Download File

Examination of the
Breasts and Axillae
Dr. Maysa Almomani
Fall 2015
Chapter 10
Anatomy of the Breast
 located on the anterior chest wall
 superficial to the pectoralis major and inferior
margion, the serratus anterior muscles
 female breast composed of gland, fiber and fat
with proportions dependent on age, genes,
nutrition and childbearing
 Cooper suspensory ligaments, attached to
underlying muscle, provide support along with
the layer of subcutaneous fibrous tissue
Anatomy of Breast (cont.)
 divided into 4 quadrants and a tail
 the upper outer quadrant contains the most
glandular tissue
 breast tissue extends from the upper outer
quadrant into the axilla, forming the tail of
Spence
 in the axillae, the mammary tissue is in
direct contact with the axillary lymph
nodes
The Breast:
Lymphatic Drainage
 Each breast contains a lymphatic network
that drains the breast radially and deeply to
underlying lymphatics.
 The axillary nodes are more superficial than
others draining the breasts and are therefore
more accessible and relatively easy to
palpate.
The Axillary Lymph Nodes
 Anterior axillary (pectoral)

along lower border of pectoralis major
 Posterior axillary (subscapular)

along the lateral border of the scapula
 Central

high in the axilla close to the ribs
 Lateral axillary

along the upper humerus, drain most of the arm
Breast Anatomy:
Variations

Menopause & Older Adults
• some premenopausal decrease in tissue
• after menopause, glandular tissue atrophies, replaced by fat
• inframammary ridge thickens, suspensory ligaments loosen,
and nipples become smaller, flatter and less erectile
• skin may become thin & dry and axillary hair may decrease
Breast and Axillae Assessment:
History Review
 Present Problem (common symptom)
breast pain or discomfort

breast mass or lump: ranging from cyst & fibroadenoma

nipple discharge: spontaneous & after compression of the nipple
Galactorrhea: inappropriate discharge of milk containing fluid
Common questions: do you examine your breast? How often?

 Past Medical History






previous breast disease
surgeries
menstrual history
pregnancy
lactation
hormonal medications
.
 Family History


breast cancer
other breast disease in female and male relatives
 Personal & Social History







age
cyclic & noncyclic changes in breast characteristics
menstrual or menopausal status
breast self-examination
self care
hormonal meds
risk factors for cancer
Breast Cancer:
Risk Factors
 General




age (80% occur after age
40)
gender: female
personal history of breast
cancer
personal history of
ovarian, endometrial,
colon or thyroid cancer
 Specific Risks for Women

family history of breast
cancer
• mother, sister, grandmother, or
aunt




early menarche (<12)
late menopause (>55)
nulliparity
birth of first child after age
30
Physical Examination







