Breasts and Axillae
Anatomy and physiology review
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The breasts are paired mammary glands on the anterior chest wall.
Breasts are composed of glandular, fibrous, and adipose tissue.
The nipple is centrally located within the pigmented areola.
The mammary ridge extends from the axillae to the groin.
The male breast is composed of a small nipple and flat areola,
superior to a disk of breast tissue on the chest wall.
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Lymph nodes drain lymph from the breasts and axillae. Superficial
nodes drain the skin, and deep nodes drain the mammary lobules.
Muscles of the chest wall support the breast and give it shape
Common Symptoms
• A mass/lump that is painless, hard, and has irregular edges is more
likely to be cancerous, but some rare cancers are tender, soft, and
rounded.
• A change in the size or shape of the breast.
• A change in the way the skin of the breast, areola, or nipple looks or
feels (for example, scaly, warm, swollen, red)
• Breast pain or discomfort
• Nipple discharge
• Many of these breast symptoms are due to benign breast conditions
The most common risk factors
• Getting older
• Presence of close blood relatives who have had or have this disease.
A woman with breast cancer has 3 to 4 times a greater chance of
developing a new cancer.
• Depending on race: white women are more frequently diagnosed with
breast cancer than black women. But black women die more of this
disease. Asian, Hispanic, and American Indian women are at lower
risk.
• Treatment w/ DES (Diethylstilbestrol)- Between 1940 and 1960, some
pregnant women were given DES to lower their chances of
miscarriage. Recent studies show that these women have a 35%
increased risk of getting breast cancer.
• Radiation: women who have had chest radiation treatment have a
greater risk of breast cancer.
• Genetic factors: about 1 case of breast cancer in 10 is linked to
changes/mutations in certain genes.
• Menstrual history: women having her menstrual periods before 12
years of age or who went through menopause after age 50 have a
slightly higher risk.
• Reproductive history: women that have no children or who have their
first child after 30 have a 40% higher risk.
Gathering the data
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The focused interview includes questions to elicit information about
the breast health and the client’s perceptions about her breasts.
The focused interview includes questions about breast changes, breast
illness, and family history of breast disease as well as questions
related to self-care, diet, and practices that promote or reduce breast
health.
Physical assessment of the breasts and axillae includes the techniques
of inspection and palpation.
Inspection includes observation of the skin and contour of the breast
as the client moves through several positions.
Palpation of the breast is done by gentle pressure of the finger pads of
the first three fingers compressing the breast tissue against the chest
wall in a concentric circle pattern to include all of the breast tissue.
Palpation of the breast includes compression of the nipple to observe
for discharge.
The axillae are inspected for lesions and hair distribution.
The axillary lymph nodes are palpated in the anterior and posterior
axillae, along the inner upper arm, deep in the axillae, and along the
rib cage.
Male breasts are palpated and nipples compressed to observe for
discharge.
Abnormal findings of the breast
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Physiologic nodularity or cystic breasts occur in about 30% of
females. It is characterized by pain and tenderness associated with
the menstrual cycle.
Fibroadenoma occurs in teenage and young adult females. Mobile,
firm, well-delineated lumps are often surgically removed.
The incidence of carcinoma of the breast increases with aging.
Visible signs of carcinoma of the breast include dimpling of the skin,
deviation of the nipple, nipple retraction, and change in the shape of
one breast, edema, and discharge.
Males may experience gynecomastia in puberty as a result of
hormonal changes and after age 50 in response to hormonal
treatment for prostate cancer, from cirrhosis, or associated with
medications.
Health promotion and client education
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Age-related problems in the breast include cyclic pain and the
occurrence of benign breast disease, fibroadenoma, and cancer.
Cultural factors that influence health seeking include backgrounds that
prohibit looking at or touching oneself, low income, and language
barriers.
Risk factors for breast cancer include: Age, familial history, menstrual
history, breasts conditions and diseases, genetic predisposition, not
having children, hormone replacement therapy, high-fat diets, and
obesity.
Males are at risk for breast cancer if there is a familial history or they
use estrogen products in treatment of disease.
Screening for breast cancer includes self-breast examination (SBE),
physical examination by a healthcare provider, and mammography.
SBE is recommended monthly for all females after the age of 20.
Yearly mammography and physical examination of the breast is
recommended in females over 40.
Males with risk factors for breast cancer should have physical
examination conducted as part of their regular health exams.