Breasts and axillae

Ask the woman with large pendulous breast to lean forward while you support her forearms Normal findings

. Note the symmetric free- forward movement of both breast

Male Breast Cancer

1% of the breast cancer occurs in men. There is no standard screening mammography, thus it is detected by clinical symptoms. If present is a painless palpable mass-hard, irregular, fixed to the area, may have nipple retraction. Nipple discharge, with or without palpable mass, is significant warning of early breast cancer. Note retraction and ulceration shown here. Early spread of axillary lymph nodes occurs because of minimal breast tissue. Because lack of screening and general awareness ,men are diagnosed 10 years later than women and at later stages with the mean age between 60 and 70 years. The stage of diagnosing is the most important indicator of survival

The glandular tissue contains

15 to 20 lobes radiating from the nipple. These are composed of lobules. Each lobule contains clusters of alveoli that produce milk.

Breast Abscess

A rare complication of generalized infection e.g., mastitis if untreated. A pocket of pus that feels hard, looks red and is quite tender accumulates in one local area. Here there is extensive nipple edema and abscess is pointing at 3 o'clock position on areolar margin. May nurse depending on the location of abscess, associated with pain, and the time of medicine. Continue to nurse on the unaffected side. Treat with antibiotics, surgical incision and drainage

The nurse is performing a clinical breast examination (CBE) on a patient. Which assessment finding should the nurse refer for further investigation?

A recent increase in size in one of the breasts

Abnormal finding in breast

A sudden increase in size of one breast signifies inflammation or new growth. Hyperpigmentation Redness and heat with inflammation, unilateral dilated superficial veins in a non-pregnant women

Lymphadenopathy

Are there any regional lymph nodes palpable

FIXATION

Asymmetry, distortion or decreased mobility with the elevated arm maneuver. As cancer becomes invasive the fibrosis fixes the breast to the underlying pectoral muscles. not that the right breast is held against the wall

What is the marked change in the breast seen in a patient who has reached menopause?

Atrophy of the glandular tissue

Aging Woman breast Abnormal findings

Because atrophy causes shrinkage of normal granular tissue, cancer detection is somewhat easier. Any lump that cannot be positively identified as a normal structure should be referred

Gynecomastia

Benign breast enlargement that occurs in male when estrogen concentration exceeds testosterone levels. mobile disk of tissue located centrally under the nipple-areola. At puberty is usually mild and transient. In older men is bilateral, tender and firm but not has hard as breast cancer. It occurs with Cushing syndrome, liver cirrhosis because estrogen cannot be metabolized, adrenal disease, hyperthyroidism and numerous drugs: alcohol and marijuana, estrogen treatment for prostate cancer, antibiotics i.e. metronidazole, isoniazid. Spironolactone, digoxin, angiotensin-converting enzyme (ACE) inhibitors, psychoactive drugs i.e. diazepam, tricyclic antidepressants.

gynecomastia

Benign enlargement of the male breast that occurs when estrogen concentration exceeds testosterone levels

Abnormal findings Breast Lumps

Benign i.e. Frbrocystic Breast Disease Cancer Fibroadenoma

Fibroadenoma

Benign tumor most commonly present as self-detected in late adolescent. Solitary nontender mass that is solid, firm, rubbery and elastic. Round , oral or lobulated, 1 to 5 cm. Freely movable, slippery, fingers slide it easily through tissue. Usually no lymphadenopathy. Diagnose is by stripe test i.e. palpation, ultrasound and needle biopsy. Because of risk of deformity of surgery to a growing, excisional surgery is reserved for masses greater than 5 cm, for continuously enlarging, well circumscribed, multiple masses or with suspicious ultrasound findings.

