Breast Massage Flashcards
How far does breast tissue extend beyond the breast contour?
• Upper: Lower edge of the clavicle
• Lower: 1” below the breast contour, overlying upper fibers of rectus abdominis
• Medial: Sternal mid-line
• Lateral: Anterior edge of latissimus dorsi
• Variable amount: Extending into the axilla
Why is understanding breast tissue extent important?
Findings of breast tissue tenderness, nodularity, and benign/malignant lumps can occur outside the obvious breast contour.
How is breast tissue typically mapped for landmarking and recording?
The quadrant system is used to communicate locations of tissues, structures, and lesions.
What is the basic functional unit of the breast?
The lobule
How does milk move through the breast?
Each lobule empties into a ductule → ductules propel contents into the central duct channel of their lobe → terminates in a milk sinus (lactiferous sinus) behind the nipple.
What happens to breast tissue after discontinuing breastfeeding?
Milk production stops, and the additional breast parenchyma regresses. This process can take several days to weeks and involves congested distension, which may be alleviated by massage and hydrotherapy.
What is involution in the context of breast tissue?
Involution describes the regression of breast parenchyma away from pregnancy and lactation readiness. It occurs:
• In the second part of the menstrual cycle if ovulation does not result in conception
• At the cessation of breastfeeding
• From age 35 onward, replacing functional tissues with fat
What happens to breast tissue during involution from age 35 to 60?
• Lobular parenchymatous structures and supportive fascial stroma are gradually replaced by fat.
• Dense collagen is initially deposited, entrapping epithelial cells before regressing to fat.
• Microcysts may form, which are considered normal.
• Involution leads to many benign breast conditions (e.g., dense nodular areas, macrocysts).
Why has research focused on involution-related breast changes in recent decades?
Many benign and malignant breast changes coincide in the 40-60 age range, requiring better differentiation between normal variations and dangerous conditions.
What symptoms can involution cause?
• General soreness
• Local tenderness
• Discomfort
• Increased breast pendulousness due to replacement of stroma by fat
What is mastitis?
Mastitis is inflammation of breast tissue, most commonly caused by bacterial infection.
What is lactational mastitis?
Lactational mastitis is mastitis that occurs during breastfeeding due to bacterial infection entering the breast’s duct system.
Why does lactational mastitis develop?
It develops when bacteria gain access to the breast ducts, often through small lesions or cracks in the nipple or areola, or via ductal openings without visible damage.
What factors contribute to lactational mastitis?
• Nipple and areola damage
• Maternal fatigue
• Poor nursing technique
• Warmth, vascularization, and milk providing an ideal environment for bacterial growth
How common is lactational mastitis?
It occurs in 1-5% of breastfeeding women, with a 10% likelihood of recurrence in future breastfeeding.
When is lactational mastitis most likely to occur?
• In the first month of breastfeeding
• When the baby starts teething (around 6 months)
• During weaning or sudden reduction in nursing frequency
What are the common bacterial causes of lactational mastitis?
• Staphylococcus aureus (most frequent, often picked up in the hospital nursery)
• Staphylococcus epidermidis
• Streptococcus
How do Staphylococcus and Streptococcus infections present differently in lactational mastitis?
• Staphylococcal infections: Focalized lesions, initially confined to one breast segment
• Streptococcal infections: More disseminated, involving the entire breast
What are the symptoms of lactational mastitis?
• Pain and induration (hardening) in the breast
• Local inflammation and edema
• Fever and flu-like symptoms
• Baby is usually not sick or has minor symptoms
What is the treatment for lactational mastitis?
• 10-day antibiotic course (safe for breastfeeding)
• Continued breastfeeding to prevent congestion and stasis
• Supplementary pumping if needed
• Bed rest and breast support
What is the major risk if lactational mastitis is untreated?
Abscess formation, which can cause permanent damage to breast tissue.
What reduces the risk of abscess formation in lactational mastitis?
• Completing the full 10-day antibiotic course
• Frequent breast emptying
What alternative therapies may help with lactational mastitis symptoms?
• Cold hydrotherapy (e.g., “figure 8 wrap”)
• Gentle lymphatic drainage (to reduce congestion)
Why is direct breast massage contraindicated during lactational mastitis?
It can damage inflamed blood vessels, cause thrombophlebitis, and spread the infection through the breast glandular system, leading to larger and distant abscesses.
What hygiene precautions should massage therapists take when working with lactating mothers?
• Thorough hand washing
• Standard hygienic precautions to minimize bacterial transmission
What is non-lactational mastitis?
Mastitis occurring in non-breastfeeding women, often with an unknown cause (idiopathic).
What are common causes of non-lactational mastitis?
