Breasts
modified sweat glands which lie over the pectoralis major muscle
-specialized for milk production
What is a benign breast disorder?
any noncancerous breast abnormality
What are the most commonly encountered benign breasts disorders?
Fibrocystic disease
Fibroadenomas
Mastitis
Fibrocystic Breast Changes
also known as benign breast disease (BBD) represents a variety of changes in the glandular and structural tissue of the breast
Wha causes fibrocystic changes?
An overgrowth of fibrous tissues in the connective tissues supporting the breasts
What would you find on your assessment of a patient with Fibrocystic breast changes?
Lumpy tender breasts caused by fluid filled cysts
Clear-to-yellow nipple discharge upon manipulation
Dull, aching pain
Feeling of fullness
What is the main cause of concern for women with fibrocystic changes?
Breast exams and mammography become more difficult to interpret with multiple cysts present and early cancerous lesions may be overlooked
How can the patient manage the symptoms of fibrocystic changes?
SELF CARE: diet and life style changes, wearing a supportive bra, OC pain relievers, limit salt and caffeine consumption
In severe cases of Fibrocystic changes what medications may the patient have to take?
Tamoxifen, bromocriptine, or danazol
Tamoxifen
used to reduce the influence of estrogen on breast tissues
-Masculinization is a common undesirable side effect
What is a last resort for pain relief and swelling reduction for fibrocystic changes?
Aspiration or surgical removal of the breast lumps will reduce pain and swelling by removing the space-occupying mass
When is the best time to exam a woman’s breast?
A week after menses, when swelling has subsided
Mammography
Can help distinguish fibrocystic changes from breast cancer
Ultrasound
Often used w/ mammography to help distinguish a cystic mass from a solid mass
Nursing Management of BBD
- instruct patient to perform monthly self breast exams (triple touch method)
- Oral contraceptives can help hormones
- Low fat diet high in fruits, veggies, and grains
- Heat to reduce pain
- Thiamine and Vitamin E
- Decrease salt and avoid caffeine
Fibroadenomas
Common benign SOLID breast tumors; usually unilateral but can be bilateral
**PAINFUL
What can stimulate fibroadenomas?
External estrogens, progesterones, lactation, and pregnancy
Pituitary tumor = what?
spontaneous nipple discharge
Treatment of Fibroadenomas
- Watch and wait-many will shrink on their own
- Some require surgical removal
- Cryoablation (RARE)
Cryoablation
extremely cold gas is pumped into the tumor using ultrasound guidance; the tumor freezes and dies
Fibroadenoma Lumps
firm, rubbery, and well circumscribed, and freely MOBILE
-Usually found in upper/outer quadrant
What is important to remember about a woman with a mass?
Should be evaluated and cancer should be excluded
Diagnostic tests for Fibroadenomas
Mammography, ultrasound, some form of biopsy
Nursing Management for Fibroadenomas
- Advise patient and encourage to return in 6 months for reevaluation
- Emotional support
- Allow time to ask questions
Mastitis
an infection or inflammation of connective breast tissues
When does mastitis typically occur in women?
When they are lactating
What are the two types of Mastitis?
Lactational and Non-lactational
What are the most common organisms that cause LACTATIONAL Mastitis?
Staphylococcus aureus, Haemophilus influenzae, and Haemophilus and streptococcus species
Lactating Mastitis
Typically occurs in first 2-3 weeks of lactation
-One or more of the ducts becomes blocks resulting in bacterial growth
Nursing Assessment of Mastitis
- History of ductal abnormalities of breasts
- Assess for cracks or fissures in nipples
- Assess for proper breast emptying w/ feeding
- Supportive bra
- Assess breast feeding schedule
Symptoms of Mastitis
- Localized, unilateral area of erythema of breast
- fever
- flu-like symptoms
- leukocytosis
- cracked nipples
- breast distended w/ milk
How is engorgement different then Mastitis?
Engorgement means that both breasts will be full of milk while mastitis is only one
What can cause Non-lactational Mastitis?
Duct ectasia
-milk ducts become clogged w/ secretions and or debris
Nursing management for Mastitis
- effective milk removal
- pain meds (Tylenol)
- antibiotic therapy
- heat
- encourage breast feedings
Breast feeding with Mastitis
- Begin w/ affected breast first
- Massage breast before and during feeding
- Supportive bra 24/7
- increase fluid
- Make sure infant is positioned correctly and change positions
Where does breast cancer typically start?
the epithelial cells that line the mammary ducts within the breasts
What does the growth rate for breast cancer depend on?
Hormonal influence-estrogen and progesterone
What are the 2 major categories of breast cancer?
Invasive and Noninvasive
Non-invasive Breast Cancer
“In Situ” = localized
Have NOT extended beyond their ducts, lobule, or point of origin into the surrounding tissue
Invasive Breast Cancer
HAS extended into the surrounding breast tissue with the potential to metastasize
Metastasis
can take place to almost all organs of the body, but primarily to the lungs, bone, liver, lymph nodes, and brain
What are usually the first sites of metastasis?
Usually local or regional, involving the chest wall or axillary supraclavicular lymph nodes or bone
What is the most common type of breast cancer?
Invasive ductal carcinoma
Invasive Ductal Carcinoma
a malignant tumor that occurs in epithelial tissue; tends to infiltrate and give rise to metastases
- spreads rapidly to lymph nodes
- women > 60
Invasive Lobular Carcinoma
Women 40-50
Does NOT present as a well defined mass-starts as ill defined thickening
Where does invasive lobular carcinoma usually originate?
terminal lobular units of breast ducts
Tubular Carcinoma
uncommon
Women 55 years and older
Colloid Carcinoma
Women 60-70
Medullary Carcinoma
younger women 50 and younger
grows in large tumor masses
Inflammatory Breast Cancer
presents with skin edema, redness, and warmth
poor prognosis
Paget’s Disease
originates in the nipple and typically occurs with invasive ductal carcinoma
3 Stages of Breast Cancer
Tumor size
Extent of lymph node involvement
Evidence of metastasis
What is the purpose of staging breast cancer?
- determine the probability that the tumor has metastasized
- Determine course of therapy
- Assess prognosis
Non-modifiable risk factors for breast cancer
- gender
- age
- genetic mutation
- personal history
- increased breast density
- race/ethnicity
- previous abnormal biopsy
- exposure to chest radiation
- early menarche
Modifiable risk factor for breast cancer
- Not having children at all or not having them after age 30
- Post-menopausal use of estrogen and progesterone
- Failing to breast feed for 1 year after birth
- Alcohol consumption
- Smoking
- Obesity and high fat diet
- Sedentary lifestyle
Testing for Breast Cancer
Mammography MRI Fine-needle aspiration Stereotactic needle-guided biopsy Hormone receptor staus Infrared thermal imaging DNA status/Genetic markers
Surgical Options for Breast cancer
- Breast conserving surgery-lumpectomy w/ radiation
- Modified radical mastectomy
- Radical mastectomy
- Breast implants/augmentation