Carcinoma

Bloody nipple discharge that is unilateral and from a single duct requires further investigation. Although there was no palpable lump associated with the discharge . Mammography revealed a 1-cm, centrally located, ill defined mass

Normal finding in aging women breast

Breast glandular tissue atrophy due to decrease in estrogen and progesterone and replace with fibrous connective tissue. Fat envelope atrophies also beginning in the middle years and becoming marked in the 70s and 80s. Which decreases the breast size and elasticity so the breast droop and sag, looking flattened and flabby. Dropping is accentuated by kyphosis in some older women increase in breast size in marks the inner structures more prominent. Breast lump may be present for years but is suddenly palpable, around the nipple the lactiferous ducts are more palpable and feel firm and stringy because of fibrosis and calcification. The axillary hair decreases

Developmental competence Normal findings in Lactating Woman

Colostrum changes to milk production around the 3rd postpartum day. The breast may become engorged, appearing enlarged, reddened, shiny and feeling warm and hard. Frequent nursing helps drain the ducts and sinuses and stimulates milk production. Nipple sourness is normally appearing around the 20th nursing, lasting 24 to 48 hours and then disappears rapidly. The nipples may look red and irritated. They may even crack but heal rapidly if they kept dry and exposed to air and again frequent nursing is the best treatment for nipple soreness

Differentiating Breast lumps

Differentiating Breast Lumps Number: Usually single clear margins Cancer 30-80 years, risk increases after 50 years Shape: Irregular, star-shaped Consistency :Firm to soft, to stony hard Demarcation: Poorly defined Number: single Mobility:

Abnormal findings Signs of Retraction and Inflammation

Dimpling Edema i.e. Peau d' Orange Fixation Deviation in Nipple Pointing

During the physical examination of a prepubertal child, the nurse documents "premature thelarche." What does this indicate?

Early development of breasts without hormone-dependent signs

Paget disease also known as Intraductal Carcinoma

Early lesions has unilateral, clear, yellow discharge and dry scaling crusts, friable at the nipple apex. Spreads outward to areola with erythematous halo areola and crusted, eczematous, retracted nipple. Later lesion shows nipple reddened, excoriated, and ulcerated with bloody discharge, and an erythematous palque surrounding the nipple. Symptoms include tingling, burning, itching. Expect for the redness and occasional cracking from initial breastfeeding, any dermatitis of the nipple area must be explored carefully and referred immediately.

Which information should the nurse provide to a lactating patient with a plugged duct?

Ensure complete emptying of the breast

The nurse is assessing a patient who reports finding a lump in the left breast. Which intervention by the nurse is most appropriate?

Examine the features of the right breast followed by the left breast.

Male breast Abnormalities

Gynecomastia Male Breast Cancer

Abnormalities in breast palpation

Heat, redness and swelling in nonlactating and nonpostpartum breasts indicates inflammation

The nurse is evaluating the relative risk for breast cancer in a patient. Which factor contributes to a relative risk greater than 4.0?

History of genetic mutations for BRCA1 or BRCA2

The nurse is caring for a lactating patient. Which assessment finding indicates the presence of a plugged duct?

If a section of the breast appears red and tender, This is common when milk is not removed completely due to poor latching, ineffective suckling, or infrequent nursing. The breasts of a lactating patient appear engorged, enlarged, reddened, and shiny. This is a normal finding, which is resolved by frequent nursing to drain the ducts and sinuses and stimulate milk production. It is normal for the nipples to appear sore, red, and cracked. It may last for 24 to 48 hours and heals rapidly if kept dry and exposed to air.

What is the cause of gynecomastia in a patient with Cushing syndrome?

Inability to metabolize estrogens

Mastitis

It is uncommon, an inflammation mass before abscess formation. usually occurs in single quadrant. Area is swollen, tender, very hot and hard, here forming outward from areola upper edge in right breast. The woman also has a headache, malaise, fever, chills, sweating, increased pulse, flulike symptoms. May occur during the first four months from infection or from stasis from plugged duct. Treat with rest, local heat to area, antibiotics and frequent nursing to keep breast as empty as possible. Must not wean (don't stop breast breast feeding) now, or the breast will become engorged, and the pain will increase. Mother's antibiotics not harmful to infant. Usually resolve 2 to 3 days.

