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    Breast: Anatomy & Physiology

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    iron
    The breast is located in the anterior thoracic cavity and consists of glandular, fibrous, and adipose tissues. Estrogen stimulates breast growth while progesterone and prolactin promote milk production. During breast exams, clinicians systematically inspect for abnormalities and thoroughly palpate using varying pressures to check for lumps or tenderness. Regular breast self-exams and clinical exams are important for early cancer detection.

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    Breast: Anatomy & Physiology

    Uploaded by

    iron
    33 views6 pages
    The breast is located in the anterior thoracic cavity and consists of glandular, fibrous, and adipose tissues. Estrogen stimulates breast growth while progesterone and prolactin promote milk production. During breast exams, clinicians systematically inspect for abnormalities and thoroughly palpate using varying pressures to check for lumps or tenderness. Regular breast self-exams and clinical exams are important for early cancer detection.

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    The breast is located in the anterior thoracic cavity and consists of glandular, fibrous, and adipose tissues. Estrogen stimulates breast growth while progesterone and prolactin promote milk production. During breast exams, clinicians systematically inspect for abnormalities and thoroughly palpate using varying pressures to check for lumps or tenderness. Regular breast self-exams and clinical exams are important for early cancer detection.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    33 views6 pages

    Breast: Anatomy & Physiology

    Uploaded by

    iron
    The breast is located in the anterior thoracic cavity and consists of glandular, fibrous, and adipose tissues. Estrogen stimulates breast growth while progesterone and prolactin promote milk production. During breast exams, clinicians systematically inspect for abnormalities and thoroughly palpate using varying pressures to check for lumps or tenderness. Regular breast self-exams and clinical exams are important for early cancer detection.

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    of 6

    BREAST

    HISTORY & PE

    ANATOMY & PHYSIOLOGY

    Against the anterior thoracic cavity


    Between the:
    Clavicle and 2nd rib superiorly
    6th rib inferiorly
    Sternum medially
    Mid-axillary laterally
    Overlies 2 muscle:
    Pectoralis major, superiorly
    Serratus anterior, inferiorly
    In describing clinical findings:
    Divide the breast by quadrant
    Explaining the location using time on the face of the clock
    Distance by centimeters from nipple
    Hormonally sensitive tissue
    Consisting tissue:
    Glandular tissue: secretory tubuloalveolar gland and ducts
    Divided into 15-20 septated lobes
    Drains into the milk-producing ducts (lactiferous gland) and
    sinuses (lactiferous sinus/ampulla)
    Opens up in the areola or nipple
    Fibrous connective tissue: provides structural support
    Fibrous bands and suspensory ligaments
    Adipose tissue: predominant in the superficial and periphery area
    Estrogen stimulate the growth of the mammary gland and the
    deposition of fat to give mass to the breast
    High estrogen state of pregnancy also completed the
    development of glandular tissue production of milk
    Final development into milk secreting organ also requires progesterone
    Prolactin: enzyme promoting the milk secretion
    Secretes by the anterior pituitary gland
    Colostrums: fluid secreted during the last few days and 1st day after
    parturition (birth of the baby)
    Normal protein; no fat
    Hypothalamic control: mainly inhibit prolactin
    Prolactin inhibitory hormone (ex. Dopamine): secreted to
    decrease the production of prolactin
    Ejection process of milk production:
    Oxytocin involves: posterior pituitary gland
    Mechanism:
    Suckling somatic impulses hypothalamus secretion of oxytocin &
    prolactin
    To the blood

    Expressing milk to the alveoli Contraction of


    myoepithelial cells
    With +10-20 mmHg pressure

    Flow of the milk

    Tactile stimulation may cause:


    Nipple smaller, firmer and more erect
    Areola pucker and wrinkles
    Physiologic condition
    Areolar surface has small, rounded elevations:
    Sebaceous gland
    Sweat gland
    Accessory areolar gland

    CHANGES WITH AGING

    Adolescence
    Breast bud stage: elevation as a small mound, enlargement of
    areolar diameter
    Further enlargement of elevation with no separation of contours
    Projection to form 2nd mound
    Mature stage: projection of nipple only
    Adult
    Normal: soft, granular, nodular or lumpy
    Uneven texture: physiologic nodularity bilateral
    Nodularity may increase during premenstrual period may cause
    tenderness
    Aging
    May atrophy and being replaced by fats
    More flaccid & pendulous

    LYMPHATICS
    Central nodes: most frequently palpable
    Lie along the chest wall
    Inside the axilla apex
    Midway between anterior and posterior axillary folds
    Pectoral nodes
    Anterior
    Lower border of pectoralis major muscle
    Inside the anterior axillary fold
    Drains most of the breast and anterior chest wall
    Subscapular nodes:
    Posterior
    Lateral border of scapula
    Deep within the posterior axillary fold
    Drains the posterior chest wall and a portion of the arm
    Lateral nodes:
    Along the upper humerus
    Drains most of the arm
    Supraclavicular & Infraclavicular
    All 3 will drain to the central nodes and central nodes will drain to
    these 2
    Pectoral nodes may drain directly to these nodes

    HEALTH HISTORY
    Common questions:
    Do you examine your breast?
    How often?
    When during your monthly cycle?
    3 Common Concern:
    Are there any lumps?
    Are there any pain or discomfort?
    Are there any discharge?
    If yes, ask when it occurs? Spontaneous or after squeezing?
    What color, consistency and quantity? Unilateral or
    bilateral?

