Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Breasts and Regional Lymphatics Chapter.

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Breasts  The breasts, or mammary glands, are present in both females and males, although in men they are rudimentary throughout life  Female breasts are accessory reproductive organs whose function is to produce milk for nourishing newborn  Breast have extensive lymphatic drainage  Most of lymph, more than 75%, drains into ipsilateral (same side) axillary nodes Slide 17-2

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function  Surface anatomy  Breasts lie anterior to pectoralis major and serratus anterior muscles Located between second and sixth ribs, extending from side of sternum to midaxillary line Located between second and sixth ribs, extending from side of sternum to midaxillary line Superior lateral corner of breast tissue, called axillary tail of Spence, projects up and laterally into axilla Superior lateral corner of breast tissue, called axillary tail of Spence, projects up and laterally into axilla Nipple is just below the center of the breast Nipple is just below the center of the breast  It is rough, round, and usually protuberant; its surface looks wrinkled and indented with tiny milk duct openings Slide 17-3

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function(cont.) Structure and Function (cont.)  Surface anatomy (cont.)  Areola surrounds nipples; contain small elevated sebaceous glands called Montgomery’s glands Montgomery’s glands secrete protective lipid material during lactation Montgomery’s glands secrete protective lipid material during lactation Areola has smooth muscle fibers that cause nipple erection when stimulated Areola has smooth muscle fibers that cause nipple erection when stimulated Both nipple and areola are more darkly pigmented than rest of breast surface; color varies from pink to brown depending on person’s skin color and parity Both nipple and areola are more darkly pigmented than rest of breast surface; color varies from pink to brown depending on person’s skin color and parity Slide 17-4

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function(cont.) Structure and Function (cont.)  Internal anatomy  Breast is composed of: Glandular tissue Glandular tissue Fibrous tissue including suspensory ligaments Fibrous tissue including suspensory ligaments Adipose tissue Adipose tissue  Glandular tissue contains 15 to 20 lobes radiating from nipple, and these are composed of lobules Within lobules are clusters of alveoli that produce milk Within lobules are clusters of alveoli that produce milk Each lobe empties into lactiferous duct; lactiferous ducts form collecting duct system converging toward nipple Each lobe empties into lactiferous duct; lactiferous ducts form collecting duct system converging toward nipple There, ducts form ampullae, or lactiferous sinuses, behind nipple, which are reservoirs for storing milk There, ducts form ampullae, or lactiferous sinuses, behind nipple, which are reservoirs for storing milk Slide 17-6

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function(cont.) Structure and Function (cont.)  Internal anatomy (cont.)  Suspensory ligaments, or Cooper’s ligaments, are fibrous bands extending vertically from surface to attach on chest wall muscles These support breast tissue; they become contracted in cancer of breast, producing dimples in overlying skin These support breast tissue; they become contracted in cancer of breast, producing dimples in overlying skin  Lobes are embedded in adipose tissue These layers of subcutaneous and retromammary fat actually provide most of bulk of breast These layers of subcutaneous and retromammary fat actually provide most of bulk of breast The relative proportion of glandular, fibrous, and fatty tissue varies depending on age, cycle, pregnancy, lactation, and general nutritional state The relative proportion of glandular, fibrous, and fatty tissue varies depending on age, cycle, pregnancy, lactation, and general nutritional state Slide 17-7

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function(cont.) Structure and Function (cont.)  Internal anatomy (cont.)  Breast may be divided into four quadrants by imaginary horizontal and vertical lines intersecting at nipple This makes a convenient map to describe clinical findings This makes a convenient map to describe clinical findings Upper outer quadrant, is axillary tail of Spence, cone- shaped breast tissue that projects up into axilla, close to pectoral group of axillary lymph nodes Upper outer quadrant, is axillary tail of Spence, cone- shaped breast tissue that projects up into axilla, close to pectoral group of axillary lymph nodes Upper outer quadrant is site of most breast tumors Upper outer quadrant is site of most breast tumors Slide 17-8

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function(cont.) Structure and Function (cont.)  Lymphatics  Breast has extensive lymphatic drainage More than 75%, drains into ipsilateral axillary nodes More than 75%, drains into ipsilateral axillary nodes  Four groups of axillary nodes are present Central axillary nodes: high up in middle of axilla, over ribs and serratus anterior muscle; receive lymph from other three groups of nodes Central axillary nodes: high up in middle of axilla, over ribs and serratus anterior muscle; receive lymph from other three groups of nodes Pectoral (anterior): along lateral edge of pectoralis major muscle, just inside anterior axillary fold Pectoral (anterior): along lateral edge of pectoralis major muscle, just inside anterior axillary fold Subscapular (posterior): along lateral edge of scapula, deep in posterior axillary fold Subscapular (posterior): along lateral edge of scapula, deep in posterior axillary fold Lateral: along the humerus, inside upper arm Lateral: along the humerus, inside upper arm Slide 17-10

