CH 18- Breasts and axillae

where are the breasts located?

Paired mammary glands within the superficial fascia of the anterior chest wall

What are breasts in mammals

Milk-producing organs that provide nourishment for offspring

What are “milk lines”?

Embryonic ridges extending from the axillae to the inguinal regions where mammary glands develop.

How do male and female breast development differ after birth?

• Males: little development

• Females: significant development during adolescence due to estrogen and progesterone.

What is the vertical and lateral extent of the breasts?

From the 2nd to 6th ribs and from the sternal margin to the midaxillary line.

How are breasts divided for assessment?

Into quadrants using vertical and horizontal lines intersecting at the nipple.

What are the three types of breast tissue?

Glandular, fibrous, and subcutaneous/retromammary fat.

How many lobes are in each breast?

15–20 lobes.

What are lobules (alveoli)?

Structures within lobes containing milk-producing acini cells.

each lobe is composed of…?

20-40 lobules/alveoli

Where is most glandular tissue located

Upper outer quadrant.

What is the axillary tail of Spence?

Extension of breast tissue into the axilla.

What supports the breast?

Subcutaneous fibrous tissue and Cooper ligaments.

What is the function of the nipple muscles?

Contract to produce erection and empty lactiferous ducts.

What are Montgomery glands?

Sebaceous glands that lubricate the nipple during lactation.

When are breasts smallest in the menstrual cycle?

Days 4–7.

What symptoms occur before menstruation?

Fullness, tenderness, and pain.

What changes occur during pregnancy/lactation?

Increased ducts, alveoli, and milk production in response to luteal and placental hormones

What is the structure of the male breast?

Thin layer of undeveloped tissue beneath the nipple.

What is gynecomastia?

Enlargement of male breast tissue during puberty and again as they get older bc testosterone decreases

Where does most breast lymph drain?

Toward axillary lymph nodes (>75%).

Other lymph drainage routes?

Subclavicular, supraclavicular, internal mammary, subdiaphragmatic, and opposite breast.

OLD CARTS

Onset, Location, Duration, Characteristics, Aggravating factors, Related symptoms, Treatments, and Severity

Why ask about medications?

Some cause breast discomfort or nipple discharge; hormone therapy increases cancer risk.

color of discharge

• Serous (yellow)= Usually normal

• Serosanguineous (straw colored)= Carcinoma, ductal ectasia

• Sanguineous (bloody)= Carcinoma, intraductal papilloma, ductal ectasia, vascular engorgement

• Clear (watery)= Pharmacologic causes, carcinoma

• Milky= Pituitary adenoma, pharmacologic causes, galactorrhea

• Purulent= Infectious process, ductal ectasia

• Multicolored (green, gray, brown)= Fibrocystic changes, carcinoma, infectious process, ductal ectasia

Methods for breast palpation- circular method

Place the finger pads of your middle three fingers against the outer edge of the breast. Press gently in small circles around the breast until you reach the nipple. Try not to lift your fingers off the breast as you move from one point to another

Methods for breast palpation- wedge method

Place the finger pads of your middle three fingers on the areola and palpate from the center of the breast outward. Return your fingers to the areola and again palpate from the center outward, covering another section of the breast (in a spoke-like fashion). Repeat this until the entire breast has been covered.

Methods for breast palpation- vertical strip method

Place the finger pads of your middle three fingers against the top outer edge of the breast. Palpate downward and then upward, working your way across the entire breast.

Why assess breast changes?

Changes may indicate lesions or inflammation.

Major gender risk?

Females (99% of cases).

Age risk?

Most cases in women ≥55.

Genetic risk?

BRCA1/BRCA2 mutations.

Reproductive risk factors?

• Early menarche (<12)

• late menopause (>55)

• nulliparity

• first pregnancy after 30.

Lifestyle risk factors?

Alcohol, obesity, inactivity, hormone therapy >5 years.

How does family history affect risk?

First-degree relative doubles risk; two relatives triple risk.

Most common breast symptom?

Pain (mastalgia).

Types of breast pain?

Cyclic (menstrual-related) and noncyclic.

What should be assessed for lumps?

Location, onset, tenderness, changes, relation to cycle.

What is concerning about new lumps?

May indicate pathology and require evaluation

What type of discharge is concerning?

Bloody or spontaneous discharge.

What suggests pathology?

Unilateral discharge.

Why assess axilla?

Contains lymph nodes and tail of Spence.

What may cause tenderness?

Shaving, deodorants, or infection.

What are key inspection steps?

Inspect breasts, skin, areolae, nipples, and different positions.

Normal breast findings?

Symmetric, smooth, elastic, nontender.

Abnormal findings?

Dimpling, retraction, asymmetry, masses.

What is assessed during palpation?

Tissue, masses, axillae, nipples.

Normal lymph nodes?

Not palpable or small, soft, mobile, nontender.

Normal findings in males?

Symmetric, smooth tissue, no masses.

Concerning findings?

Enlargement, masses, nipple discharge.

Newborn breast finding?

Temporary enlargement and “witch’s milk.”

Older adult breast change?

Replacement of glandular tissue with fat.

What are fibrocystic changes?

Multiple cysts causing tender, mobile masses.

What is fibroadenoma?

Firm, rubbery, mobile, nontender lump.

What is ductal ectasia?

Dilated ducts with sticky discharge.

What are intraductal papillomas?

Cause clear or bloody nipple discharge.

Common presentation of breast cancer

Unilateral, nontender lump.

Other signs of breast cancer

Dimpling, retraction, peau d’orange, discharge.

What is mastitis?

Infection causing redness, warmth, pain, fever.

What is galactorrhea?

Milk production unrelated to pregnancy.

What is gynecomastia (clinical)?

Soft, tender enlargement in males.