Breast Tissue/ Regional lymphs

Question 1

Surface anatomy

Answer 1

Tail of spence - superior lateral corner of breast tissue, projects up and laterally into axila
Nipple - below centre of breast, rough, round and usually protuberant, wrinkly w tiny milk duct openings
Areola- surrounds nipple for a 1-2cm radius, areola has small and elevated sebaceous glands called montgomery glands, has lipid secretion when breastfeeding

Question 2

Internal anatomy

Answer 2

glandular tissue - has 15-20 lobes , each containing lobules
- each lobule has a cluster of alveoli that produces milk and they empty into a lactiferous duct
- these lactiferous ducts converge to form a single duct to the nipple
- coopers ligaments are attatched to chest wall and hold breast up
- breast are mostly made of adipose tissue and retromammary fat
- the tail of spence that extends to axilla is where most tumors occur

Question 3

Call Pastor Sam Lee

four groups of axillary node

Answer 3

Central Axillary: High up in the middle of the axilla, over the ribs and serratus anterior muscle. These receive lymph from the other three groups of nodes.
Pectoralis (anterior): Along the lateral edge of the pectoralis major muscle, just inside the anterior axillary fold.
Subscapular (posterior): Along the lateral edge of the scapula, deep in the posterior axillary fold.
lateral : Along the humerus, inside the upper arm. From the central axillary nodes, lymph flows up to the infraclavicular and supraclavicular nodes.

Question 4

Developmental consideration for an adoloscent

Answer 4

• estrogen hormone stimulates breast changes, tenderness and asymmetry. menarche happens here (breast changes with cycle) and nodularity of breasts

Question 5

developmental consideration for a pregnant woman

Answer 5

• pregnancy stimulated the expansion of ductal system.
• nipples enlarge and darken and become more erectile
• areola becomes large and darken as preg progresses
• within the 4th month - colostrum is released- thick yellow substance rich in protein and lactose but no fat
• after pregnancy, colostrum is still relased for a couple days - rich with antibodies and protect newborn against infection

Question 6

developmental consideration in older women

Answer 6

-after menopause - ovary secretes less estrogen and progesterone which causes atrophy to breast glandular tissue
- muscle turns into fibrous tissue - leading to drooping breast

Question 7

developmental consideration in men

Answer 7

• breast is a rudimentary organ,consits of a thin disc of underdeveloped tissue under the nipple
• smaller nipples with areola
• gynecomastia - temporary development

Question 8

risk factors

Answer 8

• unmodifiable
• modifiable
• nulliparous women
• pregnancy after 30
• alcohol
• hormonal contraception

Question 9

health history qns

Answer 9

• pain- any pain/tenderness? is it cyclic?
• lump? thickening anyhwere
• discharge from nipple?
• rash? (abnormal - eczema unless caused by breastfeeding)
• swelling? unilateral? bilateral?
• trauma to breast?
• history of breast disease?
• surgery on breast? biopsy?
• self care- cancer screening?
• axilla: tenderness, lump? - axilla contains lymph nodes , lymphatic of breast drains
• axilla: rash?

Question 10

hint: related to pain

what is mastalgia

Answer 10

breast pain- occurs with trauma, inflammation, infection and benign breast disease

Question 11

hint: related to discharge

what is galactorrhea

Answer 11

secretion of white, milky substance from nipple from a woman or man who is not pregnant or breastfeeding

Question 12

related to rash

paget’s disease

Answer 12

starts with small crust in nipple and spreads to areola

Question 13

screening recommendation tools

Answer 13

early detection for clients at high risk:
- gail model - breast cancer risk assessment tool
- pedigree assessment tool - risk associated with herditary breast cancer
- mammography (x-ray to visualize internal anatomy of breast) - every 2-3 years for ages 50-74
- CBE (clinical breast exam) no longer recommended for those that are at low risk and aged 40-74

Question 14

Inspect breast: objective data

Answer 14

general appearance: size and shape (abnormal -sudden increase in size of one breast - inflammation or new growth)
skin - smooth, even colour, skin lesions, edema, pale striae in pregnant women or weight gain/loss (abnormal - edema, superficial dilated vein in non pregnant women, inflammation - redness, hyperpigmentation)
lymphatic drainage area - look at axillary and supraclavicular regions: note bulging, edema, discoloration
nipple - should be symmetrical, free of discharge or bleeding (abnormal - deviation in nipple, nipple retraction (nipple turned inward) signifies acuired disease)

CF: unexplained nipple discarge/bleeding

Question 15

Sexual maturity rating in women

Answer 15

1. preadoloscent - only small elevated nipples are present
2. breast bud stage - small mound of breast and nipple with areola widening
3. nipple is flush with skin, breast and areola enlarge
4. nipple and areola make a secondary mound over breast
5. continues to make secondary for some- areola is flush with skin and nipples protrude

Question 16

Inspect and palpate axillae

Answer 16

examine axilla when sitting, inspect for rash, tenderness or pain
palpation technique:
- reach fingers high in axilla and move firmly in four directions
a. down chest wall in a line from middle of axilla
b. along anterior border of axilla
c. along posterior border of axilla
d. along inner aspect of upper arm

note: nodes are not palpable

Question 17

Palpate breast

Answer 17

• supine position and raise arm over head - makes sure breast is flat
• use pads of 3 fingers in rotatory motion over breast
• vertical strip pattern to detect breast mass
• in nulliparous women - breast are firm, smooth and elastic, whereas in pregnant women - soft and loose
• premenstrual engorgement (breast swell) - normal due to increase in progesterone
• firm transverse ridge felt in lower quadrant - do not confuse with abnormal lump
• depress nipple - tissue should move easily
• ## for large pendulous breast - use bimanual techique

Question 18

NORMAL OR ABNORMAL

multiparous women shows signs of discharge as well as redness and swelling of breast

Answer 18

normal- only abnormal if nulliparous

Question 19

LoST my MCDoNaldS Last Night

Asssement of breast with a lymph list

Answer 19

1.Location: Using the breast as a clock face, describe the distance in centimetres from the nipple (e.g., “7:00 position, 2 cm from the nipple”). Or diagram the breast in the woman’s record and mark in the location of the lump.
2. Size: Judge in centimetres in three dimensions: width × length × thickness.
3. Shape: State whether the lump is oval, round, lobulated, or indistinct.
4. Consistency: State whether the lump is soft, firm, or hard.
5. Movable: Note whether the lump is freely movable or is fixed when you try to slide it over the chest wall.
6. Distinctness: Note whether the lump is solitary or multiple.
7. Nipple: Determine whether the lump is displaced or retracted.
8. Note the skin over the lump: Is it erythematous, dimpled, or retracted?
9. Tenderness: Note whether the lump is tender to palpation.
10. Lymphadenopathy: Determine whether any regional lymph nodes are palpable