Chapter 14
Breasts and Regional
Nodes
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Describe the anatomy and
physiology of the breasts and
regional lymphatics, including agerelated variations.
Demonstrate assessment
techniques for the evaluation of the
breasts and regional lymphatics.
(continues)
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Competencies
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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
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Function: milk production and
sexual pleasure
Tail of Spence
Cooper’s ligaments
Nipple
Lactiferous ducts
(continues)
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Anatomy and
Physiology— Breast
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Areola
Montgomery’s tubercles
Lobes
Lobules
Alveoli or acini
Lymphatic drainage
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Axillary nodes: central, pectoral,
subscapular, lateral
Internal mammary chain
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Breast Development
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Usually begins at 10 to 11
years of age
Stimulated by estrogen release
during puberty
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Health History
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Patient profile
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Age
Gender
Race
(continues)
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Health History
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Common chief complaints
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Breast mass, tenderness, discharge
Assess the following characteristics
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Location
Quality
Quantity
Associated manifestations
Aggravating factors
Alleviating factors
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Health History
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Past health history
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Breast specific vs. Systemic
Medical
Surgical
Medications
Allergies
(continues)
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Health History
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Family history
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Breast cancer
Benign breast disease
(continues)
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Health History
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Social history
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Alcohol use
Tobacco use
Work environment
Home environment
Economic status
Ethnic background
(continues)
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Health History
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Health maintenance activities
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Diet
Exercise
Breast self-exam
Mammogram
(continues)
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Assessment
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Equipment
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Towel, drape, centimeter ruler,
teaching aid for breast self-exam
General approach
Inspection
Patient positions
(continues)
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Assessment
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Assess the following areas
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Breasts
Areolar areas
Nipples
Axillae
(continues)
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Assessment
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Assess the following characteristics
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Color
Vascularity
Thickening/edema
Size and symmetry
Contour
Lesions/masses
Discharge
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Palpation
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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
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Location
Size
Shape
Number
Consistency
(continues)
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Evaluation of Breast
Mass Characteristics
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Definition
Mobility
Tenderness
Erythema
Dimpling or retraction
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Normal Findings
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Breast and axillae are flesh
colored
Areolar areas and nipples are
darker in pigmentation
Moles and nevi are normal
variants
No thickening or edema
(continues)
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Normal Findings
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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
(continues)
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Normal Findings
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Breasts, areolar areas, nipples
should be symmetrical
Breasts are convex, without
flattening, retractions, or dimpling
Free from masses, tumors, primary
or secondary lesions
(continues)
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Normal Findings
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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
(continues)
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Normal Findings
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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
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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
(continues)
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Risk Factors for Breast
Cancer
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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
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Mammography
X ray
Ultrasonography
Magnetic resonance imaging
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Gerontological
Variations
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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)
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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
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Bed (B): supine position
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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
(continues)
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BSE
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Standing (S)
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Repeat previous process in standing
position
Examination (E)
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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
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