Ch 20 - Assessing Breasts and Lymphatic System

The clinic nurse is teaching a young female college student about risk factors for developing breast cancer in an attempt to impress upon her the importance of doing breast self-examinations. Included in the teaching should be which of the following (Select all that apply.) A. early menarche B. late pregnancies C. late menopause D. young age E. an affected grandmother

A, B, C, E: early menarche; late pregnancies; late menopause; an affected grandmother Early menarche, pregnancy after the age of 30, late menopause, and family history of breast cancer are all possible risks for the client developing breast cancer. Young age has not been shown to be a risk factor.

When preparing a teaching session for women about breast cancer, the nurse should include information about which modifiable risk factor(s)? Select all that apply. A. Having no children B. Postmenopausal hormone therapy C. Gene mutations D. Obesity E. Physical inactivity

A, B, D, E: Having no children; Postmenopausal hormone therapy; Obesity; Physical inactivity Modifiable risk factors (lifestyle factors) for breast cancer for women include having no children, having children after the age of 30, postmenopausal hormone therapy, obesity, and physical inactivity. Oral contraceptive use, breastfeeding, and alcohol use are also lifestyle risk factors. Gene mutations are nonmodifiable risk factors of breast cancer.

A nurse is teaching a client about self breast examination. What would the nurse emphasize? (Mark all that apply.) A. Inspection B. Pain C. Timing D. Palpation E. Pallor

A, C, D: Inspection; Timing; Palpation It is important to guide clients through self breast examination that emphasizes timing, inspection, and palpation. Pain and pallor are not emphasized when teaching self breast examination.

A nurse is examining the breasts of a 75-year-old woman. Which of the following are normal findings in the breasts of an older adult? Select all that apply. A. Smaller, flatter nipples B. Peau d'orange skin C. Nipples that are less erectile on stimulation D. Pendulous breasts E. Spontaneous discharge

A, C, D: Smaller, flatter nipples; Nipples that are less erectile on stimulation; Pendulous breasts The older client often has more pendulous, less firm, and saggy breasts and smaller, flatter nipples that are less erectile on stimulation. Peau d'orange skin, associated with carcinoma, and spontaneous discharge are not normal findings in the breasts of older adults and should be referred for further evaluation.

Which characteristics are present in a cancerous breast lesion? Select all that apply. A. irregular in shape B. elastic in consistency C. well delineated from surrounding tissue D. usually nontender E. may cause retraction of the nipple

A, D, E: irregular in shape; usually nontender; may cause retraction of the nipple A cancerous breast is likely to be irregular in shape, firm or even hard to the touch, not clearly delineated, usually nontender, and may cause noticeable retraction of the nipple.

The client reports to the nurse that she is concerned she has cancer as she has been experiencing clear discharge from her breasts. What is the best response of the nurse? A. "Do you take any medications?" B. "Do you have a history of breast cancer in your family?" C. "You are most likely pregnant." D. "You must be experiencing stress."

A. "Do you take any medications?" Some medications such as steroids, calcium channel blockers, oral contraceptives, or tranquilizers may also cause nipple discharge. Stress, family history and early pregnancy do not cause clear discharge.

When should a woman conduct self breast examination with respect to her menses? A. 5 to 7 days following her menses B. Midcycle C. Immediately prior to menses D. During her menses

A. 5 to 7 days following her menses The breast examination should be conducted during the time with the least estrogen stimulation of the breast tissue. This corresponds to 5 to 7 days following menses.

The nurse is assessing a 15 year old male and finds soft, fatty enlargement of breast tissue. The nurse would document this as what? A. Gynecomastia B. Cysts C. Breast abscess D. Fibroadenoma

A. Gynecomastia Gynecomastia is a breast enlargement. Cysts are lumps that may be found in the breasts. Abscesses are an infection. Fibroadenoma is a well-defined, usually single or multiple, nontender, firm or rubbery, round or lobular mass that is freely movable.

A nurse is examining the breasts of a woman who has had a mastectomy. Which of the following should the nurse do? A. Palpate the scar for redness, lesions, lumps, swelling, or tenderness B. Visually inspect but not palpate the affected breast C. Palpate the affected breast but avoid the scar D. Refer the client to a physician if any white scar tissue is observed

A. Palpate the scar for redness, lesions, lumps, swelling, or tenderness If the client has had a mastectomy or lumpectomy, it is still important to perform a thorough examination. Palpate the scar and any remaining breast or axillary tissue for redness, lesions, lumps, swelling, or tenderness. White scar tissue in a client who underwent a mastectomy or lumpectomy is a normal finding and need not be referred.

