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Breast Exam Flashcards

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1
Q

Female Breast Structures

A

fat, glandular and connective tissue, as well as lobes, lobules, ducts, lymph nodes, blood vessels and ligaments

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2
Q

Lobules and ducts

A

Lobules branch out from the nipple - each holds tiny, hollow sacs (alveoli).

The lobules are linked by a network of thin tubes (ducts).

If you’re breast-feeding, ducts carry milk from the alveoli toward the dark area of skin in the center of the breast (areola).

From the areola, the ducts join together into larger ducts ending at the nipple.

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3
Q

Superior breast anatomy

A

Breast tissue extends superiorly from the second and third ribs, inferiorly to the inframammary fold, and transversely from the sternum to the midaxillary lines.

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4
Q

Tail of Spence

A

peninsula of breast tissue may project into the axilla

It passes through an opening in the deep Pectoral fascia is known as (foramen of langer)

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5
Q

Two facial layers that enclose the breast tissue

A
  1. superficial layer beneath the dermis
  2. The deep layer overlying the pectoralis major muscle fascia
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6
Q

Breast tissue overlaying the dermis via bands of connective tissue

A

ligaments of Cooper

+ retro-mammary bursa, support the breast’s position while allowing free movement over the underlying thoracic walls

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7
Q

Breast positioning

A

base of the breast - 2nd - 6th ribs

From the lateral margin of the sternum to the mid axillary line

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8
Q

Foramen of langer

A

a defect in the deep pectoralis fascia at the level of the third intercostal space, through which the upper lateral portion of the breast extends into the axilla forming the axillary tail of Spence.

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9
Q

Breast Muscle

A

The breast has no muscle tissue.

Muscles lie underneath the breasts, however, separating them from your ribs.

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10
Q

Lymphatics of the breast

A
  1. Superficial lymphatics: Drains skin over the breasts except nipple and areola
  2. Deep lymphatics:
    Drains the parenchyma of breasts and drains the nipple and areola
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11
Q

Deep surface of breast

A
  1. The retromammary space: - It is loose areolar tissue between the gland and deep fascia (pectoral fascia)- Allows the free mobility of the breast over the deep fascia.
  2. The deep fascia : covering the pectoralis major muscle
  3. The flat base of the breast lies on the pectoralis major (medial 2/3) and serratus anterior (lateral 1/3).
  4. The lower lateral part of the gland rests on the external oblique muscle of the abdomen
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12
Q

Breast Lymphatic Drainage

A
  1. Axillary Lymph node
    Drains 75% of chest wall and upper extremity
  2. Dermal Lymphatics
    Allows spread to the other breast
  3. Inferior Nodes
    Spread to stomach and liver
  4. Infrasternal nodes
    Spread to vertebral column up to the brain
  5. Rotter’s nodes
    Bypass the axillary nodes
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13
Q

Arterial supply to the breasts

A

1) Internal Thoracic Artery -50%
2) Intercostal Artery
3) Axillary Artery

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14
Q

Nerve supply of the breast

A
  1. Intercostal nerves 2nd-6th
  2. Lateral Cutaneous nerves - 3-6
  3. Supraclavicular branches
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15
Q

Venous Drainage

A

1) Axillary vein is main route
2) Internal mammary vein
3) Intercostal Vein

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16
Q

Breast fascia positioning

A

Deep layer of this fasciasits immediately atop the pectoralis muscle

Superficial layer sits just under the skin.

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17
Q

projection from just below the center of the breast , Lies in the 4th intercostal space, contains circular smooth muscle

A

Nipple

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18
Q

Carries the opening of lactiferous ducts (15-20 openings.

A

Longitudinal smooth muscle - flattens the nipple

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19
Q

Pigmented area of skin that surrounds the base of the nipple and outer margin structure.

A

Areola -

It is rich in modified sebaceous gland particularly at the outer margin.

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20
Q
A

1) Papilla mammaria

2) Areola mammae

3) Tubercula areolae

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21
Q

Tubercule of Montgomery

A

sebaceous (oil) glands that appear as small bumps around the dark area of the nipple.

primary function -lubricating and keeping germs away from the breasts.

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22
Q

Breast Development stages

A

Stage 1: Prepubertal.

Stage 2: Breast bud stage with elevation of breast and papilla; enlargement of areola.

