Breasts and Regional Lymphatic Assessment Flashcards
Surface Anatomy
The breasts lie anterior to the pectoralis muscle and serratus anterior muscles
→ between the 2nd and 6th ribs, extending from the sternum to the midaxilary line
a. tail of spence
b. nipple
c. aerola
Tail of Spence
superior lateral corner of breast tissue extending into the axilla
- part of the upper outer
quadrant
Internal Anatomy
a. glandular tissue
b. fibrous tissue
c. adipose tissue
Glandular Tissue
contains 15-20 lobes radiating from the nipple, composed of lobules which contain clusters of alveoli that produce milk
→ each lobe empties into a lactiferous duct, and the duct forms the lactiferous sinuses, which store produced milk behind the nipple
Fibrous Tissue
suspensatory ligaments (Cooper’s Ligaments) are fibrous bands extending vertically from the surface to attach onto the chest wall and support the breast tissue
Name of the Fibrous Ligaments Supporting the Breast
Cooper’s Ligaments
Adipose Tissue
layers of subcutaneous and retromammary fat provide most of the bulk of the breast
What Causes Adipose Tissue Levels to Change
- age
- stage of menstrual cycle
- lactation
- pregnancy
- nutritional state
Quadrants of the Breasts
the breasts can be divided into four quadrants with the nipple at the center
L or R:
UOQ
LOQ
UIQ
LIQ
Lymph Nodes of the Breasts
more than 75% of lymph drains into the ipsilateral (same side) axillary nodes
a. Central Axillary Node
b. Pectoral Node
c. Subscapular Node
d. Lateral Axillary Node
Male Considerations
Gynecomastia - temporary tissue enlargement, typically occurring during puberty or in older adult males due to changes in levels of testosterone
- disc of undeveloped tissue
- small areola, nipple
Older Female Considerations
breast size decreases with age
a. glandular tissue atrophies
post menopause (when
levels of estrogen and
progesterone decrease)
b. atrophy of fat - decreased
breast size and elasticity
c. more prominent inner
structures (lactiferous
ducts more palpable)
d. decreased axillary hair
Past Medical History
a. surgeries - biopsies,
enlargements,
reconstructions
b. trauma - could result in
inflammation and
accumulation of fluid
c. breast disease, cancer,
genetic factors
Subjective Data
a. Pain - mastalgia
b. Lumps - size, shape,
location, onset, pain
c. Discharge from Nipples -
colour, consistency, odour,
timing
d. Rash - size, location, pattern
e. Swelling
f. Axillary Region - tenderness,
lumps, swelling, rash
Urgent Findings
- unexplained discharge/
bleeding from nipples - open or ulcerating non-
traumatic lesions - breast masses (previous
history of breast cancer)
Physical Exam (2)
- Inspection
- Palpation
Inspection Points
- General Appearance
- Retraction Screening
General Appearance
a. symmetry of size and shape
b. skin
c. lymphatic drainage areas
d. nipple
Retraction Screening
screen for a lag in movement of one breast, dimpling or puckering of the breast skin, fixation to the chest wall, or skin retraction
Supernumerary Nipple
extra nipple that occurs along the milk line
Palpation Points
- Axilla
- Breast Tissue
- Lumps
Palpation - Axilla
Lift the patient’s arm and support it yourself (allows for loose and relaxed muscles) → using the hand opposite the patient’s arm, palpate the axilla for tenderness or palpable lymph nodes
1. Down the chest wall in a
line from the middle of the
axilla
2. Along the anterior border
of the axilla
3. Along the posterior border
4. Along the inner aspect of
the upper arm
Palpation - Breast Tissue
Have the patient lie in a supine position, with a small pad under the side to be palpated, with that respective arm raised over their head → flattens breast tissue and displaces it medially to better palpate
- more pressure is needed
around the nipple to
palpate, less around the
rest of the breast where
there is less adipose tissue
Palpation - Lumps
- location
- size
- shape
- consistency
- movability
- distinctness
- nipple
- skin over lump
- tenderness
- lymphadenopathy
Breast Cancer
Solitary, unilateral nontender mass that is solid, hard, dense, and fixed to underlying tissues or skin
- Irregular border, poorly
delineated, constant
growth
- Commonly located in the
upper outer quadrant
- firm or hard irregular
axillary nodes, skin
dimpling, and nipple
retraction, elevation and
discharge
