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

2. Copyright 2002, Delmar, A division of Thomson Learning 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. (continues)

3. Copyright 2002, Delmar, A division of Thomson Learning 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.

4. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology— Breast Function: milk production and sexual pleasure Tail of Spence Cooper’s ligaments Nipple Lactiferous ducts (continues)

5. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology— Breast Areola Montgomery’s tubercles Lobes Lobules Alveoli or acini Lymphatic drainage  Axillary nodes: central, pectoral, subscapular, lateral  Internal mammary chain

6. Copyright 2002, Delmar, A division of Thomson Learning Breast Development Usually begins at 10 to 11 years of age Stimulated by estrogen release during puberty

7. Copyright 2002, Delmar, A division of Thomson Learning Health History Patient profile  Age  Gender  Race (continues)

8. Copyright 2002, Delmar, A division of Thomson Learning Health History Common chief complaints  Breast mass, tenderness, discharge  Assess the following characteristics  Location  Quality  Quantity  Associated manifestations  Aggravating factors  Alleviating factors (continues)

9. Copyright 2002, Delmar, A division of Thomson Learning Health History Past health history  Breast specific vs. Systemic  Medical  Surgical  Medications  Allergies (continues)

10. Copyright 2002, Delmar, A division of Thomson Learning Health History Family history  Breast cancer  Benign breast disease (continues)

11. Copyright 2002, Delmar, A division of Thomson Learning Health History Social history  Alcohol use  Tobacco use  Work environment  Home environment  Economic status  Ethnic background (continues)

12. Copyright 2002, Delmar, A division of Thomson Learning Health History Health maintenance activities  Diet  Exercise  Breast self-exam  Mammogram (continues)

13. Copyright 2002, Delmar, A division of Thomson Learning Assessment Equipment  Towel, drape, centimeter ruler, teaching aid for breast self-exam General approach Inspection Patient positions (continues)

14. Copyright 2002, Delmar, A division of Thomson Learning Assessment Assess the following areas  Breasts  Areolar areas  Nipples  Axillae (continues)

15. Copyright 2002, Delmar, A division of Thomson Learning Assessment Assess the following characteristics  Color  Vascularity  Thickening/edema  Size and symmetry  Contour  Lesions/masses  Discharge

16. Copyright 2002, Delmar, A division of Thomson Learning Palpation Sequential manner Supraclavicular and infraclavicular nodes Breasts, arms at side, arms raised Axillary nodes Breasts, supine position

17. Copyright 2002, Delmar, A division of Thomson Learning Evaluation of Breast Mass Characteristics Location Size Shape Number Consistency (continues)

18. Copyright 2002, Delmar, A division of Thomson Learning Evaluation of Breast Mass Characteristics Definition Mobility Tenderness Erythema Dimpling or retraction

19. Copyright 2002, Delmar, A division of Thomson Learning 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 (continues)

20. Copyright 2002, Delmar, A division of Thomson Learning 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 (continues)

21. Copyright 2002, Delmar, A division of Thomson Learning 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 (continues)

22. Copyright 2002, Delmar, A division of Thomson Learning 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 (continues)

23. Copyright 2002, Delmar, A division of Thomson Learning 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

24. Copyright 2002, Delmar, A division of Thomson Learning 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 (continues)

25. Copyright 2002, Delmar, A division of Thomson Learning 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

26. Copyright 2002, Delmar, A division of Thomson Learning Diagnostic Techniques Mammography X ray Ultrasonography Magnetic resonance imaging

27. Copyright 2002, Delmar, A division of Thomson Learning 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

28. Copyright 2002, Delmar, A division of Thomson Learning 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)

29. Copyright 2002, Delmar, A division of Thomson Learning 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 (continues)

30. Copyright 2002, Delmar, A division of Thomson Learning 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