Breasts and lymphatics

Question 1

Quadrants of breast and where most tumours develop?

Answer 1

Upper inner quadrant, lower inner quadrant, lower outer quadrant, and upper outer quadrant with tail of spence (where most tumours develop).

Question 2

Where is the breast positioned?

Answer 2

Anterior to pectoralis major between the 2nd and 6th rib

Question 3

Characteristics of the nipple and areola?

Answer 3

N- below centre of breasts, on centre of areola, rough/round, have tiny milk duct openings

A- surrounds nipple 1-2 cm radius, has Montgomery glands (secrete protective lipids during lactation)

Question 4

What is glandular tissue, fibrous tissue, and adipose tissue of the breast?

Answer 4

GT- functional piece of breast to produce milk, have lobules, lactiferous ducts for milk

FT- gives breast its structure, coopers ligaments support breasts tissue, fibrous bands attach on chest wall muscles

AT- makes up bulk of breasts, changes based on different clients, layer of subcut and retromammary fat

Proportion of each depends on age/cycle/pregnancy

Question 5

What are the axillary lymph nodes?

Answer 5

1. Central axillary- mid axillary line
2. Pectoral- anterior axillary line by pectoralis major
3. Sub scapular- along lateral edge of scapula, deep in posterior axillary fold
4. Lateral- along humerus inside the arm

> 75% of lymph drains into same side axillary nodes and a small amount will drain into opposite breasts/other nodes.

Question 6

Function of female breast and hormones associated with it?

Answer 6

Mammary glands stimulated by hormones associated with pregnancy and childbirth. Prolactin creates production of milk and oxytocin creates ejection of milk.

Question 7

What is colostrum?

Answer 7

First milk that provides a lot of calories and immunities. Thick yellow fluid. Milk lactation occurs 1-3 days postpartum with demand of newborn sucking.

Question 8

What is gynecomastia?

Answer 8

Mans breast tissue is enlarged. Feels smooth/firm/moveable disc. Usually unilateral and temporary. Happens during adolescence. Bilateral in older adults.

Question 9

Subjective data for breasts/lymphatics?

Answer 9

Breasts: pain (do pain assessment), lumps (where), discharge (colour, consistency), rash, swelling, trauma, hx of breasts disease/breasts cancer risks, surgery, self care behaviours (BSE, check ups)

Axilla: tenderness, lumps, swelling, rash

Question 10

What are some breast cancer risk factors? modifiable and non modifiable.

Answer 10

Unmodifiable: older age, gender (females), personal hx of breast cancer/family hx, BRCA gene mutation, early menarche/late menopause

Modifiable: alcohol intake, hormone replacement therapy, obesity, contraceptive use, nulliparity (hasn’t given birth to child) or 1st child after 30 yrs

Question 11

What is a supernumerary nipple?

Answer 11

An extra nipple that develops in embryonic life along the track of mammary ridge.

Question 12

What is menarche and thelarche?

Answer 12

M- begin menstruation, around 10-12 ish
T- beginning of breast development around 8-10 yrs, precedes menarche by 2 yrs

Question 13

Objective assessment of male breast?

Answer 13

Combine it with assessment of anterior thorax. Inspect chest wall (skin, lumps, swelling). Palpate nipple area for lumps/tissue enlargement and palpate lymph nodes.

Question 14

What do pregnant women breasts look like?

Answer 14

Enlarged, blue vascular pattern shows, nipples become darker as well as areola, areola also becomes wider.

Question 15

Breasts characteristics of older clients?

Answer 15

Pendulous, flattened, sagging. Feel more granular on palpation.Thickening of inframammary ridge on lower breast.

Question 16

What is carcinoma?

Answer 16

Common over 60 yrs, 1% of male breast cancer, nipple retraction, irregular borders/hard/fixed/non tender mass.

Question 17

What is fibroadenoma?

Answer 17

Benign mass that’s non tender/movable/grows quick/solid/firm/rubbery/elastic.

Question 18

What is benign breast disease?

Answer 18

Multiple tender masses, swelling, tenderness, severe pain, lumps, nipple discharge, infection.

Question 19

Characteristics of breast cancer?

Answer 19

Irregular borders, solitary, unilateral, nipple retraction, solid/hard/firm, not moveable, non tender usually, grows constantly.