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function(cont.) Structure and Function (cont.)  Lymphatics (cont.)  From the central axillary nodes, drainage flows up to infraclavicular and supraclavicular nodes Smaller amount of lymphatic drainage does not take these channels but flows directly up to infraclavicular group, deep into chest, or into abdomen, or directly across to opposite breast Smaller amount of lymphatic drainage does not take these channels but flows directly up to infraclavicular group, deep into chest, or into abdomen, or directly across to opposite breast Slide 17-11

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function(cont.) Structure and Function (cont.)  Male breast  Rudimentary structure consisting of a thin disk of undeveloped tissue underlying nipple  Areola well developed, although nipple is small  Gynecomastia: during adolescence, it is common for breast tissue to temporarily enlarge Condition is usually unilateral and temporary Condition is usually unilateral and temporary Reassurance is necessary for adolescent male, whose attention is riveted on his body image Reassurance is necessary for adolescent male, whose attention is riveted on his body image Gynecomastia may reappear in aging male and may be due to testosterone deficiency Gynecomastia may reappear in aging male and may be due to testosterone deficiency Slide 17-13

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Developmental Competence  During embryonic life, ventral epidermal ridges, or “milk lines,” are present and curve down from axilla to groin bilaterally  Breast develops along ridge over thorax, and rest of the ridge usually atrophies  Occasionally a supernumerary nipple (i.e., an extra nipple) persists and is visible along track of mammary ridge  At birth, the only breast structures present are lactiferous ducts within nipple; no alveoli have developed; little change occurs until puberty Slide 17-14

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Developmental Competence (cont.)  Adolescent  At puberty estrogen stimulates breast changes Breasts enlarge, mostly as a result of extensive fat de- position; duct system also grows and branches, and masses of small, solid cells develop at duct endings; these are potential alveoli Breasts enlarge, mostly as a result of extensive fat de- position; duct system also grows and branches, and masses of small, solid cells develop at duct endings; these are potential alveoli A 1997 study of 17,077 girls in the United States aged 3 through 12 years indicates puberty is occurring earlier A 1997 study of 17,077 girls in the United States aged 3 through 12 years indicates puberty is occurring earlier Onset of breast development occurred at an average (mean) age between 8 and 9 years for black girls and by 10 years for white girls; earlier studies cited breast development beginning at an average age of 10 to 11 Onset of breast development occurred at an average (mean) age between 8 and 9 years for black girls and by 10 years for white girls; earlier studies cited breast development beginning at an average age of 10 to 11 Slide 17-15

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Developmental Competence (cont.)  Adolescent (cont.)  Occasionally, one breast may grow faster than other, producing a temporary asymmetry May cause some distress; reassurance is necessary May cause some distress; reassurance is necessary Tenderness common also; age of onset varies widely, the five stages of breast development follow this classic description of sexual maturity rating, or Tanner staging Tenderness common also; age of onset varies widely, the five stages of breast development follow this classic description of sexual maturity rating, or Tanner staging Full development from stage 2 to stage 5 takes an average of 3 years Full development from stage 2 to stage 5 takes an average of 3 years During this time, pubic hair develops, and axillary hair appears 2 years after onset of pubic hair During this time, pubic hair develops, and axillary hair appears 2 years after onset of pubic hair Slide 17-16

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Developmental Competence (cont.)  Adolescent (cont.)  Beginning of breast development precedes menarche by about 2 years Menarche occurs in breast development stage 3 or 4, usually just after peak of adolescent growth spurt around age 12 Menarche occurs in breast development stage 3 or 4, usually just after peak of adolescent growth spurt around age 12 Breasts of nonpregnant woman change with ebb and flow of hormones during monthly menstrual cycle Breasts of nonpregnant woman change with ebb and flow of hormones during monthly menstrual cycle Nodularity increases from midcycle up to menstruation Nodularity increases from midcycle up to menstruation During the 3 to 4 days before menstruation, breasts feel full, tight, heavy, and occasionally sore; breast volume is smallest on days 4 to 7 of menstrual cycle During the 3 to 4 days before menstruation, breasts feel full, tight, heavy, and occasionally sore; breast volume is smallest on days 4 to 7 of menstrual cycle Slide 17-17