Fibroadenoma main points

Likely age : 15-30 years, can occur up to 55 years Shape: Round, lobular Consistency:Usually firm, rubbery Demarcation: Well demarcated, clear margins Number: Usually single Mobility: very mobile, slippery Tenderness: usually none Skin Retraction: none Pattern of growth: grows quickly and constantly Risk to health: Benign—Diagnose by ultrasound and biopsy; may spontaneously resolve in women <20 years. Should be resected in women >35 years as it carries a small risk of associated cancer.

Cancer main points

Likely age: 30 to 80 years, risk increases after 50 Shape: irregular, star-shaped Consistency: Firm to stony hard Demarcation: Poorly defined Number: single Mobility: fixed tenderness : usually none can be tender Skin retraction: usually Pattern of growth: grows constantly Risk to Health: Serious, need early treatment

Benign Breast Disease main points

Likely age: 30-55 years; decreases after menopause Shape: Round, lobular Consistency: firm to soft rubbery Demarcation: Well demarcated, Number: Usually multiple; may be Single Mobility : Mobile Tenderness: usually increases before menses, may be noncyclic Skin retraction: none Pattern of growth: size may increase or decrease rapidly, cyclic with menstrual periods Risk to health: Benign, although general lumpiness may mask other cancerous lump

peau d'orange.

Lymphatic obstruction causes edema of the breasts. Edema thickens the skin and exaggerates the hair follicles, giving a pigskin or orange-peel appearance.

The nurse notices edema on the breast skin of a patient that has a "pigskin" look. Which condition does the nurse suspect from this observation?

Lymphatic obstruction causes edema of the breasts. Edema thickens the skin and exaggerates the hair follicles, giving a pigskin or orange-peel appearance. This condition is called peau d'orange. It is a severe condition indicating cancer.

Abnormal Nipple Discharge

Mammary Duct Estasia Intraductal Papilloma Carcinoma Paget Disease also known as Intraductal Carcinoma

The nurse is assessing a patient in the perimenopausal stage. The patient has itching and burning around the nipple with white purulent discharge. What is the likely diagnosis for this patient?

Mammary duct ectasia

The nurse is caring for a patient in the second month of lactation. The patient has an inflammatory mass forming outward from the areola and flu-like symptoms. What is the diagnosis for this patient?

Mastitis

Disorders Occurring During Lactation

Mastitis Breast Abscess Plugged Duct

How to inspect and palpate the Axillae

Move them firm down in all four directions: 1. down to the chest wall in a line from the middle of the axilla 2. along the anterior chest wall of the axilla 3. along the posterior border 4. along the inner aspect of the upper arm move the woman's arm through a range of motion that you can reach

Abnormal finding in the Axillae

Nodes enlarged with any local infection of the breast, arm, or hand and with breast cancer metastases

Many women have benign breast disease

Nodualarity occurs bilaterally, regular firm nodules are mobile, well demaracated, and feel rubbery like small water balloons. Pain may be dull, heavy, and cyclic as nodules enlarge. Some women have nodularity but no pain and vice versa. Cysts are discrete, fluid-filled sac. Dominant lumps and nipple discharge must be investigated carefully. Nodularity itself is not premalignant but produces difficulty in detecting other cancerous lumps

Developmental competence Abnormal findings in Adolescent Breast

Note precocious i.e. unusual development before 8 years, it is usually normal but occurs with thyroid dysfunction, stilbestrol ingestion, or ovarian or adrenal tumor Note delayed development with hormonal failure, anorexia nervosa, or severe malnutrition At this age a mass is almost always a benign fibrodenoma or a cyst

Several changes occur in the breasts of a pregnant woman.

On palpation, the breasts feel more nodular. Therefore, a nodular breast during pregnancy is a normal finding. .