When inspecting the nipples, which of the following findings is unexpected? A. Retraction of the left nipple B. Long-standing inversion C. Supernumerary nipples D. Downward point of the nipples

A. Retraction of the left nipple Longstanding nipple inversion and supernumerary nipples do not constitute threats to health. A downward point of the nipples, provided symmetry exists, is not necessarily pathological, while retraction can indicate underlying cancer.

When palpating the female breast for masses, the nurse distinguishes which of the following characteristics as a potentially cancerous mass? A. Single, firm, fixed nodule B. Multiple round, mobile nodules C. Multiple soft, nontender nodules D. Single, tender, well-delineated nodule

A. Single, firm, fixed nodule Any mass that is firm, fixed, poorly circumscribed, and qualitatively different from surrounding tissue strongly suggests cancer.

The nurse has discussed the risks for breast cancer with a group of high school seniors. The nurse determines that one of the students needs further instructions when the student says that one risk factor is A. having a baby before the age of 20 years. B. a family history of breast cancer. C. consumption of a high-fat diet. D. late menopause.

A. having a baby before the age of 20 years. Having a baby before 20 years of age does not increase the risk of breast cancer. The risk of breast cancer is greater for women who have never given birth or for those who had their first child after age 30. A family history of breast cancer, consumption of a high-fat diet, and late menopause are all factors that increase the risk of breast cancer.

The lymph nodes that are responsible for drainage from the arms are the A. lateral lymph nodes. B. central lymph nodes. C. anterior lymph nodes. D. posterior lymph nodes.

A. lateral lymph nodes. The lateral nodes drain most of the arms.

At puberty, the female breasts enlarge in response to estrogen and A. progesterone. B. aldosterone. C. lactogen. D. prolactin.

A. progesterone. The male and female breasts are similar until puberty, when female breast tissue enlarges in response to the hormones estrogen and progesterone, which are released from the ovaries.

A nurse teaches a client about breast self-examination. What should the nurse tell the client about examining the underarm? The arm should be: A. slightly raised B. raised straight up C. rested on the hips D. kept at 90 degrees

A. slightly raised When performing an underarm examination during breast self-examination, the nurse should tell the client to keep the arm slightly raised up. Raising the arm straight up tightens the tissue in the area and makes it very difficult to examine. The examination may not yield accurate results if the arms are straightened up, kept on the hips, or kept at 90 degrees.

A client who recently received breast implants asks for recommendations on performing breast self-examination (BSE). Which of the following should the nurse mention? Select all that apply. A. BSEs are not recommended for clients with breast implants. B. Ask the surgeon to help her distinguish the implant from her breast tissue. C. Manipulate the valve on the implant to detect for tumors in the area. D. Press firmly inward at the edges of the breast implants to feel the ribs beneath.

B, D: Ask the surgeon to help her distinguish the implant from her breast tissue; Press firmly inward at the edges of the breast implants to feel the ribs beneath. If the client has breast implants, she may perform breast self-examination monthly on the implanted breast. To do this effectively, she should ask her surgeon to help her distinguish the implant from her breast tissue. She should press firmly inward at the edges of the breast implants to feel the ribs beneath, checking for any lumps or bumps. However, she should be careful not to manipulate (i.e., squeeze) the valve on the implant excessively, which may cause valve leakage and make the breast implant deflate.

A 23-year-old computer programmer comes to the office for an annual examination. She has recently become sexually active and wants to start oral contraception. Her only complaint is that the skin in her armpits has become darker. She states it looks like dirt; she scrubs her skin nightly with soap and water, but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods have been irregular for 3 years. Her mother has type 2 diabetes and her father has high blood pressure. The client denies tobacco but drinks four to five drinks on Friday and Saturday nights. She denies any illegal drug use. Examination shows a mildly obese woman breathing comfortably. Her vital signs are unremarkable. Inspection of the axillae reveals dark velvet-like skin. Her annual examination is otherwise unremarkable. What disorder of the breast or axilla is she most likely to have? A. Peau d'orange B. Acanthosis nigricans C. Hidradenitis suppurativa

B. Acanthosis nigricans Acanthosis nigricans can be associated with an internal malignancy, but in most cases it is a benign dermatological condition associated with polycystic ovarian syndrome, a syndrome consisting of acne, hirsutism, obesity, irregular periods, infertility, ovarian cysts, and early onset type 2 diabetes. It is also known to correlate with insulin resistance.

