What are some problems or chief complaints about the breast/axillary?
Pain, tenderness, lumps, nipple discharge,
What are the causes of Gynecomastia?
Testerone disorders, Testicular cancer & other cancers, puberty, & obesity, or hormonal disorders.
Upon inspection what are some normal findings of the breast?
Symmetrical or slightly off, contour is smooth, convex, & even, even pigmentation, skin is smooth, abscess, erythemia, rash, venous patterns are bilaterally the same, Venous patterns may be pronounced in the obese, or pregnancy, & a rough/thickened skin.
What does peau d' orange mean?
A term used to describe the orange-like texture of breasts that have edema
Upon inspection what are some abnormal findings of the breast?
Uneven venous patterns, marked asymmetry, dimpling, retraction, or bulging
Upon inspection what are some normal findings of the areola?
Color pink-black, Montgomrey's glands/tubercles, round or oval & hair.
Upon inspection what are some abnormal findings of the areola?
Oddly shaped, unsymmetrical, lesions, or changes in pigment.
Upon inspection what are some abnormal findings of the nipple?
Point in different directions (malignancy), recent nipple inversion or retraction, discharge
What are Supernumerary nipples?
Nipples that resemble small pink or brown moles, they are sometimes found on the embryonic milk line.
Straw colored: Carcinoma, Ductal ectasia, Bloody: intraductal papiloma, Ductal ectasia, Carcinoma,, prepartum women from vascular engorgement
What are some abnormal findings when palpating the axillary?
Enlargement & tenderness of lymph nodes, hard masses, or fixed nodules.
What can be cause hard masses or fixed nodules in the axillary region?
Tumors, metastatic carcinoma, or Lymphoma.
What are the four methods of breast palpation?
Sweeping, Wedge, Circular, or the Vertical strip method
What are abnormal finding upon palpation of the breasts?
Loss of elasticity, & thick nipple tissue, & well as lumps.
Upon inspection of a mastectomy & axillary site what are we looking for?
Color changes, redness, rash, irritation, edema, thickening, lumps, muscle retraction, or Lymphedema
What is Lymphedema?
A collection of lymph in the interstitial spaces caused by the removal of lymph nodes.
Internal anatomy: 3 tissues
1. Glandular tissue =
• lobes, lobules,& alveoli
• lactiferous ducts & sinuses
2. Fibrous tissue =
• suspensory ligaments or Cooper's ligaments
3. Adipose tissue
Health history questions: Breast
- Rash (under arm as well)
- abnormal mammogram
- History of breast disease
- Surgery (implants, lumps)
- Self‐care behaviors
• Breast self‐examination • Last mammogram
physical exam: breasts
• General appearance
• Lymphatic drainage areas
• Maneuvers to screen for retraction
• Palpation patterns
• Expected findings
• Bimanual palpation or one handed
Patterns of breast exams (3)
3. Vertical strip
**Be sure to go up into the axilla (tail of Spence)
If a lump is present, note:
- Location = which quadrant
- Consistency = soft, firm, etc.
- Distinctness = part of tissue or separate
- Nipple retraction
- Overlying skin = is it different than surrounding
Signs of Retraction and Inflammation
• Edema (peau d'orange)
• Deviation in nipple pointing
• Nipple retraction
= benign disease → inflammation & dilation of subareolar ducts
• sticky nipple discharge that is commonly dark green or black. as progresses → burning, itching, edema
= benign masses
• cysts that are palpable masses.
• round, well delineated, mobile and tender
• often fluctuate with menses
= inflammation of breast
• usually in one area of the breast
• red, edematous, tender, warm & hard
• axillary lymph nodes often enlarged & tender
• common in breast feeding
• solitary, unilateral, non-tender lump, thickening or mass
• as tumor grows there may be asymmetry, discoloration, unilateral vein prominence, peak d'orange, ulceration, dimpling, puckering, retraction of skin
• borders irregular, nipple may be inverted