Chapter 17-Breast and Regional Lymphatics

- Any hx of breast disease/ What type? how was it dx? when? treated? -Family hx of breast disease? What ages?

Stage 1: Preadolescenct: only small, elevated nipple Stage 2: Breast bud stage: small mound of breast and nipple develops; areola widens Stage 3: Breast and areola enlarge; nipple is flush with breast surface Stage 4: the areola and nipple form a secondary mound over the breast Stage 5: Mature breast: only nipple protrudes; the areola is flush with breast contour

Subjective: -Breast: Pain, Lump, Discharge, Rash, Swelling, Trauma, Hx of breast dx, srugery or radiation, medications, pt-centered -Axilla: tenderness, lump, swelling, rash Objective: -Inspection: General appearance, skin, lymphatic drainage areas, nipple, maneuvers for screen retration -Inspect and Palpate the Axilla -Palpate breasts -Teach breast self-examination

-Early detection of breast cancer is important, if cancer isn't invasive, survival rate is 98% -Explain correct techniques and rationales and expected findings -Perform in front of mirror while disrobed -Palpate in shower, then while laying supine *Perform right after menstrual period (or familiar date once a month after menopause)

-minute extra nipple along embryonic milk line

Male: can have abbreviate exam, but do not omit. -can just combine with anterior thorax -Gynecomastia--> benign breast growth in adolescent male

Benign breast disease: bilateral nodules; pain (dull, heavy and cyclic) Can make detecting cancerous lumps difficult abscess: Packet of puss that feels hard, looks red, and is tender acute mastitis: Inflammatory mass before abscess. Usually single quadrant, red, swollen, tender, hot and hard. *usually with lactation bc of stasis or plugged duct* fibroadenoma: solitary nontender mass that is solid, firm, rubbery, and elastic; round, oval, or lobulated; detected in late adolescence. Benign! cancer: solitary, unilateral, nontender. solid, hard, dense, and fixed. Grows constantly paget disease: -early lesion has unilateral, clear, yellow discharge and dry, scaling crusts, friable @ nipple axex. Erythmatous halo on areola -later lesions show nipple reddened, excoriated and ulcerated with bloody discharge and erythematous plaque surrounding nipple

Location: clock face Size: width x length x thickness Shape: oval, round, lobulated, or indistinct Consistency: soft, firm, hard Movable: freely or fixed? Distinctness: solitary or multiple Nipple: displaced or retracted Note skin over lump: erythematous, dimpled, or retracted Tenderness: tender on palpation Lymphadenopathy: regional lymph nodes palpable?

benign growth of breast tissue, making it distinguishable from other tissues on chest wall. Smooth, firm, movable disk Temporary *Adolescent boys

Alcohol, physical exercise reduces, low income, lack of health insurance, geographic, culture and language barriers, racial bias -Alcohol/western diet increases -Mediterranean diet protective against

smallest structures in the mammary gland

darkened area surrounding the nipple

thin, yellow fluid, precursor of milk, secreted for a few days after birth

syspensory ligaments; fibrous bands extending from the inner breast surface to the chest wall muscles

benign breast mass

persistent white discharge of milk between nursing sessions or after weaning

serosanguineous nipple discharge

nipples that are depressed or invaginated

conveying milk

pain in breast

inflammation of the breast

sebaceous glands in the areola that secrete protective lipid duringn lactation -also called tubercles of Montgomery

intraductal carcinoma in the breast

orange peel appearance of breast due to edema

dimple or pucker on the skin

atrophic pink, purple, or white linear streaks on the breasts, associated with pregnancy, excessive weight gain, or rapid growth during adolescence

minute extra nipple along the embryonic milk line

extension of breast tissue into the axilla

beginning of prepubertal breast development