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Developmental Competence (cont.)  Pregnant woman  Breast changes start during the second month of pregnancy and are an early sign for most women Pregnancy stimulates expansion of ductal system and supporting fatty tissue as well as development of true secretory alveoli Pregnancy stimulates expansion of ductal system and supporting fatty tissue as well as development of true secretory alveoli Thus breasts enlarge and feel more nodular; nipples are larger, darker, and more erectile Thus breasts enlarge and feel more nodular; nipples are larger, darker, and more erectile Areolae become larger and grow darker brown as pregnancy progresses, and tubercles become more prominent Areolae become larger and grow darker brown as pregnancy progresses, and tubercles become more prominent Venous pattern prominent over skin surface Venous pattern prominent over skin surface Slide 17-18

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Developmental Competence (cont.)  Pregnant woman (cont.)  Colostrum may be expressed after fourth month This thick yellow fluid is precursor for milk, containing same amount of protein and lactose, but practically no fat This thick yellow fluid is precursor for milk, containing same amount of protein and lactose, but practically no fat Breasts produce colostrum for first few days after delivery Breasts produce colostrum for first few days after delivery It is rich with antibodies that protect newborn against infection, so breastfeeding is important It is rich with antibodies that protect newborn against infection, so breastfeeding is important  Lactation, milk production, begins 1 to 3 days post partum; whitish color is from emulsified fat and calcium caseinate Slide 17-19

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Developmental Competence (cont.)  Aging woman  After menopause, ovarian secretion of estrogen and progesterone decreases, causing breast glandular tissue to atrophy This is replaced with fibrous connective tissue; fat envelope atrophies also, beginning in middle years and becoming marked in eighth and ninth decades This is replaced with fibrous connective tissue; fat envelope atrophies also, beginning in middle years and becoming marked in eighth and ninth decades These changes decrease breast size and elasticity so breasts droop and sag, looking flattened and flabby These changes decrease breast size and elasticity so breasts droop and sag, looking flattened and flabby Drooping accentuated by kyphosis in some older women Drooping accentuated by kyphosis in some older women Slide 17-20

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Developmental Competence (cont.)  Aging woman (cont.)  Decreased breast size makes inner structures more prominent  A breast lump may have been present for years but is suddenly palpable  Around nipple the lactiferous ducts are more palpable and feel firm and stringy because of fibrosis and calcification  Axillary hair decreases Slide 17-21

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Cultural Competence  In the 1997 study of 17,077 American girls African American girls begin puberty about 1 to 1.5 years earlier than white girls and start menstruating about 8.5 months earlier Onset of breast development occurred at an average (mean) age of 8.87 years for African American girls and 10 years for white girls Onset of breast development occurred at an average (mean) age of 8.87 years for African American girls and 10 years for white girls  At age 8, about half of African American girls and 14.7% of white girls began breast and pubic hair development  Menses began at an average age of 12.16 years for African American girls and 13 for white girls Slide 17-22

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Breast cancer  Incidence of breast cancer varies in cultural groups Although incidence of breast cancer is 12% lower in African American women than in white women, African American women had a 36% higher death rate that white women Although incidence of breast cancer is 12% lower in African American women than in white women, African American women had a 36% higher death rate that white women Asian, Hispanic, and American Indian women have a lower risk for development of breast cancer Asian, Hispanic, and American Indian women have a lower risk for development of breast cancer  This racial difference in mortality may relate to insufficient use of early detection procedures, including mammograms and breast self-examinations Slide 17-23

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Breast cancer (cont.)  Morbidity rate of breast cancer incidence (out of 100,000 in 1998 to 2002) was 141.1 for whites, 119.4 for African Americans, 96.6 for Asians, 89.9 for Hispanics, and 54.8 for American Indians  Mortality rate of breast cancer incidence (out of 100,000 in 1998 to 2002) was 25.9 for whites, 34.7 for African Americans, 12.7 for Asians, 16.7 for Hispanics, and 13.8 for American Indians Slide 17-24

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Breast cancer (cont.)  Use of mammograms in 2003 by women over 40 years old was 69.5% but 63.1% among African American women 63.1% among African American women 63.1% among Asians 63.1% among Asians 57.6% among American Indian and Alaska Natives 57.6% among American Indian and Alaska Natives 65% among Hispanic women 65% among Hispanic women  Factors contribute to breast health care access include low income, lack of health insurance, geographic, cultural, and language barriers, and racial bias Slide 17-25

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Breast cancer (cont.)  Some studies have found that diet rich in certain fats has strong promoting effect on breast cancer and that breast cancer is less common in countries where diet is low in total fat, low in polyunsaturated fat, and low in saturated fat  Although the relationship of breast cancer to dietary fat is unclear at this time, it is known that reducing intake of dietary fat in postmenopausal women has a subsequent reduced risk of invasive breast cancer Slide 17-26

