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.