1. Lecturer/ Hanaa Eisa

4. o Function: o Milk production.

5. o Tail of Spence o Cooper’s ligaments o Nipple o Lactiferous ducts o Areola o Montgomery’s tubercles o Lobes o Lobules

6. o Alveoli or acini o Lymphatic drainage o Axillary nodes: central, pectoral, subscapular, lateral o Internal mammary chain

7. o Usually begins at 10 to 11 years of age o Stimulated by estrogen release during puberty

8. Patient profile o Age o Gender o Race

9. Common chief complaints o Breast mass, tenderness, discharge o Assess the following characteristics Location Quality Quantity Associated manifestations Aggravating factors Alleviating factors

10. Past health history o Breast specific vs. Systemic o Medical o Surgical o Medications o Allergies

11. Family history o Breast cancer o Benign breast disease

12. Social history o Alcohol use o Tobacco use o Work environment o Home environment o Economic status o Ethnic background

13. Health maintenance activities o Diet o Exercise o Breast self-exam o Mammogram

14.  Equipment o Towel o drape o centimeter ruler o teaching aid for breast self-exam  General approach  Inspection  Patient positions

15. Assess the following areas o Breasts o Areolar areas o Nipples o Axillae

16. Assess the following characteristics 1. Color 2. Vascularity 3. Thickening/edema 4. Size and symmetry 5. Contour 6. Lesions/masses 7. Discharge

17. 1. Sequential manner 2. Supraclavicular and Infraclavicular nodes 3. Breasts, arms at side, arms raised 4. Axillary nodes 5. Breasts, supine position

18. 1. Location 2. Size 3. Shape 4. Number 5. Consistency

19. 1. Definition 2. Mobility 3. Tenderness 4. Erythema 5. Dimpling or retraction

20. 1. Breast and axillae are flesh colored 2. Areolar areas and nipples are darker in pigmentation 3. Moles and nevi are normal variants 4. No thickening or edema

21. 1. Minor size variation in the breasts and areolar areas 2. Usually breast on dominant side is larger 3. Nipples should point upward and outward, may point outward and downward

22. 1. Breasts, areolar areas, nipples should be symmetrical 2. Breasts are convex, without flattening, retractions, or dimpling 3. Free from masses, tumors, primary or secondary lesions

23. 1. No discharge from nipples in nonpregnant, nonlactating female 2. Usually, palpable lymph nodes less than 1 cm in diameter are clinically insignificant 3. Palpation should not elicit pain

24. 1. Consistency of breast tissue is highly variable depending upon age, time in menstrual cycle, and proportion of adipose tissue 2. Breasts are usually nodular or granular prior to menses 3. Variation with breast augmentation— breasts feel fluid filled or firm throughout

25. 1. Age > 50 2. Personal history of breast CA 3. Mother, grandmother, or sister with breast CA 4. Menarche at an early age 5. Menopause at advanced age 6. Obesity 7. Alcohol intake > 3 servings per day

26. 1. American or European descent 2. Urban dweller 3. Estrogen therapy 4. Nulliparous 5. First birth after age 30 6. Higher education and socioeconomic status 7. Atypical hyperplasia

27. 1. Mammography 2. X- ray 3. Ultrasonography 4. Magnetic resonance imaging

28. 1. Breast tissue atrophy 2. Decreased glandular tissue, resulting in granular feeling 3. Breasts become smaller, pendulous, and flatter 4. Ductal tissue becomes more palpable. Stringy feeling

29. 1. Performed once a month 2. Performed on a fixed date each month, or eight days after menses 3. Avoid completing during menstruation or ovulation 4. Use calendar for monthly reminder 5. Include significant other in examination process

30. Bed (B): supine position 1. Use palmar surface of fingers 2. Place right arm over head and palpate right breast 3. Move in concentric circles from the periphery inward 4. Squeeze the nipple to examine for discharge 5. Use same procedure to check left breast

31. Standing (S) o Repeat previous process in standing position Examination (E) o Stand before mirror, arms at side o Assess for symmetry, retractions, dimpling, inverted nipples, or nipple deviation o Repeat with arms above head, and hands pressed into hips