The nurse reviews factors related to which of the following areas to assess a client's risk of breast cancer? A. Family history, age, occupation B. Age, family history, reproductive history C. Lifestyle, occupation, exposure to hazardous chemicals D. Exposure to hazardous chemicals, lifestyle, reproductive history

B. Age, family history, reproductive history While numerous risk factors have been identified for breast cancer, age, family history, and reproductive history are among the most significant.

A 72-year-old retired saleswoman comes to the office with a bloody discharge from her left breast for 3 months. She denies any trauma to her breast. Her past medical history includes high blood pressure and abdominal surgery for colon cancer. Her aunt died of ovarian cancer and her father died of colon cancer. Her mother died of a stroke. The client denies tobacco, alcohol, or drug use. She is a widow and has three healthy children. On examination her breasts are symmetrical with no skin changes. The nurse can express bloody discharge from the client's left nipple. No discrete masses are palpable, but her left axilla has a hard 1-cm fixed node. The remainder or her heart, lung, abdominal, and pelvic examinations are unremarkable. What is the most likely cause of nipple discharge in her circumstance? A. Benign breast abnormality B. Breast cancer C. Galactorrhea

B. Breast cancer Nipple discharge in breast cancer is usually unilateral and can be clear or bloody. Although a breast mass is not palpated, in this case a fixed lymph node is palpated. Other forms of breast cancer can present as a chronic rash on the breast.

Which of the following assessment findings is most likely benign on breast examination? A. Dimpling of the skin resembling that of an orange B. One breast larger than the other C. One nipple inverted D. One breast with dimple when the client leans forward

B. One breast larger than the other Asymmetry in size of the breasts is a common benign finding. The others are concerning for underlying malignancy.

A 44-year-old woman comes to the clinic complaining of severe dry skin in the area over her right nipple. She denies any trauma to the area. She noticed the skin change during a self-breast examination 2 months ago. She also admits that she had felt a lump under the nipple but kept putting off making an appointment. She does admit to 6 months of fatigue but no weight loss, weight gain, fever, or night sweats. Her past medical history is significant for hypothyroidism. She does not have a history of eczema or allergies. She denies any tobacco, alcohol, or drug use. Examination shows a middle-aged woman appearing her stated age. Inspection of her right breast reveals a scaly eczema-like crust around her nipple. Underneath a nontender 2-cm mass is palpable. The axilla contains only soft moveable nodes. The left breast examination and axilla are unremarkable. What visible skin change of the breast does she have? A. Nipple retraction B. Paget's disease C. Peau d'orange skin

B. Paget's disease This uncommon form of breast cancer starts as an eczema-like scaly skin change around the areola. The lesion may weep, crust, or erode. It can be associated with an underlying mass, but skin change can also be found alone. Any eczema-like area around the nipple that does not respond to topical treatment needs to be evaluated for breast cancer.

During the physical examination of a client's breast, which finding should the nurse recognize as a possible indication of a malignant tumor? A. Well-defined lump B. Retraction of nipples C. Stretch marks on breast D. Tenderness of breast

B. Retraction of nipples Retracted nipples are indicative of a malignant tumor. A malignant tumor has fibrous strands attached to the breast tissue and fascia of the muscles. As the muscle contracts, it draws the breast tissue and skin with it, causing dimpling or retraction. Lumps are ill defined and nontender in breast cancer. Linear stretch marks may be seen during and after pregnancy or with significant weight gain or loss. A generalized increase in nodularity and tenderness may be a normal finding associated with the menstrual cycle or hormonal medications.

How should a nurse instruct a client to perform a breast self-examination to most effectively cover the entire breast? A. In a circular pattern beginning at the nipple and moving outward B. Up-and-down pattern starting at the underarm and moving across the breast C. Rub the finger pads across the breast in a horizontal motion D. Raise the arm straight up and over the head so that the underarm tissue is exposed

B. Up-and-down pattern starting at the underarm and moving across the breast There is some evidence that the up-and-down pattern, also referred to as the vertical pattern, is the best method to most effectively cover the breast tissue. It is important to teach the client that breast tissue covers the entire upper chest, thus the exam should be performed from the underarm and move across the breast to the middle of the chest bone (sternum). Hands should go up and down the breast until the client feels the ribs and up to the neck area.

