Breasts & Axilla Flashcards
The glandular tissue is arranged into ____ to ____ lobes per breast that radiate about the nipple
15-20
Each lobe of the breast is composed of __ to ____ lobules.
20-40
Each lobule consists of milk producing ____ cells that empty into ____ ducts.
acini
lactiferous
What extends from the connective tissue later through the breast and attach to the underlying muscle fascia providing support to the breast?
suspensory (Cooper) ligaments
What are the muscles that form the floor of the breast? (7)
pectorals major and minor serratus anterior latassimus dorsi subscapularis external oblique rectus abdominis
What provides vascular supply to the breast?
branches of the internal mammary and lateral thoracic artery
What constitutes most of the bulk of breast and gives it soft consistency?
subcutaneous and retromammary fat
Where does the greatest amount of glandular tissue lie in the breast?
upper outer quadrant which extends into axilla, forming the tail of Spence
What are the tiny sebaceous glands on the areola surface?
Montgomery tubercles or follicles
Which lymph nodes are more superficial and accessible to palpation when enlarged?
axillary nodes
What axillary lymph nodes are located along the lower border of the pectorals major inside the lateral axillary fold?
anterior axillary (pectoral)
What axillary LN are high in the axilla close to the ribs?
midaxillary (central)
What axillary LN lie along the lateral border of the scapula and deep in the posterior axillary fold?
posterior (subscapular)
What axillary LN can be felt along the upper humerus?
Lateral (brachial)
Where does the drainage from the deep retroareolar area go?
inter pectoral (rotter) nodes into the axillary chain
Where does the drainage go from the superficial upper outer quadrant go?
scapular, brachial, intermediate nodes toward axillary lymph nodes
Where does the drainage go from the superficial medial portion go?
internal mammary chain toward opposite breast and abdomen
What happens to the breast during pregnancy in response to luteal and placental hormones?
the lactiferous ducts proliferate and the alveoli increase in size and number causing the breast to enlarge 2-3x prepregnant size
What happens towards the end of pregnancy?
Epithelial secretory activity increases, colostrum is produced and accumulates in the acinus cells (alveoli)
What happens to the areolae during pregnancy?
more deeply pigmented and their diameter increases
What happens to vasculature during pregnancy?
It increases causing veins to engorge and become visible below surface of skin
In the first few days after delivery what is secreted from the breasts?
colostrum containing more protein and minerals compared to milk and also antibodies
When does milk production replace colostrum?
2-4 days after delivery
What stimulates milk production?
surging prolactin levels, declining estrogen levels and the stimulation of sucking
When does involution occur?
at the termination of lactation over a period of 3 months
What happens to the breast after menopause?
glandular tissue atrophies and is replaces by fat
inframammary ridge at the lower edge of the breast thickens
nipples become smaller and flatter and less erectile
hang more loosely as a result of tissue change and relaxation of suspensory ligaments
skin becomes dry and thin
loss of axillary hair may also occur
What medications are associated with nipple discharge?(6)
contraceptives hormones phenothiazines digitalis diuretics steroids
What medications can be associated with breast enlargement in males? (9)
cimetidine omeprazole spirinolactone anti androgens (finasterides) HIV meds some chemo antihypertensives some antipsychotics estrogen
What genetic mutations or hereditary cancers are important in past medical history?
known BRCA1 or BRCA2
hereditary nonpolyposis colorectal cancer
Li-Fraumeni syndrome
Cowden syndrome
What are the non modifiable risk factors? (11)
age gender genetics personal history of breast ca family history of breast ca precious breast biopsies race (whites) Previous breast radiation menstrual periods (menarche before 12 or menopause after 55) Breast density Diethylstilbestrol therapy
What is the % of developing breast ca with known BRCA1 or BRCA2 mutations?
have a 45-80% chance of developing breast ca compared to average risk of 12%
What is the risk if patient has one first degree relative with breast ca?
doubles the risk
if two first degree relatives the risk increases threefold
Previous biopsies of what can increase risk of developing breast ca?
atypical hyperplasia or lobular cancer in situ (LCIS)
Older women with more dense tissue are at ____ to ___ times the risk.
1.2 to 2 times
What are the modifiable risk factors of breast ca? (5)
childbirth hormone therapy alcohol obesity and high fat diets lack of physical activity
How does hormone therapy affect breast cancer risk?
use of combined estrogen and progesterone hormone replacement therapy (HRT) after menopause for more than 4 years increases the risk
Transgender women taking hormones for 5-10 years is uncertain
How does having more fat tissue affect breast ca risk?