Stage 3: Further enlargement of breast and areola; no separation of their contour.

Stage 4: Areola and papilla form a secondary mound above level of breast.

Stage 5: Mature stage with projection of papilla only, related to recession of areola.

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23
Q

Benign Diseases of the Breast.

A

Fibroadenoma
Fibrocystic Disease
Galactocele

Mastitis
Breast Abscess
Hematoma

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24
Q

Fibroadenoma

A

common noncancerous (benign) breast lumps that rarely increase breast cancer risk.

(may get bigger or smaller over time)

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25
Fibrocystic Disease
Painful, lumpy breasts.  Formerly called fibrocystic breast disease, this common condition is, in fact, not a disease. Many women experience these normal breast changes, usually around their period.
26
Galatocele
Caused by any kind of blockage in the ducts of the breast during or just after stopping lactation. While breast carcinomas may sometimes cause a blockage which results in a galactocele, these lesions are due to more routine and benign causes in a majority of women. Tx - Warm compress/pump with taper
27
Mastitis
an inflammation of breast tissue that sometimes involves an infection.
28
Mastitis notes
Usually 1st 6 weeks post partum The inflammation results in breast pain, swelling, warmth and redness. You might also have fever and chills. DX: PE, U.S, aspiration Mammogram after tx to R/O abscess
29
Breast Abscess
A localized collection of inflammatory exudate (ie, pus) in the breast tissue. Most commonly when mastitis or cellulitis does not respond to antibiotic treatment, but an abscess can also be the first presentation of breast infection. It is an uncommon problem in breastfeeding.
30
Breast Hematoma
is a collection of blood that accumulates in your breast tissue. Most hematomas resolve on their own without treatment.
31
Breast Cancer
Except for skin cancer, breast cancer is the most common cancer in women in the United States. breast cancer remains the second leading cause of cancer death among women overall, although death from breast cancer has declined overall.
32
Breast Cancer insidence and details
1 out of 8 women will develop breast CA Average age is 60 Affects women ages 30-90 Usually: Hard, non-tender Irregular Fixed mass
33
Un-changeable breast cancer risk factors
1. Age - most are diagnosed after age 50. 2. Genetic - BRCA1 & BRCA2 3. Reproductive history  - Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer. 4. Having dense breasts.  More connective tissue than fatty tissue - make it hard to see tumors on a mammogram.
34
More Un-changeable breast cancer risk factors
1. Personal history of breast cancer or certain non-cancerous breast diseases.  2. Family history of breast or ovarian cancer. (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk. 3. Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (for instance, treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life. Exposure to the drug diethylstilbestrol (DES). DES was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage. Women who took DES, or whose mothers took DES while pregnant with them, have a higher risk of getting breast cancer.
35
Changeable Breast cancer risk factors
1. Not being physically active.  2. Taking hormones - hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. 3. Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk. 4. Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.
36
High risk critera for breast cancer
If you have a strong family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, you may have a high risk of getting breast cancer. You may also have a high risk for ovarian cancer.
37
BRCA genes function
Tumor suppressor genes these genes help keep breast, ovarian, and other types of cells from growing and dividing too rapidly or in an uncontrolled way
38
American cancer society screening recs
1. Women between 40 and 44 have the option to start screening with a mammogram every year. 2. Women 45 to 54 should get mammograms every year. Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. 3. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
39
Breast cancer signs and symptoms
new lump or mass (although most breast lumps are not cancer). A painless, hard mass that has irregular edges is more likely to be cancer, but breast cancers can be also soft, round, tender, or even painful.
40
More breast cancer signs and symptoms
Swelling of all or part of a breast (even if no lump is felt) Skin dimpling (sometimes looking like an orange peel) Breast or nipple pain Nipple retraction (turning inward) Nipple or breast skin that is red, dry, flaking, or thickened Nipple discharge (other than breast milk) Swollen lymph nodes under the arm or near the collar bone (Sometimes this can be a sign of breast cancer spread even before the original tumor in the breast is large enough to be felt.)
41
Signs of advance breast cancer