Abnormalities in Lactating women

One section of the breast surface appearing red and tender indicates a plugged duct

The breast has four groups of axillary nodes. Where is the central axillary node located?

Over the ribs and serratus anterior muscle

Developmental competence abnormal findings in infants and childern

Premature thelarche is the early breast development with no other hormone dependent sign such as pubic hair and menses

The nurse is assessing a patient who reports feeling nodules in the breast. Further assessment reveals that the patient is in the midcycle of menstruation. What is the best intervention by the nurse?

Repeat the examination a week after menstruation.

Abnormalities Maneuvers to Screen for retraction

Retractions signs are caused by fibrosis in the breast tissue, usually caused by growing neoplasms. The fibrosis shortens with time, causing contrasting signs with the normally loose breast tissue. Note a lag in the movement of one breast Note a dimpling a pucker, which indicates skin retraction

What is a normal finding in the breasts of a prepubertal child?

The areola has darker pigmentation with flat nipples.

The nurse first assesses the unaffected breast to establish a baseline of normal consistency for the patient.

The bimanual technique involves the use of one hand to support the breast while palpating with the other hand and is only appropriate when palpating large, pendulous breasts. If a lump is detected, the nurse describes the distance of the lump from the nipple in centimeters, using the breast as a clock face. The size of the lump is judged in width, length, and thickness, measuring the dimensions in centimeters.

During a physical assessment, a teenager tells the nurse, "My left breast is smaller than the right one and it makes me feel self-conscious." How should the nurse respond?

The breasts start developing at puberty. Occasionally, one breast may grow faster than the other, resulting in temporary asymmetry. This condition may cause embarrassment or stress. The nurse must emphasize that this is a normal condition

A plugged duct is common during lactation due to poor latching, ineffective suckling, and infrequent nursing, leading to incomplete emptying of the breast.

The patient does not have an infection but may have a tender lump, which is reddened and warm to the touch

DIMPLING

The shallow dimple also called a skin tether is a sign of retraction. Cancer causes fibrosis, which contract the suspensory ligament, the dimpling may be apparent at rest with compression, or with lifting of the arms. Also note the distortion of the areola here as the fibrosis pulls the nipple towards it.

Which findings are normal in the breast examination of a lactating 20-year-old patient? Select all that apply

There is a slight enlargement and tenderness. The lobes feel prominent, with distinct margins. There is a transverse tissue in the lower quadrant.

The presence of pain and nodules in the breast is a common finding in most patients in the midcycle of menstruation.

Therefore, the nurse asks the patient to return for a follow-up examination a week after menstruation, on day 4 to 7 of the cycle. During this time the hormone levels will be lower, and normal edema will be absent. The nurse need not refer the patient for further investigation until a repeat examination confirms the presence of a lump. At this stage, the nurse need not report the finding to the health care provider or inform the patient of the need for a biopsy at this stage.

Intraductal Papilloma

These are discrete benign tumors that arise in a single or multiple papillary ducts. May have serous or serosanguineous discharge. Often there is a palpable nodule in underlying ducts. Most common in women ages 40 to 60 years. Most are benign, although multiple papillomas have a higher risk of subsequent cancer than do solitary ones. Requires core needle biopsy and possible excision

Prior to palpating the breast, the patient is helped to a supine position. A small pad is tucked under the side to be palpated and the arms are raised.

These maneuvers flatten the breast tissue and displace it medially. This facilitates the detection of significant lumps. Pain in the breast is not a normal finding, and it cannot be diminished by asking the patient to lie down or raise her arm.

enlargement of breasts due to maternal estrogen crossing the placenta.

This causes the breasts to secrete a clear or white fluid called "witch's milk.

