HA CH18: Breast, Axilla, Regional Lymphatics

Puberty

estrogen levels stimulate breast tissue changes

Enlargement (fat deposition), growth of duct system, potential alveoli develop

Aromatase (1)

fat cells, which secrete a form of estrogen

Higher BMI is linked to earlier onset of breast tissue development

Mean onset of breast development has dropped in the last century (possibly linked to obesity epidemic)

Aromatase (2)

Vary by race, ethnicity, and BMI

African American girls: 8.8 years

Hispanic girls: 9.2

Caucasian girls: 9.6

Asian girls: 9.9

Tanner Staging

Five stages of breast tissue development

Thelarche

beginning of breast development

Full development of stages 2-5 average 3 years

Pubic and axillary hair develops

Menarche

onset of menstruation

Occurs in Tanner stage 3-4, around 12 years of age

Size of fully developed females may ebb and flow with hormonal changes during cycle.

Stage 2/ Breast Budding

Breasts may become asymmetrical and tender, this is an expected finding, however, a clinical exam could rule out any abnormalities (i.e. cancer, tumor, cyst, etc.) which are unlikely at this age.

Stage 3 & 4 (Tanner Staging)

Ages 12+ --> Menarche

Pregnancy (1)

Breast changes during second month - early common sign of pregnancy

Breasts enlarge and feel more nodular

Expansion of ductal system, supporting fatty tissue, development of true secondary alveoli.

Areolae larger and darker as pregnancy progresses (color may fade after delivery, but size remains)

Increased vascularity

Pregnancy (2)

Colostrum may be expressed after the fourth month

Precursor for milk, containing protein and lactose

Produced again after the first few days of delivery

Rich in antibodies

Aging Women: Post-Menopause (1)

Ovarian secretion of estrogen and progesterone decreases

Breast glandular tissue atrophies, replaced with fibrous connective tissue

Subcutaneous tissue also atrophies

Aging Women: Post-Menopause (2)

Decreased breast size and elasticity

Inner structures more prominent

Lump may have been present, but now more noticeable

Axillary hair decreases

Inspect and Palpate the Axillae (1)

Note rashes or discoloration

When palpating, move firmly in four directions:

1.Down the chest wall, from the middle of the axilla

2.Anterior border of the axilla

3.Posterior border of the axilla

4.Inner aspect of the inner arm

Lymph nodes are not usually palpable

Inspect and Palpate the Axillae (2)

Some is common and tenderness expected high in the axilla*

Note any enlarged and tender lymph nodes

Infection of breast, arm, hand or breast cancer metastasis

Modifiable Risk Factors for Breast Cancer (1)

Nulliparity or first child after 30 y/o

Current oral contraceptive use

Long-term use of HRT

Not breast feeding

Modifiable Risk Factors for Breast Cancer (2)

Alcohol intake 2-5 drinks daily

Obesity (especially after menopause)

Physical inactivity

Non-Modifiable Risk Factors for Breast Cancer (1)

First-degree relatives of BC patients who were diagnosed premenopausal and had bilateral disease have the greatest risk of developing breast cancer

Female > 50y/o

Personal history

BRCA1 or BRCA2 gene mutation

Non-Modifiable Risk Factors for Breast Cancer (2)

History of hyperplasia on biopsy

Previous breast irradiation

Menarche before 12 y/o

Menopause after 50 y/o

White Race