breast lump that you can either see or feel. skin changes, like dimpling or rash. nipple discharge. breast pain or discomfort. fatigue. unexplained weight loss. loss of appetite.
42
Discuss the following with your patient: Assessing risk of breast cancer
1. Screening measures: self breast exam, clinical breast exam, and mammography 2. How to do self breast exam? 3. Concerns about palpable masses of the breast.
43
BREAST self exam
Women 20 yo and up may perform monthly self exams Exams are perform 1 week after menstrual period Done supine or standing ALWAYS inspect first Palpate /breast and axilla
44
BREAST inspection
1. Abnormalities in the overall shape of the breasts 2. Changes in skin color 3. Skin dimpling / retractions 4. Spontaneous nipple discharge
45
Skin dimpling
Breast skin dimpling is when an area of the breast looks similar to an orange peel. Dimpling can be a sign of breast cancer. Sometimes, it is inflammatory breast cancer.  This rare form of breast cancer blocks the skin’s lymph vessels,  causing swelling, redness, and inflammation. 
46
Early warning signs of breast cancer
1. visible lump 2. nipple change - inversion 3. color or texture change 4. dimpled or depressed skin 5. bloody discharge
47
Female breast exam
Clinical breast examination enhances detection of breast cancers that mammography may miss and provides opportunity for the patient demonstrate techniques for self-examination
48
Clinician approach and technique to breast exam
Clinicians should adopt a standardized approach Use a systematic and thorough search pattern Use finger pads Vary palpation pressures Use a circular motion
49
Patient interaction with breast exam
Women and girls may feel apprehensive about the exam Reassure the patient Use a courteous and gentle approach Keep the patient properly draped Ask the patient if she has noticed any lumps or other problems and if she performs monthly breast self-exam
50
components to female breast exam
1. Inspect the breasts with the patient in sitting position and disrobed to the waist 2. Look for skin changes (color, thickening, and unusually prominent pores), size and symmetry, contour, characteristics of the nipples (size, shape, direction in which they point, rashes, ulceration, and discharge) 3. Ask the patient to raise her arms above her head or press them against the hips as this can bring out dimpling or retraction Assess four views: arms at sides, arms over head, arms pressed against hips, and leaning forward
51
palpation technique with female breast exam
Place the patient in the supine position Palpate a rectangular area from clavicle to inframammary fold and midsternal line to posterior axillary line and into axilla for the tail of the breast Thorough examination takes 3 minutes per breast Use finger pads of the 2nd, 3rd, and 4th fingers Use the vertical strip pattern (best validated technique) Palpate in small, concentric circles Apply light, medium, and deep pressure Examine the entire breast, including periphery, tail, and axilla
52
Con’t palpation female breast exam
Lateral portion of breast Ask the patient to roll onto the opposite hip, hand on forehead with shoulder pressed against exam table This flattens lateral breast tissue Medial portion of breast Ask the patient to lie with shoulders flat against the exam table; place her hand at her neck and lift up her elbow until it is even with her shoulder
53
Palpation feeling for
Consistency of tissues Tenderness Nodules Location Size Shape Consistency Delimitation Tenderness Mobility
54
Nipple exam
Palpate each nipple Note elasticity
55
Findings consistent with malignancy
Hard consistency Irregular shape Dimpling of overlying skin Associated retraction of nipple Non-tender
56
Male breast exam
Inspect the nipple and areola for nodules, swelling, ulceration Palpate the areola and breast tissue for nodules If the breast is enlarged: Distinguish between soft, fatty enlargement of obesity and the firm disc of glandular enlargement (gynecomastia)
57
Con’t male exam 2
Have patient in a sitting position Inspection Rash Infection Unusual pigmentation
58
cont male exam 3
Left axilla: ask patient to relax with left arm down Cup together the fingers of your right hand Reach as high as possible toward the apex of axilla Fingers should lie directly behind pectoral muscles, toward midclavicle Press fingers toward chest wall and slide them downward Try to feel central nodes against chest wall One or more soft, small (<1 cm), nontender nodes is normal
59
axillae exam cont
If central nodes feel large, hard, or tender—or if there is suspicious lesion—feel for other groups of axillary nodes Pectoral nodes Lateral nodes Subscapular nodes
60
Assessment of spontaneous nipple discharge
Try to determine origin Compress areola with index finger Watch for discharge appearing through one of the duct openings on nipple’s surface Note color, consistency, quantity, and exact location
61
Chronic abscess
think DM, TB or duct tumor

PD II (4 decks)

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