Plugged Duct

This is a common when milk is not remove completely because of poor latching, ineffective suckling, infrequent nursing, or switching to second breast too soon. There is a tender lump that may be reddened and warm to touch. No infection. This is important to keep the breast as empty as possible and milk flowing. The woman should nurse the baby frequently on affected side to ensure complete emptying and manually expressing any remaining milk. It usually resolves in less than 1 day

The nurse is doing a breast assessment of a pregnant patient. On palpitation, the nurse finds that the breasts feel nodular. The patient does not complain of any pain. What does the nurse deduce from these findings?

This is a normal finding.

Before a breast examination, the nurse asks the patient to lie down and raise her arms. What is the rationale behind this instruction?

To flatten the breast tissue

What is the function of the Cooper's ligaments in the breast?

To support the breast tissue

Edema i.e. Peau d' Orange

When lymphatic obstruction produces edema. This thickens the skin and exaggerates the hair follicles, giving a pigskin or orange-peel look. This condition suggests cancer. Edema usually begins in the skin around and beneath the areola, the most dependent area of the breast. also note nipple infiltration here

A patient with carcinoma may have

a bloody discharge from a single duct. The discharge may be unilateral and may or may not be associated with a palpable mass.

Developmental competence Normal findings in Pregnant women

a delicate blue vascular pattern is visible over the breast breast increases in size and the nipple Jagged linear stretch marks, or striae may develop if the breasts have a larger increase. Nipples also becomes darker and more erectile. Areolae widen, grow darker and contains the small, scattered, elevated montgomery glands On palpation the breast feels more nodular, thick yellow colostrum can be expressed after the first trimester

inframammary ridge

a firm transverse ridge of compressed tissue in the lower quadrant and especially noticeable in larger breast. Do not confuse this with abnormal lump. palpate using a bimanual technique.

It is common to have a slight asymmetry in the breasts; however

a recent increase in the size of one of the breasts needs further investigation. It may signify new growth or inflammation. The skin is normally smooth and of even color. Pale linear striae or stretch marks may be seen on the skin surface of a patient after pregnancy. A pregnant patient may have a fine blue vascular network on the skin.

Paget disease starts with

a small crust on the nipple apex and spreads to areola which is abnormal

Rapid decrease in estrogen level in menopausal women will cause

actual shrinkage in breast

Deviation in Nipple Pointing

an underlying cancer causes fibrosis in the mammary ducts which pulls the nipple angle toward it. here note the swelling behind the right nipple and that the nipple tilts laterally

The female breast is also known as mammary glands they lie

anterior to the pectoralis majar and serratus anterior muscles

Intraductal papillomas

are discrete benign tumors that arise in a single or multiple papillary ducts. They lead to serous or serosanguineous discharge.

Eczema or other dermatitis usually starts on the

areola or surrounding skin and spreads to the nipple

palpate the breast obese patient

ask the woman to rotate the hip during palpating to distribute the breast tissue medially across the chest wall

Ovarian secretion of estrogen and progesterone decreases after menopause. This results in

atrophy of the glandular tissues of the breast. The ductal system expands during pregnancy, not menopause. Nodularity of the breasts increases from midcycle up to menstruation; a woman who has reached menopause will not have her menstrual cycle. Extensive fat deposition occurs during puberty, not menopause.

Breast tissue extends up into the

axilla, it contains many lymph nodes

Oral contraceptives may control symptoms of

benign i.e. fibrocystic breast disease

Fibroadenoma is a

benign tumor that may be painless and does not cause discharge or affect the nipple.

Long term use of combined estrogen and progestin therapy increased the risk of developing

breast cancer

Normal findings in pregnant women breast

breast changes starts at the second month and are a common early sign of pregnancy Pregnancy stimulates the expansion of the ductal system and supporting fatty tissue and development of the true secretory alveoli Breast enlarges and feels more nodular, nipples enlarger, darker and more erectile , areolae becomes larger and darker brown as pregnancy progresses and the tubercles become more prominent over the skin surface. Colostrum may be expressed after the four month. The breast produces colostrum for the first few days after delivery which is rich in antibodies that protects the newborn against infection. Milk production i.e. lactation begins 1 to 3 days after delivery. The whitish color is form the emulsified fat and calcium caseinate

Developmental competence normal findings in Adolescent

breast development begins on an average between 8 to 10 years of age. Expect asymmetry during growth. tanner staging is used to record breast development. Breast is normally firm and uniform You should consider BMI when evaluating breast budding before age 8 years. Breast budding before age 8 is premature in non-Hispanic White girls but may be normal in 7-year-old Black or Mexican-American girls. note that is difficult to distinguish breast budding from adipose tissue.

