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Chapter 14

Breasts and Regional


Nodes

Copyright 2002, Delmar, A division of Thomson Learning


Competencies
 Describe the anatomy and
physiology of the breasts and
regional lymphatics, including age-
related variations.
 Demonstrate assessment
techniques for the evaluation of the
breasts and regional lymphatics.

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
 Distinguish common variations and
abnormal changes of the breasts.
 Discuss methods of teaching breast
self-examination to patients.
 Identify risk factors for breast
cancer.

Copyright 2002, Delmar, A division of Thomson Learning


Anatomy and
Physiology— Breast
 Function: milk production and
sexual pleasure
 Tail of Spence
 Cooper’s ligaments
 Nipple
 Lactiferous ducts

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Anatomy and
Physiology— Breast
 Areola
 Montgomery’s tubercles
 Lobes
 Lobules
 Alveoli or acini
 Lymphatic drainage
 Axillary nodes: central, pectoral,
subscapular, lateral
 Internal mammary chain
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Breast Development
 Usually begins at 10 to 11
years of age
 Stimulated by estrogen release
during puberty

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Health History
 Patient profile
 Age
 Gender
 Race

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Health History
 Common chief complaints
 Breast mass, tenderness, discharge
 Assess the following characteristics
 Location
 Quality
 Quantity
 Associated manifestations
 Aggravating factors
 Alleviating factors

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Health History
 Past health history
 Breast specific vs. Systemic
 Medical
 Surgical
 Medications
 Allergies

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Health History
 Family history
 Breast cancer
 Benign breast disease

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Health History
 Social history
 Alcohol use
 Tobacco use
 Work environment
 Home environment
 Economic status
 Ethnic background

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Health History
 Health maintenance activities
 Diet
 Exercise
 Breast self-exam
 Mammogram

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Assessment
 Equipment
 Towel, drape, centimeter ruler,
teaching aid for breast self-exam
 General approach
 Inspection
 Patient positions

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Assessment
 Assess the following areas
 Breasts
 Areolar areas
 Nipples
 Axillae

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Copyright 2002, Delmar, A division of Thomson Learning
Assessment
 Assess the following characteristics
 Color
 Vascularity
 Thickening/edema
 Size and symmetry
 Contour
 Lesions/masses
 Discharge

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Palpation
 Sequential manner
 Supraclavicular and infraclavicular
nodes
 Breasts, arms at side, arms raised
 Axillary nodes
 Breasts, supine position

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Evaluation of Breast
Mass Characteristics
 Location
 Size
 Shape
 Number
 Consistency

(continues)
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Evaluation of Breast
Mass Characteristics
 Definition
 Mobility
 Tenderness
 Erythema
 Dimpling or retraction

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Normal Findings
 Breast and axillae are flesh
colored
 Areolar areas and nipples are
darker in pigmentation
 Moles and nevi are normal
variants
 No thickening or edema
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Normal Findings
 Minor size variation in the breasts
and areolar areas
 Usually breast on dominant side is
larger
 Nipples should point upward and
outward, may point outward and
downward
(continues)
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Normal Findings
 Breasts, areolar areas, nipples
should be symmetrical
 Breasts are convex, without
flattening, retractions, or dimpling
 Free from masses, tumors, primary
or secondary lesions

(continues)
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Normal Findings
 No discharge from nipples in
nonpregnant, nonlactating female
 Usually, palpable lymph nodes less
than 1 cm in diameter are clinically
insignificant
 Palpation should not elicit pain

(continues)
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Normal Findings
 Consistency of breast tissue is
highly variable depending upon
age, time in menstrual cycle, and
proportion of adipose tissue
 Breasts are usually nodular or
granular prior to menses
 Variation with breast
augmentation— breasts feel fluid
filled or firm throughout
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Risk Factors for Breast
Cancer
 Age > 50
 Personal history of breast CA
 Mother, grandmother, or sister with
breast CA
 Menarche at an early age
 Menopause at advanced age
 Obesity
 Alcohol intake > 3 servings per day
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Risk Factors for Breast
Cancer
 American or European descent
 Urban dweller
 Estrogen therapy
 Nulliparous
 First birth after age 30
 Higher education and
socioeconomic status
 Atypical hyperplasia
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Diagnostic Techniques
 Mammography
 X ray
 Ultrasonography
 Magnetic resonance imaging

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Gerontological
Variations
 Breast tissue atrophy
 Decreased glandular tissue,
resulting in granular feeling
 Breasts become smaller,
pendulous, and flatter
 Ductal tissue becomes more
palpable. Stringy feeling

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Breast Self-Examination
(BSE)
 Performed once a month
 Performed on a fixed date each
month, or eight days after menses
 Avoid completing during
menstruation or ovulation
 Use calendar for monthly reminder
 Include significant other in
examination process (continues)
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BSE
 Bed (B): supine position
 Use palmar surface of fingers
 Place right arm over head and palpate
right breast
 Move in concentric circles from the
periphery inward
 Squeeze the nipple to examine for
discharge
 Use same procedure to check left
breast (continues)
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BSE
 Standing (S)
 Repeat previous process in standing
position
 Examination (E)
 Stand before mirror, arms at side
 Assess for symmetry, retractions,
dimpling, inverted nipples, or nipple
deviation
 Repeat with arms above head, and
hands pressed into hips
Copyright 2002, Delmar, A division of Thomson Learning

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