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data  Breast  Pain  Lump  Discharge  Rash  Swelling  Trauma  History of breast disease  Surgery  Self-care behaviors  Perform breast self- examination  Last mammogram  Axilla  Tenderness, lump, or swelling  Rash Slide 17-27

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  In Western culture female breasts signify more than their primary purpose of lactation  Women are surrounded by messages that feminine norms of beauty and desirability are enhanced by and dependent on size of breasts and their appearance  More recently, women leaders have tried to refocus this attitude, stressing women’s self-worth as individual human beings, not as stereotyped sexual objects Slide 17-28

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  Intense cultural emphasis is slow to change  Matters pertaining to breasts affect woman’s body image and generate emotional responses This emotionality may take strong forms that you observe as you discuss woman’s history This emotionality may take strong forms that you observe as you discuss woman’s history One woman may be acutely embarrassed talking about her breasts, as evidenced by lack of eye contact, minimal response, nervous gestures, or inappropriate humor One woman may be acutely embarrassed talking about her breasts, as evidenced by lack of eye contact, minimal response, nervous gestures, or inappropriate humor Another woman may talk wryly and disparagingly about size or development of her breasts Another woman may talk wryly and disparagingly about size or development of her breasts A young adolescent is acutely aware of her own development in relation to her peers A young adolescent is acutely aware of her own development in relation to her peers Slide 17-29

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  A woman who has found a breast lump may come to you with fear, anxiety, and panic  Although many breast lumps are benign, women initially assume worst possible outcome, including cancer, disfigurement, and death  While you are collecting subjective data, tune in to cues for these behaviors that call for a reasoned and straightforward attitude Slide 17-30

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  Breast  Pain Any pain or tenderness in breasts? When did you first notice it? Any pain or tenderness in breasts? When did you first notice it? Where is pain? Localized or all over? Where is pain? Localized or all over? Is painful spot sore to touch? Do you feel a burning or pulling sensation? Is painful spot sore to touch? Do you feel a burning or pulling sensation? Is pain cyclic? Any relation to your menstrual period? Is pain cyclic? Any relation to your menstrual period? Is pain brought on by strenuous activity, especially involving one arm; a change in activity; manipulation during sex; part of underwire bra; exercise? Is pain brought on by strenuous activity, especially involving one arm; a change in activity; manipulation during sex; part of underwire bra; exercise? Slide 17-31

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  Breast (cont.)  Lump Ever noticed lump or thickening in breast? Where? Ever noticed lump or thickening in breast? Where? When did you first notice it? Changed at all since then? When did you first notice it? Changed at all since then? Does lump have any relation to your menstrual period? Does lump have any relation to your menstrual period? Noticed any change in overlying skin: redness, warmth, dimpling, swelling? Noticed any change in overlying skin: redness, warmth, dimpling, swelling?  Discharge Any discharge from nipple? When did you first notice this? Any discharge from nipple? When did you first notice this? What color is discharge? What color is discharge? Consistency; thick or runny? Odor? Consistency; thick or runny? Odor? Slide 17-32

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  Breast (cont.)  Rash Any rash on breast? Any rash on breast? When did you first notice this? When did you first notice this? Where did it start? On the nipple, areola, or surrounding skin? Where did it start? On the nipple, areola, or surrounding skin?  Swelling Any swelling in breasts? In one spot or all over? Any swelling in breasts? In one spot or all over? Related to your menstrual period, pregnancy, or breastfeeding? Related to your menstrual period, pregnancy, or breastfeeding? Any change in bra size? Any change in bra size? Slide 17-33

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  Breast (cont.)  Trauma Any trauma or injury to the breasts? Any trauma or injury to the breasts? Did it result in any swelling, lump, or break in skin? Did it result in any swelling, lump, or break in skin?  History of breast disease Any history of breast disease yourself? Any history of breast disease yourself? What type? How was this diagnosed? What type? How was this diagnosed? When did this occur? How is it being treated? When did this occur? How is it being treated? Any breast cancer in your family? Who? Sister, mother, maternal grandmother, maternal aunts, daughter? Any breast cancer in your family? Who? Sister, mother, maternal grandmother, maternal aunts, daughter? At what age did this relative have breast cancer? At what age did this relative have breast cancer? Slide 17-34

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  Breast (cont.)  Surgery Ever had surgery on the breasts? Was this a biopsy? What were the biopsy results? Ever had surgery on the breasts? Was this a biopsy? What were the biopsy results? Mastectomy? Mammoplasty, augmentation, or reduction? Mastectomy? Mammoplasty, augmentation, or reduction? Ever had mammography, a screening x-ray examination of breasts? When was last x-ray? Ever had mammography, a screening x-ray examination of breasts? When was last x-ray? Slide 17-35

