PE of the Breast Flashcards
Location of Breasts
2nd to 6th rib and from sternal margin to mid-axillary line
Where are the Glands of Montgomery located?
Areola
[Glands of Montgomery]
Function
Produce lipoid fluid that protects nipple during suckling
Lobes per Breast
15-20
Lobules per Lobe
20-40
What contains acinar cells for milk production?
Lobules
Pathway of Milk
Lobe -> Lactiferous Duct -> Lactiferous Sinus -> Nipple Surface
[T/F]
Females have similar amounts of glandular tissue
T
[Cooper’s Ligament]
Function
Provides support for the breast
Fibrous tissue separating lobules
What do silicon implants do to the breasts?
Renders it impalpable
[PE of Breast]
Two main maneuvers
Inspection
Palpation
Proper Position for Breast Inspection
Why?
Sitting with arms at sides
Relaxes breasts and minimizes tension
[PE of Breast]
Inspect for? (4)
Size
Symmetry
Contour
Color and Texture
Dimpling in Breasts occur when?
Cooper’s Ligaments pull the skin and tissue inward due to malignant growth
Define: Peau d’orange
Enlarged pores due to edema caused by invasion of tumor in lymphatics of the breasts
Indicative of advanced malignancy
Define: Normal Venous Pattern
Bilaterally similar
Not usually visible
What could cause unilateral visible venous network?
Dilated superficial veins as a result of increased blood flow to malignant masses
[Nipple]
How should the color be?
Homogenous and matching that of the areola
Pregnancy may cause it to darken
[Nipple]
Normally everted or inverted?
Everted
What are the 5 D’s in Nipple Examination?
Discharge Depression Discoloration Dermatologic Changes Deviation
What could cause deviation of nipples?
Carcinoma pulling Cooper’s Ligaments
What could cause retraction?
Could be normal
Inward pulling by an inflammatory/malignant mass
What are supernumerary nipples?
Extra nipples that develop along the milk line
When could supernumerary nipples have a risk for malignancy?
If they have glandular tissue
Paget’s Disease
Crusting and Eczema of the Nipple
Peau d’orange is first seen in?
The Areola
[Different Positions of Breast PE]
Name 3
Arms over head
Hands hard against hips
Seated and leaning forward from waist
Why Arms Over Head?
Adds tension to upper and lower suspensory ligaments
Accentuates dimpling if present
May reveal variation in color and symmetry
Why Hands Pushed Together/Against Hips
Contracts pectoralis muscle, allows examiner to determine if breast mass is invading muscle
Mass that has invaded muscle cannot be moved in this portion
Why Seated and Leaning Forward from Waist
Helpful for large breasts
May reveal variation in contour and symmetry
In all positions, breasts should be?
7
Bilaterally equal Evenly contoured Smooth No dimpling No nipple retraction No deviation No visible discharge
[Techniques for Breast Palpitation]
Which parts of the hand to use?
2nd, 3rd and 4th finger pads
Never the palm
Techniques for Breast Palpation (3)
Back and Forth
Concentric Circles
Wedge Technique
Position of the Patient for Breast Palpation
Patient supine with one arm raised behind the head
Place a small pillow under the shoulder
Repeat with arms at the side
How to palpate large breasts?
Immobilize the inferior surface with one hand while examining the superior surface with the other hand
How to palpate the Tail of Spence
Patient should be seated with arms raised
Palpate between thumb and fingers
Documenting Breast Masses (8)
Location Size Shape Consistency Tenderness Mobility Borders Retraction
Characteristic of Cancer (5)
Irregular Shape Hard Consistency Non-Tender Movable/Fixed Irregular Borders
Where do most cancers occur?
Upper Outer Quadrant
How to palpate the nipple?
Compress gently between thumb and index finger
Is a spontaneous or non-spontaneous nipple discharge more dangerous?
Spontaneous
What color of fluid would be pathologic? What is not pathologic?
Serious/Yellowish fluid: No pathologic
Bloody: Pathologic, could be caused by a tumor
How do you determine the origin of a duct producing a discharge
Press the areola with one digit in a radial manner and observe, change position with every press
Name of the Test for Nipple Discharge
Cytologic Smear
[Patient Position]
Axilla Palpation
Seated with arms flexed at elbow
[Patient Position]
Supraclavicular Area
Seated
[Supraclavicular Area Palpation]
What do you palpate? What is it bounded by?
Supraclavicular Triangle
- Clavicle
- SCM
- Omohyoid
[Lymph Node Enlargement]
Stage IV Cancers are Found?
Stage III Cancers are Found?
- In the Neck (Cervical Lymph Nodes)
2. Supraclavicular Area
[T/F]
Axillary and supraclavicular lymph nodes are normally palpable
F