    HEALTH PROMOTION & MAINTENANCE


    PALPABLE MASSES OF THE BREAST Masses of the Breast
    Age Common Lesion Characteristics
    1525 Fibroadenoma Usually fine, round,
    mobile, nontender
    2550 1. Cysts Usually soft firm,
    round, mobile, often
    2. Fibrocystic tender
    changes Nodular, ropelike

    3. Cancer Delineated from


    surrounding tissue
    Over 50 Cancer -do-
    Pregnancy/Lactation Lactating adenomas, cysts, mastitis, and cancer

    Risk factor:
    Age: are 50 y/o
    Family history:
    1st degree family (mother or sister) establish positive
    family history
    Highest risk: 1st degree family who premenopausal
    with bilateral disease
    25% probability
    Mutation of BRCA1 & BRCA2 confer 50% risk for <50 y/o;
    80% by 65 y/o
    Highest risk: multiple relatives with breast cancer,
    combined breast & ovarian cancer, bilateral cancer of
    early onset of cancer
    Menstrual & Pregnancy
    Early menarche
    Late menopause increase risk by
    1st live birth after 35 2 3 fold
    No pregnancy at all
    Breast condition & diseases
    Atypical hyperplasia 4.4% risk
    Carcinoma in situ 6.9-12% risk
    Screening:
    Breast Self Examination (BSE): monthly after age of 20
    Clinical Breast Examination (CBE):
    Every 3 years 20-39 y/o
    40 annually
    Mammography: 40 annually

    TECHNIQUE OF EXAMINATION
    FEMALE BREAST
    Enhance detection of mass that may be overlooked at the
    mammograph
    Demonstration of proper breast examination to the patient
    Clinicians should:
    Adopt systematic & thorough pattern
    Varying palpitation pressure
    Circular motion using finger pads
    Standardized approach
    Best time: 5-7 days after the onset of menstruation
    Inspection:
    Arms at Sides:
    Appearance of the skin
    Size and symmetry of the breast
    Contour of the breast
    Characteristics of nipples: size, shape, direction, rashes,
    ulceration or discharge
    Arms over head
    Brings out dimpling and retraction otherwise invincible
    Contour of the breast
    Press hand against the hips
    Contract the pectoral muscle
    Brings out dimpling and retraction also
    Contour of the breast
    Leaning forward
    For large and pendulous breast
    Brings out dimpling and retraction also
    Contour of the breast
    Dimpling and retraction suggest underlying cancer
    Palpation
    Use the finger pads (usually 2nd, 3rd, and 4th digits)
    Be systematic
    Vertical strip pattern
    Palpate in small, concentric circle
    Lateral portion:
    Roll unto opposite hip
    Hand on forehead while keeping the shoulder pressing the
    bed or examining table
    Palpate from posterior axillary fold down to the bra-line
    (infra-mammary fold), and medially until reaching the
    nipple
    Medial portion:
    Hand at neck, lifting elbow until even with the shoulder,
    shoulder pressing the bed or examining table
    Palpate from nipple medially to the mid-sternal line, with
    vertical strip pattern
    Carefully examine:
    Consistency
    Tenderness
    Nodules
    Location
    Size
    Shape
    Consistency
    Tenderness
    Mobility
    Delimitation
    Nipple: palpate elasticity
    MALE BREAST
    Inspect the nipple and areola: nodules, swelling or ulceration
    Palpate for nodules
    Gynecomastia: imbalance of estrogen and androgen production drugs
    AXILLA
    Inspection of the skin
    Rash
    Infection: sweat gland inflammation hydradenitis suppurativa
    Unusual pigmentation: deeply pigmented(velvety) acanthosis
    nigricans
    Palpation: palpate the nodes
    Center nodes: reach as high into the apex of the axilla, directly
    behind pectoral muscle, pointing toward mid-clavicle. Press
    toward chest wall and slide downward.
    Pectoral nodes: grasp anterior axillary fold and feel inside the
    border of pectoral muscle
    Subscapular nodes: inside the muscle of posterior axillary fold
    Lateral nodes: high in the axilla, along the upper humerus
    SPECIAL TECHNIQUE
    Spontaneous nipple discharge:
    Compressing the areola with index finger in radial position to the
    nipple.
    Watch for discharge
    Note: color, consistency, quantity, and exact location
    Examination of mastectomy patient:
    Inspect and palpate for any mass along the scar
    Palpate for lymph nodes enlargement
    Instruction for BSE

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