Ch 18. Breasts

Question 1

Four quadrants of the breast

Answer 1

Upper inner; upper outer; lower inner; lower outer

Inner = midline
outer = towards armpit

Question 2

Descibe the glandular tissue in a breast

Answer 2

15-20 lobes that is composed on lobules that empties into Lactiferous ducts then into Lactiferous sinus that stores milk

Lobes, lobules, and alveoli, Lactiferous ducts and sinuses

Question 3

4 auxiliary nodes drain 70% of lymph fluid from breasts

Answer 3

Central – directly in armpit
Pectoral (anterior) – lateral to nipple, below armpit
Subscapular (posterior) – upper lateral to nipple, just below armpit
Lateral – lower bicept, further down armpit

Question 4

Developmental Considerations

• Pregnant women
• Older women
• Male breast

Answer 4

Pregnant women
Breast changes are early sign of pregnancy
Colostrum
Enlarged more nodules. Alveoli can be darker.

Older women
Menopause and atrophy of tissue

Male breast
Gynecomastia

Question 5

Breast cancer in Canada

Answer 5

• most common cancer for women (1/9 women)
• Declining rates of mortality from breast cancer in Canada (due to breast screening measures and mammography)
• related to obesity (Relationship of breast cancer to dietary fat)

Question 6

Subjective Breasts/Axilla, Pregnant women,

Menopausal women

Answer 6

Breast
Pain
Lump
Discharge from nipple
Rash
Swelling
Trauma
History of breast disease and risk factors
Surgery
Self-care behaviours
Breast self-examination
Last mammogram

Axilla
Tenderness, lump, or swelling
Rash

Pregnant women
Breast changes
Plans to breastfeed

Menopausal women
Changes in breasts

Question 7

Inspect Breasts

Answer 7

General appearance
Bulging/dimpling
Skin
Lymphatic drainage areas
Nipple/areaola
-inversion/eversion
Maneuvers to screen for retraction

3 positions: arms on head, lean forward

Question 8

Palpate Breasts

Answer 8

All 4 quadrants, tail of spence and nipple

Palpation patterns
>quadrants
>circular motion
>clockwise

Use pads of your first 3 fingers
Use gentle rotary motion
Palpate light, medium, and deep
Nipple: pinch it, push it in
Bimanual technique: duck bill, flatten upper/lower boob (may be used for large, pendulous breasts)

Axilla:
Lift Pt’s arm and support it
Palpate for tenderness or palpable lymph nodes
Palpate high into the axilla and move arm through ROM

Expected findings
firm, smooth, elastic
Pregnant: softer/looser
Premenstrual engorgement from increasing progesterone is normal, slightly tender

Question 9

If a lump is present, note

Answer 9

Location
Size
Shape
Consistency
Mobility
Distinctness
Nipple retraction
Overlying skin
Tenderness
Lymphadenopathy

Question 10

Abnormal Findings: Signs of retraction and inflammation

Answer 10

Dimpling
Nipple retraction
Edema (peau d’orange)
Deviation in nipple pointing
Fixation

Question 11

Pregnant women Breasts

Answer 11

Blue vascular pattern, increased size

Changes to nipples

Question 12

Lactating women’s Breasts

Answer 12

Engorged, reddened and shiny
Feel warm and hard
Nipple soreness

Question 13

Older women’s Breasts

Answer 13

Pendulous, flattened, and sagging

More granular on palpation

Question 14

Male breast

Answer 14

Abbreviated but should not be omitted
Combine with exam of chest wall
Palpate nipple area and axillary nodes
Gynecomastia