BREASTS + REGIONAL LYMPHATICS Flashcards
Location of breast
- anterior to pectoralis major + serratus anterior
- btwn 2-6th rib
- sternum to midaxillary line
Landmarks of the breast
- tail of Spence: Continuous with the upper outer quadrant; which is a common site for breast tumors
- nipples: rough, protrudes (inverted nipples are normal in some ppl)
- areola: surrounds nipple for 1-2 cm in diameter, contains Montgomery’s glands (protective lipid during breastfeeding)
Glandular tissue of the breast
- 15-20 lobes radiating from nipple
- each lobule = clusters of milk-producing alveoli
- each lobe empties into the lactiferous ducts
- lactiferous ducts converge @ nipple
- ducts behind nipple form ampullae (stores milk)
Fibrous tissue of the breast
- also call suspensory ligaments or cooper’s ligaments
- fibrous bands extending vertically from the surface to attach the breast to chest wall muscles
- in breast cancer, these ligaments contract; forming dimples in the overlying skin
where do lymph from the breast drain into?
- 75% into the ipsilateral axillary nodes
what are the 4 ipsilateral axillary nodes?
1) central
- location: high up in the middle of the axilla, over the ribs + serratus ant.
- receives lymph from the 3 other nodes
- sends lymph up to the infraclavicular + supraclavicular nodes
2) pectoral
- location: lateral edge of pectoralis maj., inside ant. axillary fold
3) subclavicular
- location: lateral edge of scapula, deep in posterior axillary fold
4) lateral - along inside of the humerus
Breast considerations in adolescents
Increased estrogen stimulate changes including:
- enlargement (increased fat deposition)
- duct development and branching (form the potential aveoli)
common NORMAL findings:
- one breast larger than the other
- tenderness
What is the tanner staging?
Sexual maturity staging
- full development from stage 2-5 takes on avg. 3 years
during this time:
- pubic + axillary hair develop
- thelarche: the beginning of breast development
- menarche: the beginning of menstruation
normal breast changes in older women
decreased estrogen + progesterone
- atrophy of glandular tissue (replaced by fibrous CT)
- atrophy of fat envelope
decreased breast size and elasticity
- saggier breasts
nipples may be retracted, but can easily be pulled out
lactiferous ducts are more palpable:
- feel firm and stringy due to fibrosis and calcification
decrease in axillary hair
What is Gynecomastia?
common enlargement of breast tissue during adolescence in MEN
- usually temporary and unilateral
if it appears in older men, it signifies testosterone deficiency
Also occurs w/ the use of anabolic steroids
Mastalgia
breast pain that occurs w/ trauma, inflammation, infection, and breast disease
Galactorrhea
Abnormal discharge that is milky-white in non-pregnant or non-breastfeeding individuals
What do we inspect during a breast examination?
SYMMETRY
- slight asymmetry is normal
- asymmetry in adolescents is normal
- sudden increase in size may indicate inflammation or new growth
SKIN
- smooth and even in color
- fine blue vascular networks and stretch marks common in pregnant women
- abnormal: hyperpigmentation, redness + heat, dilated veins in non-pregnant women
NIPPLES
- symmetrical
- protrudes (some are flat or inverted; ask pt is that is normal for them)
- supernumerary nipple (extra nipple) is normal on thorax or abdomen
- abnormal: deviation in nipple pointing, recent nipple retraction, unexplained discharge or bleeding, lesions
What are the maneuvers to screen for retraction?
1) arms over head - breasts should move up symmetrically
2) push hands on hips
3) push palms together
4) lean forward - breasts should fall and hang
what is retraction? What are the signs?
Sign of fibrosis in the breast tissue
- usually caused by growing neoplasms
Signs:
- lag in movement in one breast
- dimpling
- fixation of breast to chest wall while leaning forward