Fibrosis in the breast tissue causes a

breast lump that may be

Lactiferous ducts form a

collecting duct system from the lobes to the nipple. The ducts form ampullae, or lactiferous sinuses, behind the nipple, which are reservoirs for storing milk.

Cyclic pain

common with normal breast, oral contraceptives, and benign breast i.e. Fibrocystic disease

A supernumerary nipple is a

congenital variation. It is an extra nipple along the embryonic "milk line" on the thorax or abdomen and is a congenital finding.

Decrease estrogen level in menopausal woman causes

decreases in firmness of breast

Abnormal finding in nipple

deviation in pointing, recent nipple retraction signifies the disease ,

Maneuvers to Screen for Retraction Normal findings

direct the woman to change positions while you check the breast for skin retraction signs: First ask her to lift her arms slowly over her head and both breast should move up symmetrically next ask her to push her hands onto her hips and to push her two palms together. These maneuvers contracts the pectoralis major muscle. A slightly of both breast occurs

Normal finding in Adolescent breast

estrogen hormones stimulate the breast changes Breast enlarge due to the extension of fat deposition ducts system grows and branches and masses of small , solid cells develop at the duct endings. These are potential aveoli. Breast development starts from 8 to 9 for African american girls and by 10 years for white girls during the 3 to 4 days before menstruation , the breast feel full, tight, heavy and occasionally sore. The breast volume is smaller on days 4 to 7 of the menstrual cycle

The best time to perform breast self examine for a woman not have menstrual period i.e. pregnant or menopausal to choose

familiar date as a reminder, such as the first of the month

Cooper's ligaments consist of

fibrous connective tissue extending vertically from the skin surface to attach on the chest wall muscles

An inframammary ridge is a

firm transverse ridge of compressed tissue in the lower quadrants.

In nulliparous (women who has not given birth) normal breast tissue feels

firm, smooth and elastic

Mastitis may occur in the

first 4 months of lactation from infection or from stasis from a plugged duct. The patient with mastitis has an inflammatory mass forming outward from the areola. The patient also has headaches, malaise, fever, chills, sweating, and an increased pulse.

Early development of breast is due to

greater body mass BMI leading to obesity in childern

Between ages 10 to 30 years, chest radiation exposure has

greatest risk of breast cancer later in life

The presence of benign breast disease makes the breasts

harder to examine, the general lumpiness conceals a new lump

discharge of nipple is abnormal in

if not pregnant and not lactating, note the number of discharge droplets and the quadrants producing them. Blot the discharge on the white gauze pad ascertain its color. Test any abnormal discharge for the presence of blood

patient's relative risk for breast cancer is greater than 4.0

if the patient has a genetic mutation in the tumor suppressor genes BRCA1 or BRCA2. Early menarche before the age of 12 years contributes to a relative risk between 1.1 and 2.0. If the patient has a personal history of breast cancer after the age of 40, the relative risk is between 2.1 and 4.0. The presence of one first-degree relative with breast cancer also contributes to a relative risk between 2.1 and 4.0. The relative risk is greater than 4.0 if there are two or more first-degree relatives with breast cancer.