• Duct ectasia
• Foreign body mastitis (e.g., silicone implant reaction)
• Breast trauma or surgery
• Poor immune response (e.g., diabetes, steroid use)
• Viral infections (e.g., mumps)
• Autoimmune conditions (e.g., rheumatoid arthritis, lupus)
• Infections from nearby structures (e.g., sebaceous cysts)
• Blood-borne infections (e.g., tuberculosis, typhoid fever)
Does mastitis increase cancer risk?
No, but inflammatory breast cancers can mimic mastitis, so all breast inflammation should be investigated.
What is a breast abscess?
A localized collection of pus that can develop as a complication of mastitis.
What percentage of bacterial breast infections lead to abscess formation?
5-10%
What bacteria most commonly cause breast abscesses?
Staphylococcus aureus, which tends to form localized pockets of infection.
What are the symptoms of a breast abscess?
• Firm, tender lump with local inflammation and edema
• Possible palpable fluctuance in the center
• Fever and general malaise
• Symptoms may be temporarily masked if the woman is on antibiotics
What is an ominous sign or symptom?
A sign or symptom that suggests the possibility of a dangerous cause, warranting deeper investigation.
How does the term “ominous sign” apply in the context of breast health?
It refers to signs that could indicate breast cancer, though they are not diagnostic on their own.
Why is it important for massage therapists to recognize ominous breast signs?
They should be aware of signs suggestive of breast cancer and advise clients to seek medical evaluation while providing a balanced perspective.
What percentage of breast concerns brought to medical attention are benign?
90%
How does the term “dysplasia” differ when used to describe breast changes compared to the cervix or colon?
In the breast, dysplasia does not have the same pre-cancerous connotation as in the cervix or colon.
When is nipple discharge considered ominous?
When it is spontaneous and not associated with lactation.
What percentage of nipple discharges are caused by cancer?
5-7%
What are common benign causes of nipple discharge?
Duct ectasia, hormone imbalance, birth control pills, and dopamine antagonist drugs.
Which type of nipple discharge is rarely ominous?
Milky discharge.
What does a clear brown or tea-colored nipple discharge typically indicate?
Fluid leakage from a cyst near the nipple or cyst rupture.
Which types of nipple discharge are most concerning?
Blood or blood-related discharges (15% are cancerous) and rare colorless watery discharges.
What does nipple retraction indicate?
The nipple is being pulled inward due to changes in surrounding tissue.
What are the most common causes of nipple retraction?
Normal involutional fibrosis and duct ectasia.
How can cancer cause nipple retraction?
Subareolar cancers may cause tissue changes that pull the nipple inward.
Why is differential diagnosis by palpation alone impossible for breast lumps?
Not all cancers have a characteristic palpatory presentation.
What are common characteristics of an ominous breast lump?
• Very hard, sometimes cartilaginous.
• Feels like a discrete mass with well-defined borders.
• Typically not painful (only 6-7% of breast cancers are found due to pain).
• Does not change with the monthly hormonal cycle.
• Moves poorly in relation to adjacent breast tissue, especially with circular palpation.
Why do cancerous lumps have restricted movement?
Malignancies grow invasively into neighboring structures, reducing pliancy and creating a “dragging over” sensation during palpation.
How can cancer invasion change breast contour?
It alters tissue relationships and tensions, leading to skin contraction, dimples, or puckers.
How can skin contour changes be more noticeable?
When the woman bends forward or when breast tissue is in motion.
What are common benign explanations for skin contour changes?
Scars or fibrosity from an old injury.
What should be done if a newly developed or unexplained skin contour change is noticed?
It should be examined by a doctor.
What is peau d’orange, and what causes it?
A skin texture change resembling an orange peel due to breast carcinoma advancing into lymph vessels.
How does peau d’orange appear?
Amber/orange discoloration with dimpled skin.
When might a massage therapist notice peau d’orange?
If they observe a small patch of discolored or textured skin.
What are two examples of potentially ominous atypical breast lesion presentations?
Unexplained atypically located abscesses and postmenopausal cyst activity.
What are three concerning skin changes that may indicate cancer?
• Spontaneous or unexplained skin ulceration.
• Poor healing of a skin injury.
• Skin breakdown under minimal stress.
What are some non-cancerous causes of skin breakdown?
Diabetes and hypersensitivity reactions.
What does increased prominence of superficial breast veins potentially indicate?
Increased metabolic activity of cancer.
What are some benign causes of increased vein prominence?
Pregnancy, mastitis, breast abscess, tissue trauma, varicosities at old injury/surgery sites.
Is vein prominence a strongly ominous sign?
No, but it can be an important indicator in some cases.
Do men have breast parenchyma?
Yes, men have a small amount of breast parenchyma and can develop both benign and malignant breast conditions, though it is much rarer than in women.
How many cases of male breast cancer are diagnosed each year in the U.S.?
Between 800 and 1000 cases.
What is the average age of male breast cancer diagnosis?
59 years old, which is 5-10 years higher than the average for women.
Why is the prognosis for male breast cancer often poor?