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  Breast (cont.)  Self-care behaviors Have you ever been taught breast self-examination? Have you ever been taught breast self-examination?  (If yes) How often do you perform it? What helps you remember? It is an excellent way to be in charge of your own health; I would like you to show me your technique after we do your examination  (If not) This will be an excellent way that you can take charge of your own health; you can make breast self- examination a very routine health habit, just like brushing your teeth; I will teach you the technique after we do your examination Slide 17-36

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data(cont.) Subjective Data (cont.)  Axilla  Tenderness, lump, or swelling Any tenderness or lump in the underarm area? Any tenderness or lump in the underarm area? Where? When did you first notice this? Where? When did you first notice this?  Rash Any axillary rash? Please describe it. Any axillary rash? Please describe it. Seem to be a reaction to deodorant? Seem to be a reaction to deodorant? Slide 17-37

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data: Developmental Competence  Additional history for preadolescent girl  Have you noticed your breasts changing? How long has this been happening? How long has this been happening?  Many girls notice other changes in their bodies, too, that come with growing up What have you noticed? What have you noticed? What do you think about all this? What do you think about all this? Slide 17-38

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data: Developmental Competence (cont.)  Additional history for pregnant woman  Have you noticed any enlargement or fullness in the breasts? Is there any tenderness or tingling? Is there any tenderness or tingling? Do you have a history of inverted nipples? Do you have a history of inverted nipples?  Are you planning to breastfeed your baby? Slide 17-39

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data: Developmental Competence (cont.)  Additional history for menopausal woman  Have you noticed any change in breast contour, size, or firmness? Change may not be as apparent to obese woman or to woman whose earlier pregnancies already have produced breast changes Change may not be as apparent to obese woman or to woman whose earlier pregnancies already have produced breast changes Slide 17-40

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Subjective Data: Developmental Competence (cont.)  Risk profile for breast cancer  Breast cancer is second major cause of death from cancer in women  However, early detection and improved treatment have increased survival rates The 5-year survival rate for localized breast cancer has increased from 78% in 1940s to 98% today The 5-year survival rate for localized breast cancer has increased from 78% in 1940s to 98% today If cancer has spread regionally, survival rate is 88% If cancer has spread regionally, survival rate is 88% Slide 17-41

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data  Preparation  Woman sitting up facing examiner An alternative draping method is to use a short gown, open at back, and lift it up to woman’s shoulders during inspection An alternative draping method is to use a short gown, open at back, and lift it up to woman’s shoulders during inspection  During palpation when woman is supine, cover one breast with gown while examining other Be aware that many women are embarrassed to have their breasts examined; use a sensitive but matter-of-fact approach Be aware that many women are embarrassed to have their breasts examined; use a sensitive but matter-of-fact approach  After examination, be prepared to teach woman breast self-examination Slide 17-42

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Equipment needed  Small pillow  Ruler marked in centimeters  Pamphlet or teaching aid for breast self- examination (BSE) Slide 17-43

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Inspect the breast  General appearance Note symmetry of size and shape; common to have a slight asymmetry in size; often left breast is slightly larger than right Note symmetry of size and shape; common to have a slight asymmetry in size; often left breast is slightly larger than right  Skin Normally is smooth and of even color Normally is smooth and of even color Note any localized areas of redness, bulging, or dimpling; also any skin lesions or focal vascular pattern Note any localized areas of redness, bulging, or dimpling; also any skin lesions or focal vascular pattern Fine blue vascular network visible during pregnancy; pale linear striae, or stretch marks, follow pregnancy Fine blue vascular network visible during pregnancy; pale linear striae, or stretch marks, follow pregnancy Normally no edema is present Normally no edema is present Slide 17-44

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Inspect the breast (cont.)  Lymphatic drainage areas Observe axillary and supraclavicular regions; note any bulging, discoloration, or edema Observe axillary and supraclavicular regions; note any bulging, discoloration, or edema  Nipple Should be symmetrical on same plane on both breasts Should be symmetrical on same plane on both breasts Nipples usually protrude, although some are flat and some are inverted Nipples usually protrude, although some are flat and some are inverted Normal nipple inversion may be unilateral or bilateral and usually can be pulled out Normal nipple inversion may be unilateral or bilateral and usually can be pulled out Note any dry scaling, any fissure or ulceration, and bleeding or other discharge Note any dry scaling, any fissure or ulceration, and bleeding or other discharge Slide 17-46

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Inspect the breast (cont.)  Supernumerary nipple is normal variation An extra nipple along embryonic “milk line” on thorax or abdomen is congenital finding An extra nipple along embryonic “milk line” on thorax or abdomen is congenital finding Usually, below breast near midline and has no associated glandular tissue; looks like a mole, although a close look reveals a tiny nipple and areola Usually, below breast near midline and has no associated glandular tissue; looks like a mole, although a close look reveals a tiny nipple and areola Slide 17-47

