Copyright 2002, Delmar, A division of Thomson Learning Chapter 14 Breasts and Regional Nodes.

Copyright 2002, Delmar, A division of Thomson Learning

Chapter 14

Breasts and Regional Nodes


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.


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


Breast Development Usually begins at 10 to 11

years of age Stimulated by estrogen release

during puberty


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


Palpation Sequential manner Supraclavicular and infraclavicular

nodes Breasts, arms at side, arms raised Axillary nodes Breasts, supine position


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


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


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


Diagnostic Techniques Mammography X ray Ultrasonography Magnetic resonance imaging


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


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)


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

Copyright 2002, Delmar, A division of Thomson Learning Chapter 14 Breasts and Regional Nodes.

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