Ominous signs are frequently overlooked, leading to late diagnosis.
Where are most male breast cancers located?
Subareolarly or in the upper outer quadrant (UOQ).
What are the most common ominous signs of male breast cancer?
• Bloody nipple discharge
• Nipple retraction
• Nipple or skin ulceration
• Unexplained tenderness
• Lump fixation
What is gynecomastia?
Breast enlargement in men.
What are the potential causes of gynecomastia?
• Normal aging (testosterone declines, estrogen relatively increases)
• Body type inheritance
• Fatty deposition (non-pathological)
• Hormone imbalance (estrogen excess or androgen deficiency)
• Drug side effects (e.g., valium, steroids, insulin, dilantin, digitalis, antidepressants, hormone therapies, marijuana)
• Disorders of the testicles, adrenals, thyroid, or kidneys
• Lung pathologies
• Liver conditions (cancer, cirrhosis)
• Granulomatous diseases like tuberculosis
What are the most common breast conditions in men besides gynecomastia?
• Lipoma (benign fatty mass)
• Abscess (often due to diabetes)
• Ductal papilloma (benign endothelial tumor)
Why are cysts uncommon in men?
Because men typically lack well-defined lobular structures.
What is fibroadenosis?
A combination of fibrosis (overgrowth of stromal elements) and adenosis (overgrowth of glandular epithelium).
What is adenosis often referred to as?
Epithelial hyperplasia.
What is the typical age range for fibroadenosis?
20-45 years old.
Where is fibroadenosis most commonly found?
The outer half of the breast, especially the upper outer quadrant.
What is fibroadenosis also called?
Painful nodularity.
How does fibroadenosis feel on palpation?
Like a nodular region that is firmer and more uneven than surrounding tissue, without clear edges.
How does fibroadenosis change with the menstrual cycle?
It becomes more tender in the second half of the cycle and less tender after menstruation.
What are possible causes of fibroadenosis?
• Hormonal imbalances affecting breast tissue
• Abnormal response to normal hormonal influences
• Stress (potentially linked to fibrosis)
• Caffeine consumption (not widely supported by research)
Why are anovulatory women less likely to develop fibroadenosis?
Because fibroadenosis is believed to be related to cyclical hormonal stimulation.
What is fibroadenoma?
A benign tumor caused by lobular overgrowth, showing both connective tissue and epithelial proliferation.
How does a fibroadenoma feel on palpation?
• Round or lobulated
• Smooth, rubbery, firm, and discrete
• Highly mobile relative to surrounding tissue
• Surrounded by a fibrous capsule
What age group is most affected by fibroadenomas?
16-30 years old.
How do fibroadenomas behave in older women?
• Less mobile due to fibrous changes
• May lose smoothness
• Higher likelihood of biopsy due to increased cancer risk in older age groups
What size do fibroadenomas usually remain at?
1-3 cm in diameter.
When does a fibroadenoma warrant further investigation?
If it grows beyond 5 cm.
How do fibroadenomas change with menopause?
They usually involute and are replaced by fibrous tissue.
What is the estimated percentage of women with at least one fibroadenoma?
10-25%.
What hormone is suspected to play a role in fibroadenoma development?
Estrogen.
What factors suggest an estrogen connection to fibroadenomas?
• Enlarging rapidly during pregnancy
• More common in young women with menstrual irregularities
What is the typical treatment for fibroadenomas?
They are usually left untreated as they are benign and self-limiting.
What are microcysts?
A normal aspect of lobular involution.
What are macrocysts?
Larger cysts that develop when a lobule fails to undergo proper involution.
Are breast cysts considered precancerous?
No, they are categorized as ANDI (Aberrations of Normal Development and Involution).
What causes macrocysts?
• Obstruction of the lobule’s exit into its ductule
• Involution-based cell changes
• Collagen deposition
• Kinking of ductules due to fibrous changes
• Fluid imbalance between production and resorption
How do macrocysts feel on palpation?
• Rounded, oval, or lobulated
• Smooth and discrete
• Move well with surrounding tissue
• “Fluctuant” (contour changes with pressure, like a water-filled balloon)
What can make cysts harder to detect?
They often blend with breast tissue unless they become tense with fluid.
What age group is most affected by macrocysts?
35-55 years old.
What happens to macrocysts after menopause?
They typically disappear, unless the woman is on hormone replacement therapy.
Why is a macrocyst appearing five years post-menopause concerning?
It may indicate the development of carcinoma.
Where are cysts most commonly found?
• Usually bilateral
• More common in the left breast
• Upper outer quadrants (UOQ)
How are cysts usually discovered?
• Often asymptomatic and found by accident
• Sudden onset of pain due to leakage of fluid into surrounding tissue
• Nipple retraction if located behind the nipple
• Nipple discharge (brownish tea-colored fluid) if directly connected to the nipple
