Detailed Notes on Breast Exams and Related Topics

Breast Examination and Related Concepts

Axillary Region

  • Palpation of the axillary region is crucial during breast exams, an area often missed in self-exams.

Breast Tissue Types

  • The breast consists of glandular tissue, fibrous tissue, adipose tissue, and lymphatic tissue.

Lymph Nodes

  • Central lymphatics are important; remember their location and names.
  • Enlarged lymph nodes don't always indicate cancer; they can result from localized infections like mastitis in breastfeeding mothers.

Patient History: Pain Assessment

  • Inquire about breast pain, its relation to the menstrual cycle, and when it started.
  • Benign breast disease typically involves cyclic pain related to hormonal changes during the menstrual cycle.

Lump Assessment

  • If a patient reports a lump, ask:
    • Is it new?
    • Is it painful or tender?
    • Has it changed in size or consistency?
    • Is it solid or movable?
    • Are there accompanying symptoms like nipple discharge or tenderness?

Nipple Discharge

  • Normal discharge can include clear, watery fluid or milk (lactrorrhea).
  • Discharge can occur due to medications or up to a year post-lactation.
  • Abnormal discharge: Any discharge accompanied by a new lump requires investigation.
  • Bloody or pink-tinged discharge necessitates follow-up.

Swelling and Edema

  • Determine if swelling is localized or widespread.
  • Edema of the breast may present as peau d'orange (orange peel) skin.

Trauma

  • Determine if a lump is related to an injury.
  • Hematomas from trauma can manifest as lumps.

Medical History

  • Inquire about a history of cancer, surgery, or radiation.
  • Prophylactic mastectomies may be performed in individuals at high risk for breast cancer.

Medications

  • Hormone replacement therapy and oral contraceptives can increase the risk of breast cancer.

Risk Factors for Breast Cancer

  • Late menarche (late starting of periods).
  • Alcohol consumption.
  • Smoking.
  • Overweight or obesity.
  • Family history of two or more first-degree relatives with breast cancer.

Abnormal Findings

  • Breast and nipple retraction: Nipple appears pulled inward.
  • Breast inflammation: May resemble peau d'orange.
  • Breast lumps: Can be benign or cancerous; requires investigation.

Diagnostic Procedures

  • Mammograms and biopsies are used to determine if a lump is benign or cancerous.

Nipple Discharge Investigation

  • Any nipple discharge should be investigated, except for specific situations (e.g., recent lactation).
  • Collect and send discharge to the lab for culture.
  • Discharge can indicate adrenal or hormonal disorders, or it may be normal for the patient.

Gynecomastia

  • Gynecomastia (male breast enlargement) can occur in obese patients due to hormonal imbalances and excess adipose tissue.
  • Men can develop breast cancer.

Self-Breast Examination

  • Teach patients how to perform self-breast exams (page 401).
  • Best time: 4-7 days after the menstrual cycle.
  • Postmenopausal women: Choose a consistent day each month.
  • Technique: Examine in a mirror with hands raised and on hips to check for symmetry.
  • Palpate in the shower or after, when skin is soft.
  • Don't neglect the tail of Spence.

Changes with Aging

  • Loss of skin elasticity and adipose tissue.
  • Breasts sag and lose volume, making previously non-palpable lumps more noticeable.
  • Lactiferous ducts become more palpable and firm due to drying up.

Palpation Practice

  • Use breast models to practice palpation.

Axillary Hair

  • Axillary hair decreases with age.