THE BREASTS and the AXILLAE

BREASTS and THE AXILLA Physiology

a.k.a. Mammary glands
Lie on the anterior chest wall Located on the 2nd-3rd rib and the 6th or 7th rib
over the pectoralis major

More pronounced in females than in males

BREASTS and THE AXILLA Physiology

Structures: 1. nipple- centrally located; an erectile tissue pigmented and ringed by an areola that is darker than the adjacent tissue 2. Sebaceous gland- also called as Montgomerys tubercules are scattered into the areolar surface along with hair follicles 3. Tail of Spence small triangular tissue that projects to the axilla 4. Coopers ligaments fibrous bands that attach to the chest wall that support each breast

BREASTS and THE AXILLA Physiology

Lobes and ducts Women: - 12 to 25 glandular lobes containing alveoli that produce milk - LACTIFEROUS ducts transport milk from each lobe to the nipple Men: - has a nipple, areola and mostly FLAT tissue bordering the chest wall.

BREASTS and THE AXILLA Physiology

Lymph nodes: 1. Pectoral lymph nodes drain lymph from most of the breast and anterior chest 2. Brachial nodes drain most of the arm 3. Subscapular nodes drain the posterior chest wall and a part of the arm 4. Midaxillary nodes central draining nodes of all the lymph nodes 5. Internal mammary nodes drain the mammary lobes

BREASTS and THE AXILLA Physiology

FYI The lymphatic system is the most common route of spread of cells that cause breast cancer A womans breast make many transformations at puberty, reproductive years, pregnancy and menopause Breast devpt- puberty in girlsages 8 and 13

BREASTS and AXILLA Physical Assessment

History: Breasts lumps Biopsy Breast surgery (enlargement or reduction) Family history to breast cancer Frequency of breast examinations and mammogram

BREASTS and THE AXILLA Physical Assessment

Associate breast size and shape with aging Use of hormonal drugs/ control methods
(may cause swelling and tenderness) Diet: increased caffeine linked to fibrocystic breast disease Weight: overweights are more prone to breast cancer development

BREASTS and THE AXILLA Physical Assessment

Schedule of breastexam

Age

BSE

Mammography

Clinical Breast Exam

20-39

Monthly; 7-10 Not Every 3 days after recommended years menses begins
Monthly; 7-10 Yearly days after menses begins Yearly

40 and up

BREASTS and AXILLA Physical Assessment

Note: Having a breast exam can be stressful especially for a woman - To reduce a your patients anxiety, provide privacy, make her as comfortable as possible, explain what the examination involves.

BREASTS and AXILLA Physical Assessment

Inspection: - texture : smooth; undimpled - color : the same as the rest of the skin - edema : non-edematous (+) edema lymphatic obstruction that suggests cancer -symmetry : may be asymmetrical left usually larger than the right -discharges : none (except for lactation)

BREASTS and AXILLA Physical Assessment

Nipples : non-inverted : no dimples : no creases Positions while observing the nipple a. Holding arms over her head b. Press hands over hips c. Press hands over hips and then slouch

BREASTS and AXILLA Physical Assessment

Palpation Note: -Let the person lie in supine position with a small pillow under her shoulder -Inframammary ridge is normally firm and is mistaken for a tumor -Strokes of palpation: 1. Circular 2. Vertical 3. Wedge

BREASTS and AXILLA Physical Assessment

Palpate for: Nodules Tenderness cysts, hormonal changes, infection or cancer or premenstrual symptoms

BREASTS and AXILLA Physical Assessment

Axilla Inspect for: Rashes Infections Unusual pigmentation Odor

BREASTS and AXILLA Physical Assessment

Palpate the axilla for:

Nodes : soft, small and non-tender

BREASTS and AXILLA Abnormal findings

Firm, irregular, nontender lump Nipple retraction, deviation, inversion or
flattening Enlarged axillary lymph nodes

ALL OF THESE POINT OUT BREAST

CANCER

BREASTS and AXILLA Physical Assessment

Heat (calor) Erythema (rubor) Swelling (dolor) Pain and tenderness Fever, malaise, fatigue and aches
All of these point out to MASTITIS

BREASTS and AXILLA Physical Assessment

Abnormalities: Breast nodule aka lymph which maybe found in any part of the breast, including the axilla Dimpling the puckering or retraction of skin on the breast results from an abnormal attachment of the skin to underlying tissue. LATE SIGN of BREAST CANCER

BREASTS and AXILLA Physical Assessment

PEAU DORANGE aka orange peel skin
- another late sign of breast cancer - is edematous thickening and pitting of breast skin - looks like a strikened orange peel appearance

BREASTS and AXILLA Physical Assessment

NIPPLE RETRACTION and INVERSION
- retraction: inward replacement of the nipple below the level of surrounding breast tissue may indicate breast lesion or CA - inversion: lack of protrusion of the nipple may indicate abscess formation

BREASTS and AXILLA Physical Assessment

NIPPLE DISCHARGE
- may occur spontaneously or through nipple stimulation endocrine d/o, cancer, certain drugs, and blocked lactiferous ducts BREAST PAIN - results from benign breast disease like mastitis VISIBLE VEINS - may indicate cancer in some patients; NORMAL in pregnancy because of engorgement

BREASTS and AXILLA Quick Quiz

1. Most malignant breast cancers occur in
the region of the breast known as the: a. lower inner quadrant b. lower outer quadrant c. upper inner quadrant d. upper outer quadrant

BREASTS and AXILLA Quick Quiz

2. Normal changes in the breasts of a premenstrual woman include: a. single, hard, fixed mass b. nipple inversion and skin dimpling c. tenderness and soft, mobile cyst d. redness and scaling over a portion of the breast

BREASTS and AXILLA Quick Quiz

3. After obtaining a smear of nipple discharge on a glass slide, you would: a. freeze the slide before sending it to the lab b. let the smear air-dry before sending it to the lab c. spray the slide with a cytologic fixative before sending it to the lab d. spread the smear with a cotton swab, apply a cover slip to the slide and send it to the lab

BREASTS and AXILLA Quick Quiz

4. The tail of Spence is located for: a. above the nipple at the midclavicular line b. in the upper outer quadrant, toward the axilla c. in the upper inner quadrant, near the sternum d. in the lower outer quadrant, close to the ribs