Flashcards in PD Breast and Axilla Deck (78):
What muscles are superficial to the paired mammary glands on anterior chest?
What is the female breast composed of?
How is the glandular tissue of the breast arranged?
15-20 lobes that radiate about the nipple
How are the lobes of the breast arranged?
Each lobe composed of 20-40 lobules
What do the lobules contain?
Milk producing cells that empty into lactiferous ducts
What is the function of the fibrous tissue?
Supports the breast
Where is fat located in the breast?
What is the vascular supply to the breast?
Branches of internal mammary artery
Lateral thoracic artery
What are the five segments of the breast?
4 quadrants and a tail of Spence
Where does the greatest among of glandular tissue lie in the breast?
Upper outer quadrant
Each breast has a complex... network
In the axillae, the mammary tissue is in direct contact with what structures?
Axillary lymph nodes
Small elevations on surface of areola
Secrete lipoid material to protect nipples during nursing
What history questions do we ask patients about breasts?
FHx of breast/ovarian cancer
Breast self exam
How do we prep the patient to be examined?
Properly gowned patient
Unclothes from waste up
Warm, clean hands
Special maneuvers when lump or mass is detected
What do male practitioners need to do during a breast exam?
Males examining females should always have another female in the room
What are the positions the patient should be in for breast exam?
Sitting position with arms handing loosely at sides
Sitting, arms overhead/leaning forward
Sitting, hands on hips/pressed together
How does sitting with arms overhead or leaning forward affect the exam?
Position increases tension on suspensory ligaments and may help to accent any mass effect
How does sitting with hands on hips or pressed together affect the exam?
Maneuver contracts the pectorals muscles, lesions deeply adherent may manifest themselves
Inspection of breast
How do we need to position the breasts to examine them?
Make sure to lift each breast to inspect inferior aspect or folds
How do we compare breasts?
First compare left to right
What should we expect when comparing breasts?
Expect as a normal variant that one breast is slightly or even noticeably larger than the other
What are some breast abnormalities?
Retraction of skin surface or nipple
What kinds of patients would get infections under the breast?
What does skin dimpling most likely indicate underneath?
Common developmental anomaly results in nipple having crater-like depression
What does appearance of nipple retraction after maturity arouse?
Appearance after maturity should arouse suspicion of underlying neoplasm or inflammatory disease
Appearance of skin that indicates edema of the breast caused by blocked lymphatic drainage
Often due to carcinoma
Skin looks thickened with enlarged pores and accentuated skin markings
One or more extra nipples located along embryonic mammary ride (milk line)
Palpation of breast
Systemically palpate all 4 quadrants and tail of each breast, axillae, and supraclavicular regions
Hand and fingers flat
Small rotary motion
Don't lift hands off, slide
When would you use your thumbs for palpation of the breast?
Use thumbs only for discrete mass characterization
How firmly should you palpate the breast?
Firmly, but no so firmly that breast compressed against rib cage
Variety of methods of palpation of breast
Wedge or radial
How are patients positioned for palpation of breast?
Supine or slight incline to distribute breast tissue over chest wall and more easily compressed
Palpation of areola / nipple
Make sure to palpate breast tissue deep to areola
Compress niple between thumb and index finger - inspect for drainage
How do we characterize drainage of the areola?
More than 1/2 of breast cancers arise from what area of the breast?
Upper outer quadrant / Tail of Spence
What other regions need to be palpated, besides the breast?
For nodes - 1-2% of breast cancers only present as an enlarged LN
Overlying skin changes
Common breast lesions
Fibrocystic disease (mammary dysplasia)
Inspection of nipple discharge
Nature/consistency of discharge (clear, milky, pus, blood)
Association with mass or not
Spontaneous or must be expressed
Relationship to menses
Abnormal lactation (not associated with child bearing)
Drug causes of galactorrhea
Most commonly, drugs
Intrinsic causes of galactorrhea
Prolactin secreting tumors
Enlargement of breast tissue in boys/men
Causes of gynecomastia
Meds containing estrogens or steroids, antiHTN
Drugs like marijuana, alcohol, heroin
What does gynecomastia feel like are where is it located?
Smooth, firm, mobile, tender disk of breast tissue located behind areola
What is the most frequent disorder of the breast?
Benign cyst formation caused by ductal enlargement
Rapid fluctuation in size
Lesions filled with fluid, usually bilateral and multiple
What part of the menstrual cycle is fibrocystic disease associated with?
Long follicular or luteal phase
Describe cysts of fibrocystic disease
Filled with fluid
Bilateral and multiple
Tender/painful with increase Sx premenstrually
Round, soft to firm and tense, mobile, no retractions or dimpling
No nipple discharge
What age do patients usually present with fibrocystic disease?
Benign neoplasm accounts for majority of breast tumors in young women
Generally asymptomatic and do not change premenstrually
Round or discoid with firm/rubbery consistency
Mobile with well delineated borders
Often biopsied to rule out carcinoma
Mastitis, breast abscess
Infection of the breast
Absces if pus pocket is present
Cause of mastitis
Presentation of mastitis
Breast pain and redness in nursing mom
PE findings with mastitis
Purulent nipple discharge
What would we consider instead of mastitis in non lactating females?
Inflammatory breast Ca
What is the second most common site of cancer in women?
Lifetime risk of breast Ca
In white women, 1 in 8/9
What is the second most common cause of cancer death?
Peak age of breast carcinoma
Most common initial symptom of breast carcinoma
How does breast carcinoma metastasize?
Occur through lymphatic and vascular systems
Breast carcinoma risk factors
FHx, breast, ovarian, endometrial
Early menarche (before 12)
Late neopause (after 50)
Late age at birth of first child (over 30)
Previous breast biopsies with benign disease
Genetic mutations of BRCA1 and 2
Estrogen replacement therapy after menopause (>4 years)
Findings associated with breast carcinoma
Mass or thickening in breast
Prominent unilateral veins
Skin discolorations (erythema or ecchymoses)
Dimpling, puckering, retraction of skin or areola
Fixed inversion or deviation of nipple
Crusting or erosion of nipple/areola
What is the rationale for breast screening?
Not all breast carcinomas are palpable
What are the qualities of palpable breast ca?
Firm or hard
Poorly defined borders
Accompanied by skin/nipple changes
Accompanied by discharge
What kind of nipple discharge is indicative of breast carcinoma?
Signs of advanced breast ca
Ulceration of skin
Large primary tumor
Fixation to chest wall
Enlargement or shrinkage/retraction of breast
Axillary or supraclavicular LAD
Ipsilateral arm edema
What do recent studies suggest about BSE?
Monthly BSE do not impart any benefit to female patients towards decreases in breast cancer mortality
Clinical breast examination by a health care provider should be done... over age of...
Yearly over age of 40
American cancer society advocates ... as a cancer screening tool in women over...
Yearly mammograms in women over 40
Why is BSE done monthly?
So patient becomes familiar with the usual appearance and feel of her breasts - easier to notice changes
When should a patient do a BSE?
2-3 days after menses, when breasts are least likely to be tender