Patient disrobed to waist
Good light
Matter-of-fact attitude
Thorough exam (don’t rush it!)
Small pillow or folded towel
Glass slide and fixative (cytology)
Teach BSE / Review technique
Objective Data/ Inspection
 General appearance: pt. in sitting position
-Color/ redness from local infection or inflammatory
carcinoma
-Skin/ thickening accompany lymphatic obstruction
 Size of the breasts
 Symmetry of the breasts
 The contour of the breasts such as masses,
dimpling , flattening, retraction in 4 views
 The charac. of the nipples including size, shape,
ulceration or rashes or discharge
Inspection Positions:
Arms over head
Dimpling or retraction/ cancer
Leaning forward for asymmetry
Retraction of the nipple & areola/cancer
Hands pressed against hips
For benign lesions e.g.
mammary ducts ectasia
Arms at sides: color, thickening of the skin,
Size, symmetry, contour, change in nipple.
Palpation Methods:
Palpation
 Consistency of the tissues (tender
 Nipple: elasticity
cords suggest mammary duct ectasia)
 Tenderness (premenstrual
fullness)
 Nodules/Lump: Assess for
-Location by quadrant or clock
-Size in cm
-Shape: round or cystic, or
irregular in contour
-Consistency :soft, firm or hard
-Delimitation: circumscribed or
not
-Tenderness
-Mobility: dimpling, cysts
 Retraction: dimpling,
altered contour
 Peau d’orange sign
 Associated
lymphadenopathy
Abnormal Breast Findings:
 Dimpling
 Inflammatory cancer
Abnormal Breast Findings:
 Peau d’orange
Abnormal Breast Findings:
 Breast cancer, lump & nipple retraction
The Male Breast
 Inspect the nipple and areola for nodules,
swelling or ulceration
 Palpate the areola & breast tissue for
nodules.
 Abnormalities:
-Gynecomastia: firm disk of grandular
enlargement
-Carcinoma
The Axillae
 Inspection:
-Rash
-Infection
-Unusual pigmentation
 Palpation
-
Central nodes
Lateral nodes (brachial)
pectoral nodes (Anterior)
-Subscapular nodes (Posterior)
Mammogram
 is an X-ray test that produces an image of
the inner breast tissue on film. This
technique, called mammography, is used
to visualize normal and abnormal structures
within the breasts. Mammography,
therefore, can help in identifying cysts,
calcifications, and tumors within the breast.
It is currently the most efficient screening
method to detect early breast cancer.
 The American Cancer Society
recommends that a woman obtain her first
baseline mammogram between the ages of
35 to 40. After the age of 40, she should
receive a yearly mammogram. Women
who are at high risk for developing breast
cancer may need to obtain mammograms
earlier than these recommendations and at
more frequent intervals.
‫‪ %80‬من االورام هي اورام حميدة‬
‫بدنا ااياك‬
‫سالمة‬
‫الفحص السريري الدوري‬
‫‪30‬‬
Breast Self-Exam
 The breast self-exam is a way that female
can check her breasts for changes (such as
lumps or thickenings). It includes looking
at and feeling her breast. Any unusual
changes should be reported to the doctor.
When breast cancer is detected in its early
stages, the chances for surviving the disease
are greatly improved
‫الفحص باللمس‬
‫قومي بإجراء هذا الفحص وأنت مستلقية على ظهرك‪.‬‬
‫ضعي وسادة أو منشفة مطوية تحت الكتف جهة الثدي األيسر‪ ،‬وضعي يدك اليسرى‬
‫أجري الفحص باليد اليمنى وباستخدام باطن األصابع الثالث الوسطى(البصمات) افحصي‬
‫ثديك األيسر‪ ،‬بضغط دائري خفيف‪ ،‬ومن ثم متوسط ومن ثم عميق لكل بقعة‪ ،‬واالنتقال من‬
‫بقعة لبقعة دون رفع أصابعك‪.‬‬
‫كرري ذلك بشكل دائري حيث تبدئين بفحصه من دائرة الثدي الكبرى باتجاه دائرة الحلمة‬
‫ّ‬
‫دون أن تتركي أي جزء دون فحص‪ ،‬وأخي ار عليك فحص تحت اإلبط‪.‬‬
‫وأخي ار عليك فحص تحت اإلبط‬
‫يمكنك إعادة الفحص خالل االستحمام‪ ،‬حيث أن الصابون يخفف االحتكاك وقد يعمل على‬
‫تسهيل عملية االحساس بالكتل‪.‬‬
‫‪32‬‬
Breast Biopsy
 A procedure in which a sample of a
suspicious breast growth is removed and
examined, usually for the presence of
cancer. The sample is suctioned out
through a needle or removed surgically.
The setting depends on the size and location
of the growth, the patient's general health,
and the type of biopsy performed.
 Among the most common benign growths
in the breast are cysts (sacs filled with fluid
or semisolid material), intraductal
papillomas (small wart-like growths that
project above a tissue surface), and lumps
formed by fat necrosis (the death of tissue
often as a result of trauma to the breast).