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Inspect the breast (cont.)  Maneuvers to screen for retraction Direct woman to change position to check breasts for skin retraction signs; first ask her to lift arms slowly over head; both breasts should move up symmetrically Direct woman to change position to check breasts for skin retraction signs; first ask her to lift arms slowly over head; both breasts should move up symmetrically Next ask her to push her hands onto her hips and then to push her two palms together; these maneuvers contract pectoralis major muscle; slight lifting of both breasts will occur Next ask her to push her hands onto her hips and then to push her two palms together; these maneuvers contract pectoralis major muscle; slight lifting of both breasts will occur Ask woman with large pendulous breasts to lean forward while you support her forearms; note symmetric free- forward movement of both breasts Ask woman with large pendulous breasts to lean forward while you support her forearms; note symmetric free- forward movement of both breasts Slide 17-48

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Inspect and palpate the axillae  Examine axillae while woman is sitting Inspect skin, noting any rash or infection; lift woman’s arm and support it, so that her muscles are loose and relaxed; use right hand to palpate left axilla Inspect skin, noting any rash or infection; lift woman’s arm and support it, so that her muscles are loose and relaxed; use right hand to palpate left axilla Reach fingers high into axilla; move them firmly down in four directions Reach fingers high into axilla; move them firmly down in four directions Move woman’s arm through range-of-motion to increase surface area you can reach Move woman’s arm through range-of-motion to increase surface area you can reach Usually nodes are not palpable, although you may feel a small, soft, nontender node in central group Usually nodes are not palpable, although you may feel a small, soft, nontender node in central group Note any enlarged and tender lymph nodes Note any enlarged and tender lymph nodes Slide 17-49

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Palpate the breasts  Help woman to a supine position Tuck a small pad under side to be palpated and raise her arm over her head to flatten breast tissue and displace it medially; any significant lumps will then feel more distinct Tuck a small pad under side to be palpated and raise her arm over her head to flatten breast tissue and displace it medially; any significant lumps will then feel more distinct Use pads of your first three fingers and make a gentle rotary motion on breast; vary pressure palpating light, medium, and deep tissue in each location Use pads of your first three fingers and make a gentle rotary motion on breast; vary pressure palpating light, medium, and deep tissue in each location Vertical strip pattern currently recommended to detect a breast mass, but two other patterns are in common use: Vertical strip pattern currently recommended to detect a breast mass, but two other patterns are in common use:  From the nipple palpating out to periphery as if following spokes on a wheel  Palpating in concentric circles out to periphery Slide 17-50

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Palpate the breasts (cont.)  In nulliparous women, normal breast tissue feels firm, smooth, and elastic  After pregnancy, tissue feels softer and looser  Premenstrual engorgement is normal from increasing progesterone Consists of slight enlargement, tenderness to palpation, and generalized nodularity; lobes feel prominent and their margins more distinct Consists of slight enlargement, tenderness to palpation, and generalized nodularity; lobes feel prominent and their margins more distinct Slide 17-51

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Palpate the breasts (cont.)  Normally you may feel a firm transverse ridge of compressed tissue in lower quadrants Inframammary ridge, and it is especially noticeable in large breasts; do not confuse it with an abnormal lump Inframammary ridge, and it is especially noticeable in large breasts; do not confuse it with an abnormal lump  After palpating over four breast quadrants, palpate nipple; note any induration or subareolar mass  With your thumb and forefinger, gently depress nipple tissue into well behind areola; tissue should move inward easily Slide 17-52

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Palpate the breasts (cont.)  If woman reports spontaneous nipple discharge, press areola inward with your index finger; repeat from a few different directions; note color and consistency of any discharge  If woman mentions a breast lump that she has discovered herself, examine unaffected breast first to learn a baseline of normal consistency for this woman Slide 17-53

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Palpate the breasts (cont.)  If you feel a lump or mass, note characteristics Location: as with clock face, describe distance in centimeters from nipple; or diagram breast in woman’s record and mark in location of lump Location: as with clock face, describe distance in centimeters from nipple; or diagram breast in woman’s record and mark in location of lump Size: judge in centimeters in three dimensions: width, length, and thickness Size: judge in centimeters in three dimensions: width, length, and thickness Shape: state whether lump is oval, round, lobulated, or indistinct Shape: state whether lump is oval, round, lobulated, or indistinct Consistency: state whether lump is soft, firm, or hard Consistency: state whether lump is soft, firm, or hard Movable: is lump freely movable or fixed when you try to slide it over chest wall? Movable: is lump freely movable or fixed when you try to slide it over chest wall? Slide 17-54

