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Chapter 14
Breasts and Regional Nodes
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Competencies Describe the anatomy and
physiology of the breasts and regional lymphatics, including age-related variations.
Demonstrate assessment techniques for the evaluation of the breasts and regional lymphatics.
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Competencies Distinguish common variations and
abnormal changes of the breasts. Discuss methods of teaching breast
self-examination to patients. Identify risk factors for breast
cancer.
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Anatomy and Physiology— Breast Function: milk production and
sexual pleasure Tail of Spence Cooper’s ligaments Nipple Lactiferous ducts
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Anatomy and Physiology— Breast Areola Montgomery’s tubercles Lobes Lobules Alveoli or acini Lymphatic drainage
Axillary nodes: central, pectoral, subscapular, lateral
Internal mammary chain
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Breast Development Usually begins at 10 to 11
years of age Stimulated by estrogen release
during puberty
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Health History Patient profile
Age Gender Race
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Health History Common chief complaints
Breast mass, tenderness, discharge Assess the following characteristics
Location Quality Quantity Associated manifestations Aggravating factors Alleviating factors
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Health History Past health history
Breast specific vs. Systemic Medical Surgical Medications Allergies
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Health History Family history
Breast cancer Benign breast disease
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Health History Social history
Alcohol use Tobacco use Work environment Home environment Economic status Ethnic background
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Health History Health maintenance activities
Diet Exercise Breast self-exam Mammogram
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Assessment Equipment
Towel, drape, centimeter ruler, teaching aid for breast self-exam
General approach Inspection Patient positions
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Assessment Assess the following areas
Breasts Areolar areas Nipples Axillae
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Assessment Assess the following characteristics
Color Vascularity Thickening/edema Size and symmetry Contour Lesions/masses Discharge
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Palpation Sequential manner Supraclavicular and infraclavicular
nodes Breasts, arms at side, arms raised Axillary nodes Breasts, supine position
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Evaluation of Breast Mass Characteristics Location Size Shape Number Consistency
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Evaluation of Breast Mass Characteristics Definition Mobility Tenderness Erythema Dimpling or retraction
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Normal Findings Breast and axillae are flesh
colored Areolar areas and nipples are
darker in pigmentation Moles and nevi are normal
variants No thickening or edema
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Normal Findings Minor size variation in the breasts
and areolar areas Usually breast on dominant side is
larger Nipples should point upward and
outward, may point outward and downward
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Normal Findings Breasts, areolar areas, nipples
should be symmetrical Breasts are convex, without
flattening, retractions, or dimpling Free from masses, tumors, primary
or secondary lesions
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Normal Findings No discharge from nipples in
nonpregnant, nonlactating female Usually, palpable lymph nodes less
than 1 cm in diameter are clinically insignificant
Palpation should not elicit pain
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Normal Findings Consistency of breast tissue is
highly variable depending upon age, time in menstrual cycle, and proportion of adipose tissue
Breasts are usually nodular or granular prior to menses
Variation with breast augmentation— breasts feel fluid filled or firm throughout
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Risk Factors for Breast Cancer Age > 50 Personal history of breast CA Mother, grandmother, or sister with
breast CA Menarche at an early age Menopause at advanced age Obesity Alcohol intake > 3 servings per day
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Risk Factors for Breast Cancer American or European descent Urban dweller Estrogen therapy Nulliparous First birth after age 30 Higher education and
socioeconomic status Atypical hyperplasia
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Diagnostic Techniques Mammography X ray Ultrasonography Magnetic resonance imaging
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Gerontological Variations Breast tissue atrophy Decreased glandular tissue,
resulting in granular feeling Breasts become smaller,
pendulous, and flatter Ductal tissue becomes more
palpable. Stringy feeling
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Breast Self-Examination (BSE) Performed once a month Performed on a fixed date each
month, or eight days after menses Avoid completing during
menstruation or ovulation Use calendar for monthly reminder Include significant other in
examination process(continues)
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BSE Bed (B): supine position
Use palmar surface of fingers Place right arm over head and palpate
right breast Move in concentric circles from the
periphery inward Squeeze the nipple to examine for
discharge Use same procedure to check left breast
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BSE Standing (S)
Repeat previous process in standing position
Examination (E) Stand before mirror, arms at side Assess for symmetry, retractions,
dimpling, inverted nipples, or nipple deviation
Repeat with arms above head, and hands pressed into hips