Chapt 18: Breasts, Axillae, and Regional Lymphatics

Question 1

How many lobes are in breast glandular tissue?

Answer 1

15 to 20 lobes radiating from the nipple

Question 2

What is the tail of Spence?

Answer 2

superior lateral corner of breast tissue, called the axillary tail of Spence, projects up and laterally into the axilla.

Question 3

What lymph nodes are involved in the drainage from the breast?

Answer 3

1. Central axillary nodes—High up in the middle of the axilla, over the ribs and serratus anterior muscle. These receive lymph from the other three groups of nodes.
2. Pectoral (anterior)—Along the lateral edge of the pectoralis major muscle, just inside the
   anterior axillary fold.
3. Subscapular (posterior)—Along the lateral edge of the scapula, deep in the posterior
   axillary fold.
4. Lateral—Along the humerus, inside the upper arm.

Question 4

What hormone stimulates breast changes?

Answer 4

Estrogen

Question 5

What staging is used for breast development?

Answer 5

Tanner Staging

Question 6

What are the current ages for breast development onset?

Answer 6

Current ages for onset of breast budding (Tanner stage 2) vary by race, ethnicity, and BMI: mean age of onset is
* 8.8 years for African-American girls
* 9.2 years for Hispanic girls
* 9.6 years for Caucasian girls
* 9.9 years for Asian girls.

Question 7

When do breasts start changing in pregnancy?

Answer 7

Second Month.

Question 8

What is colostrum?

Answer 8

Thick, yellow fluid is the precursor for milk, containing the same amount of protein and lactose but practically no fat.

The breasts produce colostrum for the first few days after delivery. It is rich with antibodies that protect the newborn against infection; thus breastfeeding is important.

Question 9

How long after delivery until lactation begins?

Answer 9

Milk production (lactation) begins 1 to 3 days after delivery. The whitish color is from emulsified fat and calcium caseinate.

Question 10

What happens to breast tissue in menopause?

Answer 10

Ovarian secretion of estrogen and progesterone decreases, which causes the breast
glandular tissue to atrophy. This is replaced with fibrous connective tissue. The fat envelope
atrophies these changes cause decrease breast size and elasticity so the breasts droop and sag, looking flattened and flabby.

Question 11

What is gynecomastia?

Answer 11

Breast enlargement on a male.

Question 12

What tumor suppressor genes mutation on one or both give women a higher risk of developing breast or ovarian cancer?

Answer 12

BRCA1 and BRCA2

Question 13

At what age does American Cancer Society recommend beginning breast cancer screening?

Answer 13

Those at average risk at ages 40 to 44 years and definite annual mammography beginning at age 45 years.

Question 14

What is Mastalgia?

Answer 14

Pain that occurs with trauma, inflammation, infection, and benign breast disease.

Question 15

What is Galactorrhea?

Answer 15

discharge from the nipple

Question 16

What are medications that may cause clear nipple discharge?

Answer 16

oral contraceptives, phenothiazines, diuretics, digitalis, steroids, methyldopa, calcium channel blockers.

Question 17

What is BSE?

Answer 17

Breast Self Exam

Question 18

What is CBE?

Answer 18

Clinical Breast Exam

Question 19

What are the benefits of breastfeeding?

Answer 19

Breastfeeding alone for 6 months provides the perfect food and antibodies for the baby, decreases risk for ear infections, promotes bonding, provides relaxation, is protective against breast and ovarian CA, and places less burden on the environment

Question 20

True or False: a supernumerary nipple is a normal variation?

Answer 20

True

Question 21

How do you perform palpation and exams on breast tissue?

Answer 21

Using pads of your first 3 fingers and make a gentle rotary motion on the breast.

Question 22

What color is galactorrhea?

Answer 22

white, milky, present during pregnancy, breastfeeding, and up to 1 year after weaning.

Question 23

What characteristics does pathologic discharge have?

Answer 23

spontaneous, unilateral, has blood, or is clear, serous; it is sometimes associated with a mass

Question 24

What is a mastectomy?

Answer 24

way of treating breast cancer by removing the entire breast through surgery.

Question 25

What special considerations should be given to women with a healing or healed mastectomy?

Answer 25

-She may be very concerned about a recurrence of cancer and be anxious for your findings.
-Be gentle around the scar area because these tissues are quite sensitive.
-Lymphedema of the upper arms is a common sequela because of interruption of lymphatic drainage.

Question 26

Characteristics of Benign (“Fibrocystic”) Breast Disease

Answer 26

(1) swelling and tenderness (cyclic discomfort)
(2) nodularity (significant lumpiness, both cyclic and noncyclic)
(3) dominant lumps (including cysts and fibroadenomas)
(4) nipple discharge (including intraductal papilloma and duct ectasia)
(5) infections and inflammations (including subareolar abscess, lactational
mastitis, breast abscess, and Mondor disease).

Question 27

What are characteristics of breast cancer?

Answer 27

Solitary, unilateral, 3-dimensional, usually nontender mass. Solid, hard, dense, and fixed to underlying tissues or skin as cancer becomes invasive. Borders are irregular and poorly delineated. Grows constantly.

Question 28

Characteristics of Fibroadenoma

Answer 28

Benign mass, most commonly self-detected in late adolescence and
early adulthood. Solitary nontender mass that is solid, firm, rubbery,
and elastic. Round, oval, or lobulated; 1 to 5 cm. Freely movable,
slippery; fingers slide it easily through tissue. Usually no axillary
lymphadenopathy but frequently painful. Diagnose by palpation,
ultrasound, and needle biopsy.

Question 29

Characteristics of Mastitis

Answer 29

uncommon; an inflammatory mass before abscess formation.
Usually occurs in single quadrant. Area is red, swollen, tender, very hot,
and hard, here forming outward from areola upper edge in right breast.
The woman also has a headache, malaise, fever, chills, sweating, increased
pulse, flu-like symptoms

Question 30

Characteristics of Breast Abscess

Answer 30

rare complication of generalized infection (e.g., mastitis) if untreated. A pocket of pus that feels hard, looks red, and is quite tender accumulates in one local area.

Question 31

Characteristics of a plugged duct

Answer 31

common when milk is not removed completely because of poor
latching, ineffective suckling, infrequent nursing, or switching to second
breast too soon. There is a tender lump that may be reddened and warm
to touch. No infection. It is important to keep breast as empty as possible
and milk flowing. The woman should nurse her baby frequently on
affected side first to ensure complete emptying and manually express
any remaining milk.