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Palpate the breasts  If you feel a lump or mass, note characteristics (cont.) Distinctness: is lump solitary or multiple? Distinctness: is lump solitary or multiple? Nipple: is it displaced or retracted? Nipple: is it displaced or retracted? Note skin over lump: is it erythematous, dimpled, or retracted? Note skin over lump: is it erythematous, dimpled, or retracted? Tenderness: is lump tender to palpation? Tenderness: is lump tender to palpation? Lymphadenopathy: are any regional lymph nodes palpable? Lymphadenopathy: are any regional lymph nodes palpable? Slide 17-55

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Palpate the breasts (cont.)  Premenopausal women midcycle have tissue edema and mastalgia (pain) that make it hard to detect lesions  If your findings are in question, consider asking woman to return for follow up examination first week after menses when hormone levels are lower and edema not present Slide 17-56

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Teach BSE  Help each woman establish regular schedule of self-care The best time to conduct BSE is right after menstrual period, when breasts are smallest and least congested The best time to conduct BSE is right after menstrual period, when breasts are smallest and least congested Advise pregnant or menopausal woman not having menstrual periods to select a familiar date to examine her breasts each month Advise pregnant or menopausal woman not having menstrual periods to select a familiar date to examine her breasts each month Stress that self-examination will familiarize woman with her own breasts and their normal variation; emphasize absence of lumps (not the presence of them) Stress that self-examination will familiarize woman with her own breasts and their normal variation; emphasize absence of lumps (not the presence of them) Encourage her to report any unusual finding promptly Encourage her to report any unusual finding promptly Slide 17-57

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Teach BSE (cont.)  Focus on positive aspects of BSE Avoid citing frightening mortality statistics about breast cancer and generating excessive fear and denial that actually obstructs a woman’s self-care action Avoid citing frightening mortality statistics about breast cancer and generating excessive fear and denial that actually obstructs a woman’s self-care action  Majority of women will never get breast cancer  Great majority of breast lumps are benign  Early detection of breast cancer is important; if cancer is not invasive, survival rate close to 98% Slide 17-58

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Teach BSE (cont.)  Keep teaching simple The simpler the plan, the more likely person is to comply The simpler the plan, the more likely person is to comply Describe correct technique and rationale and expected findings to note as woman inspects her own breasts Describe correct technique and rationale and expected findings to note as woman inspects her own breasts Teach woman to do this in front of a mirror while she is disrobed to waist Teach woman to do this in front of a mirror while she is disrobed to waist At home, she can start palpation in shower, where soap and water assist palpation At home, she can start palpation in shower, where soap and water assist palpation Then palpation should be performed while lying supine Then palpation should be performed while lying supine Encourage woman to palpate her own breasts while you monitor her technique Encourage woman to palpate her own breasts while you monitor her technique Slide 17-59

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Teach BSE (cont.)  Many examiners use a simulated breast model so that woman can palpate a “lump”  Pamphlets are helpful reinforcers; give woman two pamphlets to take home and encourage her to give one to a relative or friend; this may promote discussion, which is reinforcing Slide 17-60

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Male breast  Examination of male breast can be abbreviated, but do not omit it Combine breast exam with that of anterior thorax Combine breast exam with that of anterior thorax Inspect chest wall, noting skin surface and any lumps or swelling Inspect chest wall, noting skin surface and any lumps or swelling Palpate nipple area for any lump or tissue enlargement; it should feel even, with no nodules Palpate nipple area for any lump or tissue enlargement; it should feel even, with no nodules Palpate axillary lymph nodes Palpate axillary lymph nodes Slide 17-61

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data(cont.) Objective Data (cont.)  Male breast (cont.)  Normal male breast has flat disk of undeveloped breast tissue beneath nipple Gynecomastia is a benign growth of this breast tissue, making it distinguishable from other tissues in chest wall Gynecomastia is a benign growth of this breast tissue, making it distinguishable from other tissues in chest wall Feels like a smooth, firm, movable disk Feels like a smooth, firm, movable disk Occurs normally during puberty and is temporary Occurs normally during puberty and is temporary The adolescent is acutely aware of his body image The adolescent is acutely aware of his body image Reassure him that this change is normal, common, and temporary Reassure him that this change is normal, common, and temporary Slide 17-62

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data: Developmental Competence  Infants and children  In neonate, breasts may be enlarged and visible due to maternal estrogen crossing placenta May secrete a clear or white fluid, called “witch’s milk” May secrete a clear or white fluid, called “witch’s milk” This is not significant and are resolved within a few days to a few weeks This is not significant and are resolved within a few days to a few weeks  Note position of nipples on prepubertal child Should be symmetric, just lateral to midclavicular line, between fourth and fifth ribs Should be symmetric, just lateral to midclavicular line, between fourth and fifth ribs Nipple is flat, and areola is darker pigmented Nipple is flat, and areola is darker pigmented Slide 17-63

