Breasts and Regional Lymphatic Assessment

Question 1

Surface Anatomy

Answer 1

The breasts lie anterior to the pectoralis muscle and serratus anterior muscles

→ between the 2nd and 6th ribs, extending from the sternum to the midaxilary line
a. tail of spence
b. nipple
c. aerola

Question 2

Tail of Spence

Answer 2

superior lateral corner of breast tissue extending into the axilla
- part of the upper outer
quadrant

Question 3

Internal Anatomy

Answer 3

a. glandular tissue
b. fibrous tissue
c. adipose tissue

Question 4

Glandular Tissue

Answer 4

contains 15-20 lobes radiating from the nipple, composed of lobules which contain clusters of alveoli that produce milk

→ each lobe empties into a lactiferous duct, and the duct forms the lactiferous sinuses, which store produced milk behind the nipple

Question 5

Fibrous Tissue

Answer 5

suspensatory ligaments (Cooper’s Ligaments) are fibrous bands extending vertically from the surface to attach onto the chest wall and support the breast tissue

Question 6

Name of the Fibrous Ligaments Supporting the Breast

Answer 6

Cooper’s Ligaments

Question 7

Adipose Tissue

Answer 7

layers of subcutaneous and retromammary fat provide most of the bulk of the breast

Question 8

What Causes Adipose Tissue Levels to Change

Answer 8

• age
• stage of menstrual cycle
• lactation
• pregnancy
• nutritional state

Question 9

Quadrants of the Breasts

Answer 9

the breasts can be divided into four quadrants with the nipple at the center
L or R:
UOQ
LOQ
UIQ
LIQ

Question 10

Lymph Nodes of the Breasts

Answer 10

more than 75% of lymph drains into the ipsilateral (same side) axillary nodes
a. Central Axillary Node
b. Pectoral Node
c. Subscapular Node
d. Lateral Axillary Node

Question 11

Male Considerations

Answer 11

Gynecomastia - temporary tissue enlargement, typically occurring during puberty or in older adult males due to changes in levels of testosterone
- disc of undeveloped tissue
- small areola, nipple

Question 12

Older Female Considerations

Answer 12

breast size decreases with age

a. glandular tissue atrophies
post menopause (when
levels of estrogen and
progesterone decrease)
b. atrophy of fat - decreased
breast size and elasticity
c. more prominent inner
structures (lactiferous
ducts more palpable)
d. decreased axillary hair

Question 13

Past Medical History

Answer 13

a. surgeries - biopsies,
enlargements,
reconstructions
b. trauma - could result in
inflammation and
accumulation of fluid
c. breast disease, cancer,
genetic factors

Question 14

Subjective Data

Answer 14

a. Pain - mastalgia
b. Lumps - size, shape,
location, onset, pain
c. Discharge from Nipples -
colour, consistency, odour,
timing
d. Rash - size, location, pattern
e. Swelling
f. Axillary Region - tenderness,
lumps, swelling, rash

Question 15

Urgent Findings

Answer 15

• unexplained discharge/
  bleeding from nipples
• open or ulcerating non-
  traumatic lesions
• breast masses (previous
  history of breast cancer)

Question 16

Physical Exam (2)

Answer 16

• Inspection
• Palpation

Question 17

Inspection Points

Answer 17

1. General Appearance
2. Retraction Screening

Question 18

General Appearance

Answer 18

a. symmetry of size and shape
b. skin
c. lymphatic drainage areas
d. nipple

Question 19

Retraction Screening

Answer 19

screen for a lag in movement of one breast, dimpling or puckering of the breast skin, fixation to the chest wall, or skin retraction

Question 19

Supernumerary Nipple

Answer 19

extra nipple that occurs along the milk line

Question 20

Palpation Points

Answer 20

1. Axilla
2. Breast Tissue
3. Lumps

Question 21

Palpation - Axilla

Answer 21

Lift the patient’s arm and support it yourself (allows for loose and relaxed muscles) → using the hand opposite the patient’s arm, palpate the axilla for tenderness or palpable lymph nodes
1. Down the chest wall in a
line from the middle of the
axilla
2. Along the anterior border
of the axilla
3. Along the posterior border
4. Along the inner aspect of
the upper arm

Question 22

Palpation - Breast Tissue

Answer 22

Have the patient lie in a supine position, with a small pad under the side to be palpated, with that respective arm raised over their head → flattens breast tissue and displaces it medially to better palpate
- more pressure is needed
around the nipple to
palpate, less around the
rest of the breast where
there is less adipose tissue

Question 23

Palpation - Lumps

Answer 23

• location
• size
• shape
• consistency
• movability
• distinctness
• nipple
• skin over lump
• tenderness
• lymphadenopathy

Question 24

Breast Cancer

Answer 24

Solitary, unilateral nontender mass that is solid, hard, dense, and fixed to underlying tissues or skin
- Irregular border, poorly
delineated, constant
growth
- Commonly located in the
upper outer quadrant
- firm or hard irregular
axillary nodes, skin
dimpling, and nipple
retraction, elevation and
discharge