Having more fat tissue can increase estrogen levels and increase likelihood
What are some medications that can cross the milk-blood barrier?
cometidine
clemastine
thiouracil
What do retractions and dimpling signify?
contraction of fibrotic tissue that may occur with carcinoma
What is the appearance of skin that indicates edema of the breast caused by blocked lymph drainage in advances or inflammatory breast cancer?
peau d’orange (orange skin)
Unilateral venous patterns can be the result of what?
increased blood flow to a malignancy
What is a common expected finding of the areolae?
peppering of contender, non suppurative Montgomery tubercles
The peau d’orange skin associated with cancer is often seen where first?
the areola
What change in the nipple may suggest malignancy?
recent unilateral inversion of a previously everted nipple
Supernumery nipples which are more common in blacks are associated with what in white patients?
congenital renal or cardiac anomalies
Most of the benefit of mammography results from screening ages ____ to _____
50-74
What are the ways to describe a breast mass shape? (6)
round discoid lobular stellate regular irregular
When should nipple compression be performed?
When patient reports spontaneous discharge
What is the firm transverse ridge of compressed tissue along the lower edge of the breast that is sometimes confused with a mass?
the inframammary ridge
If malignancy were to reoccur post mastectomy where is it important to examine on exam?
at the site of the scar
What is a common exam finding during the second trimester?
telangiectasias on upper chest, arms neck and face that DO NOT blanch
What is the common age to see fibrotic changes in breast tissue?
20-49
What is the common age range to see a fibroadenoma?
15-55
What is the common age range to see cancer?
30-80
What breast changes are usually bilateral?
fibrocystic changes and fibroadenoma
What is usually the shape of a breast cancer mass?
irregular or stellate
What is a common consistency of fibrocystic changes?
soft to firm; tense
What is the common shape of a fibroadenoma?
round or discoid
What is the common consistency of a cancer mass?
hard, stone like
What breast masses are usually mobile?
fibrocystic changes and fibroadenoma
What breast mass is usually tender?
fibrocystic changes
What type of breast mass does not vary with menses?
fibroadenoma and cancer
What is a benign fluid filled cyst formation caused by ductal enlargement?
fibrocystic changes
What are fibrocystic changes associated with?
long follicular or luteal phase of the menstrual cycle
When are fibrocystic changes the worst?
premenstrually
What are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit?
fibroadenoma
What can a fibroadenoma occur?
may occur at any age during the reproductive years
When does a fibroadenoma regress?
after menopause
Do fibroadenomas fluctuate with the menstrual cycle?
NO
benign breast lump occurs as inflammatory response to local injury
fat necrosis
What is epithelial hyperplasia producing a warlike tumor in a lactiferous duct causing spontaneous nipple discharge?
intraductal papillomas and papillomatosis
What is a benign condition of the subareolar ducts that produce nipple discharge
duct ectasia
Subareolar ducts become dilated and blocked with desquamating secretory epithelium, necrotic debris and chronic inflammatory cells
duct ectasia
What does duct ectasia occur most commonly?
menopausal women
What is the characteristic of the nipple discharge in duct ectasia?
spontaneous unilateral or bilateral that is often green or brown in color and may be sticky
What is elevated levels of prolactin, resulting in milk production, occur as a result of disruption of the communication between the pituitary and hypothalamus glands?
galactorrhea
What are the common causes of galactorrhea? (7)
pituitary- secreting tumors hypothalamic-pituitary disorders systemic diseases numerous medications herbs physiologic conditions local factors
What are the possible medical conditions associated with galactorrhea?
amenorrhea pregnancy post abortion hypothyroidism Cushing syndrome chronic renal failure
What are the possible medications associated with galactorrhea?
phenothazines tricyclic antidepressants some htn meds estrogens H2 receptor blockers marijuana amphetamines opiates
What is migration of malignant epithelial cells from the underling intraductal carcinoma chia the lactiferous sinuses into nipple skin?
Paget disease
What is commonly seen with Paget disease?
red, scaling, crusty patches on nipple, areola and surrounding skin that may be unilateral or bilateral that does not respond to steroids
What is the most common infectious agent causing mastitis?
staph aureus
When is mastitis most common?
in lactating patients after milk is established usually the second to third week after delivery however it can occur at any time
What is characterized by sudden breast swelling, tenderness, redness and hear often accompanied by chills and fever
mastitis
What is the presentation of mastitis?
tender, hard breast mass with an area of fluctuation, erythema and heat
may have discharge of pus (suppuration)
underlying put filled abscess may given bluish tint to skin
What is the result of increased body fat; hormone imbalance from puberty or aging, by testicular, pituitary or hormone secreting tumors, by liver failure or by a variety of medications in males?
gynecomastia
