Breast Exam Flashcards
Anatomical Boundaries and Location of Strucutres within and Around the Breast
anatomy
- pectoralis major muscle
- serratus anteroir
- suspensatory ligmanes conenct breast tissue to the wall
NV + lymph
- axillar vein
- lateral throacic vein
- subclavican nodes
- axilaary nodes
- mid-axilaary nodes (deep)
- lateral axiallary
- anterior axillary nodes (inside lateral axillary fold)
- internal mammary nodes
Palpable nodes
midaxillary nodes
lateral axillary nodes
anterior axillary
subscapular
Breast
- breast tissue
- mammary gland lobules /galdualr tissue
- nipple
- areola
- fat
Exteroir Breast
- sebaceous galnds and hair follicles
- nipple
- ductal openine
- areola
- smooth msucles
note: male anatomy is the same: with lymph system is the same, just less fat and glandualr tissue is not there: thus no lobualr character
still have the areola, nipple and “ducts” but the dont normally secrete
Supranumerary Nipples
waht are they
where
when to be concerned
Where
- occur on the milk line: from axilla to pubis in two lines downwards
What
- usually one or two
- can be a small nipple and areola
- or can just look like a mole (without areola)
Who
- can be familial
when to be concerned
- if there is no glandular tissue: not of concern
- if there is glandular tissue: congenital anomaly possible
- increase pigmentation
- swelling
- tenderness
- lactation during puberty, menstruation or pregnancy
how to “divide” the breast
sexual maturity of breasts
Divide the breas t
- four quadrants: upper outer, inner & lower outer and inner
- upper outer is the most breast tissue
- the Tail of Spence!! breast tissue which expands into the axilla
Descibre lesions
- in the quadrant
- in a clock formation
Sexual Maturity Rating
- I : prepuberty
- V: full development
History Pearls for the Breast Exam
History
Personal
- history of breast disease: fiberoadenoma or other changes
- GYN or breast related CA’s
- previous surgery: augmentation, proceudres, mastectomy
- genetic : BRCA? or other heridiatry CA
- - previous imaging; mamos’ etc. and reuslts
Menstraul Hx.
- DLMP: and all accompaying quetions
- Menopause Hx. : post-meno bleed?
- pregnant history and medication use hx.
Family
- hx. of CA, genetic or Breast CA in any males
- colorectal dx.
ROS for Breast Exam
USPSFT recs. for SBE
Mastalgia: breast pain & related to menses or not
skin changes: dimpling, lesions, rashes, ithcy, retraction and peau d’orange
Nipple Discahrge
- spontaneous or expressed
- oroder, color, consistency, milky, etc.
- unilateral or bilateral
- can eb : physiologic, pregnany, maligna or pituitary
Lymph: palpable nodes?
Breast Exam : self
- ask about it: but not recommende d now in average risk women
- report any abnormalities or changes to provider
- average risk: those without family or personal history of GYN or breast conditions or those without radation to teh chest before 30
if there is a + ROS for the Mass
- how and when was it discovered
- size (quarter, dime, etc.) and soft, mobile, etc.
Physical Exam: Breasts
- clincial screening recs
Clinical Screening
- routine screening can be offered every 1-3 years for those 25-39, then yearly for 40+
- best time to screen is post-peroid
When to Screen
- for ANYONE: male or female with a complain of a breast symptom
- need to inspect, palpate and examine the nipple
PE: Breasts
inspection
positions
nipple and areola inspection
Inspection chaparone!!!
- 4 total postions for inspection
- color, texture, venous patterning (if venous in 1 not both: malignancy risk)
- peau d’organge
- contour, size and symmetry
Positions
- 1 = straight on; arms at sides (ask to lift breasts to inspect)
- 2 = arms overhead
- 3= arms on hips
- 4 = leaning forward arms out
Nipple and Areola Inspection
- shpae, color, tecture
- eversion, can be normal or irreg.
- Retraction, deviation
- crsuting, cracking or discahrge
PE: Breasts
Lymph Node Palaption
Lymph nodes
- pt. seated, elbow flexed and support by provider
- cup fingers and reach into axillary hollow with palamar surface
Midaxillary Nodes
- palpate apex of axilla down to the bra line
Lateral Nodes
- inner portion of the upper arm down to the elbow
Pectoral Nodes
- medial wall of axilla along ribcage down anterior wall
Subscapular Nodes
- posterior wall of axilla along scapular boarder
Supraclavicular nODes
- above clavicale
- rasie pt. shoulder and turn head toward the side youre checking
Infraclavical Nodes
- below clavicle
- palpate in rotary notion
PE: Breats
Palpation
chest wall sweep
bimanual digital palpation
Palpation of Breasts
From the Seated postion…
Chest wall sweep
- flat hand, palmar side: downward sweep for superfisical lumps
Bimanual digital palpation
- two hands, palmar side
- bottom hand support breast
- top hand: use finger PADS not tips to walk across top of breasts
PE: Breast
Supine position palpation
medial and lateral Palpation
Laying Suping
- pt. lay with opposite breast covered
- one arm raised behind head
- small pillow under shoulder
Technique
- vertical strip method (clincal practice: can do conccentric)
- use finger pads and dont forget the tail of spense
- should take 3 mins. per breast
Vertical Strip Method
- use 2-4 fingers in small circles wihtout lifting up, slight flex of pads to move from axilla to the nipple in a wave (up and down the breast)
- Dont forget tail of spence
Lateral & Medial Boundaries
- 2/3rd rib superior
- 6/7th rib inferior
- sternal margin
- mid-axillar line
Palpate for
- consistency of tissue, tenderness, nodules (& location)
- dont want hard! thats bad
then Lateral Breast
- hand on head; same vertical pattern from axilla to teh nipple
then Medial
-eblow flexed now at the shoulder level and restin
- starting at nipple continue vertical pattern to midsternal area
PE: Breast
Palpation of the Nipple
Nipple Palpation
- palpate radially around each nipple
- note the deeper hollow area centrally: this is the collecting duct
- use 2 fingers to gently press the tissue inwards behind the areola
if hx. of nipple discahrge: spontaneously
- do not press, instaead compress areola around in a radial pattern
Abnormal Breast findings
inverted nipple
retraction
dimpling
Peau D’orange
inverted nipple (areola looks ok)
breast retraction: a abnormal contour
nipple retraction: a slight pucker of the skin at these areas; often assymetric
breast dimpling: a bigged pucker
Peau D’orange: skine changes due to increase edema and blockage of lymph
creates a dimpled appearance like oraange skin
Abnormal Breast Findings
Pagets Disease
Pagets Disease
- red, crusy patch on teh nipple/areola
- wont go away with steroids (if you thought it was exema)
Masitis
- red, inflammation or infection of teh breast
- often during breast feeding
- can have systemic symptoms
- staph. aureas
breast abcess
- untreated mastitis
- much more red, fluctuant; can be drained
Axillary Lymphedema
- large mass in axilla
- if tender: inflmmaiton
- if hard : cancer
Hindradentis SUpperativa
- PAINFUl
- fistaula and tracking in the axilla
- hygeine is critical here
Acantosis Nigrians
- darkening of pigment in teh axilla (or nexk)
- indicates obestiy and DM/insulin resistance