Developmental competence normal findings in infants and children

in the neonate the breast may be enlarged and visible from maternal estrogen crossing the placenta. They may secrete a clear or white fluid called witch's milk which is resolved within a few days or a week. Note the position of the nipple on the prepubertal child, they should be symmetric, just lateral to the midclavicular line between the 4th and 5th ribs. The nipple is flat and the areola is darker pigmented

Biopsy- confirmed atypical hyperplasia

increases breast cancer risk

Premenstrual engorgement is normal from

increasing progesterone, this consist of slightly enlargement, tenderness on palpation, generalized nodularity, the lobes feel prominent and their margins more distinct

Male breast normal findings

inspect the chest wall , noting the skin surface and any lumps or swelling. palpate the area of the nipple for any lump or tissue enlargement. It should feel even with no nodules. Palpate the axillary lymph nodes. The normal breast has a flat disk of undeveloped breast beneath the nipple. Gynecomastia is a benign growth of this breast tissue, making it distinguishable from the other tissue in the chest wall. It feel a smooth, firm, movable disk. this occurs in about one half of adolescent boys at 13 or 14 years of age. It can be unilateral or bilateral and is temporary.

A breast abscess

is a rare complication of an untreated infection such as mastitis. Assessment findings for a breast abscess include a pocket of pus that looks hard, red, and tender in a local area.

The male breast

is a rudimentary(limited) structure consisting of a thin disk of undeveloped tissue underlying the nipple. the areola is well developed, although the nipple is relatively very small. During adolescent is common for the breast tissue to enlarge temporarily, producing gynecomastia. This condition is temporarily and may reappear in the aging male and may be the result of testosterone deficiency

Lump in the breast caused by seat belt injury or direct blow

is caused by localized hematoma or edema and resolves short

Premature thelarche . In the neonate

is the early development of breasts without hormone-dependent signs such as pubic hair or menses

A plugged duct is common in a

lactating patient due to incomplete emptying of the breast. Poor latching, ineffective suckling, and infrequent nursing are some of the causes. The nurse instructs the patient to ensure complete emptying of the breast. The patient should nurse the baby on the affected side first and manually express any remaining milk to resolve the condition. The patient need not apply heat locally or get adequate rest or antibiotics. The condition resolves in less than a day if the breast is emptied completely.

Male breast abnormal finding

male breast cancer is rare but note any nipple discharge, with painless, firm, retroareolar lump, retraction, axillary lymphadenopathy. Gynecomastia also occurs with the use of anabolic steroids, some medication and cirrhosis

Benign i.e. Fibrocystic Breast Disease

multiple tender masses that occurs with numerous symptoms and physical findings: Swelling and tenderness i.e. cyclic discomfort Mastalgia : severe pain both cyclic and noncyclic Nodularity: significant lumpiness, both cyclic and noncyclic Dominant lumps: including intraductal papilloma and duct ectasia Infections and inflammations: including subareolar abscess, lactational mastitis , breast abscess, and mondor disease

Eczema or other dermatitis rarely starts at the

nipple unless it is caused by breast feeding

Axillae Normal findings

nodes are not palpable although you may feel a small, soft, nontender node in the central group expect some tenderness when palpating high in the axilla

Supernumerary nipple

normal and common variation. an extra nipple along the embryonic milk line on the thorax or the abdomen is a congenital (present from birth) finding. usually is 5 to 6 cms below the breast near the middle line and has no associated glandular tissue. It looks like a mole although a close look reveals a tiny nipple and areola. It is not significant, merely distinguish it from a mole

Galactorrhea

note any medication that may clear nipple discharge e.g. oral contraceptives, phenothiazines, diuretics, digitalis, steroids, methyldopa, calcium channel blockers. Bloody or blood tinged discharge is always and any discharge with a lump significant

Pendulous breast abnormalities

note fixation to chest wall or skin retraction

Mastalgia

occurs with trauma, inflammation, infection and benign breast disease

Normal finding in breast

often the left breast is slightly larger than the left breast a fine blue vascular network is visible normally during pregnancy. pale linear striae or stretch marks often follow pregnancy

