterior?
breast tissue
What are lobules?
clusters of glands that form lobes, containing milk-secreted glands (tubuloalveolar) with the ducts/sinuses open on the nipple/areola
What’s in a breast?
glandular tissue, fat, connective tissue, nerves, muscular tissue
What is a lobe?
15-20 segments of lobules situated radially around the areola
What’s the areola?
bumpy circle with sebaceous glands, sweat glands, accessory alveolar glands, that are important for breast feeding, “glands of Montgomery”
What do nerves do in the breast?
cause milk let down
How do muscles allow milk to flow?
contract
What’s the milk let-down reflex?
release of oxytocin from of hypothalamic nuclei when nipples are stimulated
What does the axilla have?
apex, base, 4 walls
What nodes are in the axilla?
lateral –> central –> subscapular –> pectoral
What should you ask about in breast history?
family history, OB/GYN history - age of menarche, first birth, menopause, prior breast biopsy, hormonal medications, common complaints (cyclic? pregnant? other hormones?)
What should you ask about the breast?
any lumps, pain, or discharge (and further questioning)
What is considered pathologic discharge?
bloody/serous, unilateral, spontaneous, associated with a mass, or in women >40 years
How is the male breast different?
small nipple/areola, thin layer of undeveloped glandular ductal tissue
What is gynecomastia?
enlargement of glandular tissue
When is the breast exam done best?
5-7 days after menstruation
What should you be inspecting in a breast exam?
full exposure – skin, size, symmetry, contour, nipples, movement
What should you palpating in a breast exam?
supine –> gentle –> physiologic nodularity –> use the finger pads in small circles
What are you looking for in palpation in breast exam?
consistency, tenderness, nodules/lumps/masses - size, shape, consistency, delimination, tenderness, mobility
What type of coverage can you do?
spiral, radial, vertical (preferred)
What are you looking at in the nipple?
elasticity/thickening of the skin, discharge
What are warning signs in a breast exam?
hardness, sores that don’t heal, redness, puckered, scaly, thickened skin, inverted nipple, breast changes, leaking
What should you consider with special exams?
post-mastectomy: careful inspection of scar, looking for lymphedema of upper arm
post-breast augmentation
What are the 5 areas you need to examine on an axilla exam?
central, lateral, anterior axillary, apical, posterior
How do you feel the anterior nodes?
grasp anterior axillary fold with thumb and fingers, w/ fingers, palpate inside border of pectoral muscle
How do you feel lateral nodes?
feel along upper humerus high in axilla
How do you feel posterior nodes?
from behind patient, feel inside muscle of posterior axillary fold
What are breast cancer risk factors?
family hx, known gene mutation, prior breast biopsy w/ specific pathology, early menarche, late menopause, nulliparity, prolonged interval between menarche and 1st pregnancy, menopausal hormone therapy, not breastfeeding, increasing age, certain ethnicities, higher BMI, alcohol consumption, smoking, dense breasts, prior exposure to high-dose therapeutic chest irradiation in young women
When should screening for women with family history start?
10 years before known family onset
What are risk factors of male breast cancer?
age, radiation exposure, BRCA gene mutations, Klinefelter syndrome, testicular disorders, alcohol use, liver disease, diabetes, obesity
Male breast cancer are usually found at a more ____ stage
advanced
T/F: Men with a BRCA1/2 inherited gene mutation should get breast cancer screening
true
What should men with BRCA1/2 inherited gene mutation starting at 35?
clinical breast exam every year, learn how to do self-exam, consider mammography every year starting at age 50 or starting 10 years before earliest in family
What are imaging techniques?
mammogram - routine vs diagnostic, difficult w/ dense breast tissue
US- cyst or solid
MRI- not routine