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data: Developmental Competence (cont.)  Adolescent girl  Breast development usually begins on an average between 8 and 10 years Expect some asymmetry during growth; record stage of development using Tanner’s staging Expect some asymmetry during growth; record stage of development using Tanner’s staging Use chart to teach adolescent normal developmental stages and to assure her of her own normal progress Use chart to teach adolescent normal developmental stages and to assure her of her own normal progress With maturing adolescents, palpate breasts as you would with adult; note any mass With maturing adolescents, palpate breasts as you would with adult; note any mass Teach BSE now, so that technique will become a natural, comfortable habit by time girl becomes an adult Teach BSE now, so that technique will become a natural, comfortable habit by time girl becomes an adult Slide 17-64

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data: Developmental Competence (cont.)  Pregnant woman  Breasts increase in size, as do nipples Delicate blue vascular pattern is visible over the breasts Delicate blue vascular pattern is visible over the breasts Jagged linear stretch marks, or striae, may develop if breasts have large increase Jagged linear stretch marks, or striae, may develop if breasts have large increase Nipples become darker and more erectile Nipples become darker and more erectile Areolae widen; grow darker; and contain small, scattered, elevated Montgomery’s glands Areolae widen; grow darker; and contain small, scattered, elevated Montgomery’s glands On palpation, breasts feel more nodular, and thick yellow colostrum can be expressed after first trimester On palpation, breasts feel more nodular, and thick yellow colostrum can be expressed after first trimester Slide 17-65

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data: Developmental Competence (cont.)  Lactating woman  Colostrum changes to milk production around the 3rd postpartum day Breasts may become engorged, appearing enlarged, reddened, and shiny and feeling warm and hard Breasts may become engorged, appearing enlarged, reddened, and shiny and feeling warm and hard Frequent nursing helps drain ducts and sinuses and stimulate milk production Frequent nursing helps drain ducts and sinuses and stimulate milk production Nipple soreness normal, appearing around twentieth nursing, lasting 24 to 48 hours, then disappearing Nipple soreness normal, appearing around twentieth nursing, lasting 24 to 48 hours, then disappearing Nipples may look red and irritated; may even crack but will heal rapidly if kept dry and exposed to air; frequent nursings best treatment for nipple soreness Nipples may look red and irritated; may even crack but will heal rapidly if kept dry and exposed to air; frequent nursings best treatment for nipple soreness Slide 17-66

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data: Developmental Competence (cont.)  Aging woman  On inspection, breasts look pendulous, flat, and sagging Nipples may be retracted but can be pulled outward Nipples may be retracted but can be pulled outward On palpation, breasts feel more granular; terminal ducts around nipple feel more prominent and stringy On palpation, breasts feel more granular; terminal ducts around nipple feel more prominent and stringy Thickening of inframammary ridge at lower breast is normal, and feels more prominent with age Thickening of inframammary ridge at lower breast is normal, and feels more prominent with age Reinforce value of BSE Reinforce value of BSE Women over 50 years old have increased risk of breast cancer Women over 50 years old have increased risk of breast cancer Slide 17-67

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Objective Data: Developmental Competence (cont.)  Aging woman (cont.)  Older women may have problems with arthritis, limited range of motion, or decreased vision that may inhibit self-care  Suggest aids to self-examination; for example, talcum powder helps fingers glide over skin Slide 17-68

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Sample charting(cont.) Sample charting (cont.) Slide 17-70

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Sample charting(cont.) Sample charting (cont.) Slide 17-71

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Abnormal Findings: Retraction and Inflammation  Dimpling  Nipple retraction  Fixation  Edema (peau d’orange)  Deviation in nipple pointing Slide 17-72

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Abnormal Findings: Breast Lump  Benign breast disease (formerly fibrocystic breast disease)  Cancer  Fibroadenoma Slide 17-73

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Abnormal Findings: Abnormal Nipple Discharge  Mammary duct ectasia  Carcinoma  Intraductal papilloma  Paget’s disease (intraductal carcinoma) Slide 17-74

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Abnormal Findings: Disorders During Lactation  Plugged duct  Breast abscess  Mastitis Slide 17-75

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Breasts and Regional Lymphatics Abnormal Findings: Male Breast  Gynecomastia  Male breast cancer Slide 17-76

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Breasts and Regional Lymphatics Chapter.

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Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Breasts and Regional Lymphatics Chapter.

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Presentation on theme: "Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Breasts and Regional Lymphatics Chapter."— Presentation transcript:

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