Trauma of the breasts will be associated with

pain, and possible infection

Mammary Duct Estasia

pastelike matter in the subareolar ducts produces stickly, purulent discharge that may be white, gray, brown, green or bloody. Caused by stagnation( no growth ) of cellular debris and secretions in the ducts, leading to obstruction, inflammation and infection. Usually occurs in perimenopause. Itching, burning or drawing pain occurs around nipple. May have subareolar redness and swelling. Ducts are palpable as rubbery, twisted tubules under areola. May have palpable mass, soft or firm, poorly delineated. Not malignant but need biopsy

Mammary duct ectasia occurs in

perimenopausal patients who have lactated. The pastelike matter in subareolar ducts produces a sticky, purulent discharge that may be white, gray, brown, green, or bloody. The patient also has itching, burning, or drawing pain around the nipple.

discharge of nipple is normal in

pregnancy and lactating women

The presence of a slight enlargement and tenderness to palpation is indicative of

premenstrual engorgement. This occurs from increasing levels of progesterone. It is also normal for the patient to have generalized nodularity with prominent lobes and distinct margins. Palpation of the lower quadrant may reveal a firm transverse ridge of compressed tissue. This is a normal finding, especially noticeable in large breasts and is known as the inframammary ridge. After pregnancy the tissue feels softer and looser, whereas the breast tissue in a nulliparous patient is firm, smooth, and elastic. The presence of localized redness, warmth, and swelling in the lactating patient indicates inflammation.

Aging Woman breast Normal findings

primary risk factor for developing breast cancer therefore an annual CBE is important. The breast looks pendulous, flattened and sagging. Nipples look retracted but can be pulled outwards. on palpation the breast feels more granular and the terminal ducts around the nipple feel more prominent and stringy. Thickening of the inframammary ridge at the lower breast is normal and feels more prominent with the age

The best time to perform breast self examine for a premenstrual patient is

right after the menstrual period day 4 to 7 of the cycle, when the breasts are smallest and least congested

After pregnancy the tissue feels

softer and looser

cancer

solitary, unilateral, nontender mass. single focus in one area, although it may be interspersed with other nodules. Solid, hard, dense, fixed to underlying tissues or skin as cancer becomes invasive. Borders are irregular and poorly delineated. Grows constantly. Often painless, although the person may have pain. Most common in the upper quadrant, found in women 30 to 80 years of age. As the cancer advances, signs include firm or hard irregular axillary nodes, skin dimpling, nipple retraction, elevation and discharge

inverted nipple may need

special care in preparation for breastfeeding

Normal findings in breast infants

supernumerary nipple i.e. an extra nipple persist and is visible somewhere along the track of the mammary ridge. The only breast structure present are the lactiferous ducts within the nipple. No alveoli have developed. little change occurs until puberty

The presence of an extra nipple along the embryonic "milk line" on the thorax is called a

supernumerary nipple. This is a normal variation and congenital finding.

Palpate the breast non obese patient

supine position, tuck a small pad under the side to be palpated and raise her arm over the head

Cooper's ligaments are

suspensory ligaments that support the breast tissue

Normal findings in nipple

symmetrically on the same plane on the two breast nipple usually protrude, although some are flat and some are inverted, nipples turn to stay in the original condition normal nipple inversion may be unilateral or bilateral and usually can be pulled out i.e. it is not fixed

To examine the axilla,

the patient should be in a sitting position. To observe skin retraction, the patient is asked to push her hands onto her hips.

NIPPLE RETRACTION

the retracted nipple looks flatter and broader, like an underlying crater. A recent retraction suggests cancer, which causes fibrosis of the whole duct system and pulls in the nipple. It may also occur with benign lesions such as ectasia of the ducts. do not confuse retraction with normal long-standing type of nipple inversion which has no broadening and is not fixed.

Colostrum

which is thick, yellow fluid is the precursor for milk, containing the same amount of protein and lactose but particularly no fat