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Breast
in front (anterior) to the pectoralis major and serratus, between 2nd/6th ribs, extend from sternum to midaxillary line
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Tail of Spence
projects up and laterally into the axilla
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Nipple
rough, round and usually protrudes - wrinkled and indented with tiny milk duct openings
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Areola
surrounds the nipple, 1-2 cm radius
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Montogomery’s Glands
small elevated sebaceous glands. Secrete a protective lipid material during lactation
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Glandular Tissue
- composed of lobules which consist of clusters of
- alveoli that produce milk
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Cooper’s Ligaments
fibrous bands that attach to chest wall muscles
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Central Axillary Lymph Nodes
high up in the middle of the axilla
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Pectoral Lymph Nodes
along the lateral edge of the pectoralis major muscle, just inside the anterior axillary fold
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Subscapular Lymph Nodes
- along the lateral edge of the scapula, deep in the
- posterior axillary fold
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Lateral Lymph Nodes
along the humerus, inside the upper arm
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Parasternal Lymph Nodes
at the sternal edges
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Infraclavicular Lymph Nodes
below the supraclavicular
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History (Subjective Data)
- 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
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Physical Exam/Assessment (Objective Data)
- 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)
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If a lump/mass is noted - note these characteristics:
- 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
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Peau d’Orange
orange peel look –>cancer (lymphatic obstruction produces edema, exaggerating the hair follicles giving the orange peel look.
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Nipple Retraction vs Nipple Inversion
- recent retraction –> cancer
- long term nipple inversion –> normal variation
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Prominent Venous Pattern
breast tumor
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Fibrocystic Breast Disease or Benign Breast Disease
- 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)
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Mastitis
an inflammatory, tender, red, hard mass. Usually an infection or stasis of a plugged duct during breastfeeding.
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Gynecomastia
enlarged breast tissue in males, very common during adolescence and aging males.
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Supernumerary Nipple
an extra nipple along the embryonic “milk line” on the thorax and abdomen is a congenital finding
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