Breast

in front (anterior) to the pectoralis major and serratus, between 2nd/6th ribs, extend from sternum to midaxillary line

projects up and laterally into the axilla

rough, round and usually protrudes - wrinkled and indented with tiny milk duct openings

surrounds the nipple, 1-2 cm radius

small elevated sebaceous glands. Secrete a protective lipid material during lactation

• composed of lobules which consist of clusters of
• alveoli that produce milk

fibrous bands that attach to chest wall muscles

high up in the middle of the axilla

along the lateral edge of the pectoralis major muscle, just inside the anterior axillary fold

• along the lateral edge of the scapula, deep in the
• posterior axillary fold

along the humerus, inside the upper arm

at the sternal edges

below the supraclavicular

• A. Breast pain or tenderness
• B. Breast lumps, lumps or swelling in axillary area
• C. Nipple discharge (color, consistency, odor)
• D. Rash - including axillary and breast
• E. Breast swelling, change in bra size
• F. Trauma or injury to breast
• G. Hx of breast disease, family hx of breast disease (at what age did relative have breast disease and which relative)
• H. Hx of breast surgery (augmentation, reduction, biopsy, etc.)
• I. Self Care Behavior - monthly self breast exam, date of last mammogram

• A. Inspection of breasts - note symmetry of shape and size
• 1. Inspect skin texture and color; note any edema, bulging or dimpling
• 2. Inspect nipple - note symmetry, skin color, texture or lesions (inverted nipples may be a normal variation)
• B. Screen for retraction - ask pt to lift arms slowly over the head (breast should move symmetrically). Next ask pt to push hands onto her hips then 2 palms together (the pectoralis major should lift slightly)
• C. Palpation of Axillae - lift pt arm while in sitting position and palpate high into the axillary area
• D. Palpation of breasts - supine position, pt arm overhead palpate breast tissue using one of two patterns (spokes on a wheel or concentric circles), also include tail of spence in palpation
• E. Palpate nipple - “milk” your fingers toward the nipple, repeat from different directions, gently squeeze nipple - note any discharge (color and consistency)

• A. Location - describe as a clock
• B. Size - in 3 dimensions (cm)
• C. Shape
• D. Consistency
• E. Movable
• F. Distinctness - is the lump solitary or multiple
• G. Nipple - is it displaced or retracted
• H. Note the skin over the lump - is it erythematous, dimpled or retracted
• I. Tenderness
• J. Lymphadenopathy

cancer

orange peel look –>cancer (lymphatic obstruction produces edema, exaggerating the hair follicles giving the orange peel look.

• recent retraction –> cancer
• long term nipple inversion –> normal variation

breast tumor

• 1. Swelling and tenderness (cyclic discomfort)
• 2. Mastalgia (severe pain - both cyclic and noncyclic)
• 3. Nodularity - significant lumpiness (cyclic and noncyclic)
• 4. Dominant lumps (cysts and fibroadenomas)
• 5. Nipple discharge (duct ectasia)
• 6. Infections and inflammations (mastitis, abscess)

an inflammatory, tender, red, hard mass. Usually an infection or stasis of a plugged duct during breastfeeding.

enlarged breast tissue in males, very common during adolescence and aging males.

an extra nipple along the embryonic “milk line” on the thorax and abdomen is a congenital finding