Which client is at greatest risk for the development of a cancerous breast lesion? A. a 36-year-old woman experiencing her first pregnancy B. a 60-year-old postmenopausal woman C. a 16-year-old athletic woman D. a 55-year-old woman on estrogen therapy

B. a 60-year-old postmenopausal woman Breast cancer is most observable in women over the age of 50. Age-related risks for cysts are higher in women over 50 on estrogen therapy. The risk for fibroadenoma is higher for women between ages 15 to 25 but can be seen in women up to age 55.

Benign conditions of the breast include A. ductal carcinoma B. fibrocystic changes C. Paget disease D. precancerous lesions

B. fibrocystic changes Cysts (due to BBD) are common lumps that are usually elliptical or round, soft, and mobile. Size may vary, and they often occur in multiple numbers, usually in both breasts, and frequently in the upper outer quadrants.

Which characteristic would support the determination that a client is at high risk for breast cancer? A. history of lobular hyperplasia B. first degree relative with a history of either BRCA1 or BRCA2 mutation C. extremely dense breast tissue D. history of atypical ductal hyperplasia

B. first degree relative with a history of either BRCA1 or BRCA2 mutation A known first-degree relative, including a father or brother, with BRCA1 or BRCA2 mutation is considered a high risk factor for the development of breast cancer. The remaining options are associated with a moderate risk.

What instruction should the nurse provide to a client to assess for dimpling or retraction of breast tissue? A. shrug the shoulders B. raise arms over the head C. bend both arms at the elbows D. extend the arms out to the side

B. raise arms over the head To bring out dimpling or retraction that may otherwise be invisible, ask the client to raise the arms over the head. Shrugging the shoulders, bending the arms at the elbows, and extending the arms out to the side are not actions to bring out breast dimpling or retractions.

Nurse G. is conducting a teaching session on breast self-examination to a group of women at a health fair sponsored by the local community center. Which of the following instructions is most accurate? A. "The best time to do BSE is at the midpoint of your menstrual cycle." B. "If you detect a lump that is larger than a grape, you should follow up with your doctor." C. "Remember that doing BSE regularly is not a replacement for regularly-scheduled mammograms or clinical examinations." D. "It's best not to do BSE in the shower because you need a mirror and a place to lie down in order to do it correctly."

C. "Remember that doing BSE regularly is not a replacement for regularly-scheduled mammograms or clinical examinations." BSE should be coupled with mammography and clinical examination on a schedule congruent with current guidelines and the client's risk factors. It should be performed 5-7 days after the beginning of the woman's period and all lumps or changes should be followed up on. A standing position in the shower is appropriate for palpation.

Which technique is appropriate for the nurse to use to palpate a client's breast? A. Tips of four fingers B. Palms of both the hands C. Flat pads of three fingers D. Palm and fingers of one hand

C. Flat pads of three fingers The nurse should use the flat pads of three fingers to palpate the breast of the client for accurate assessment. The tips of four fingers, palms of both hands, or palm and fingers of one hand are not used for assessing the breasts as they may not give accurate results on examination.

While examining a client's breasts, a nurse notices milky discharge from the nipple. The client explains that she recently had a baby and is currently breastfeeding. The nurse understands that which type of tissue in the breast is responsible for allowing milk production? A. Fibrous B. Fatty C. Glandular D. Lymphatic

C. Glandular Glandular tissue constitutes the functional part of the breast, allowing for milk production. The fibrous tissue provides support for the glandular tissue largely by way of bands called Cooper's ligaments (suspensory ligaments). Fatty tissue provides most of the substance to the breast and thus determines the size and shape of the breasts. Lymphatic tissue, which forms lymph nodes, is responsible for draining lymph from the body.

A nonpregnant female presents to the health care facility and reports new onset of breast discharge. The nurse assesses the discharge to be milky in appearance without breast tenderness or masses. What additional data should the nurse obtain from this client? A. Recent surgeries or trauma B. Environmental exposure to chemicals C. Prescribed medications such as antipsychotic agents D. Alcohol intake in excess of three drinks a day

C. Prescribed medications such as antipsychotic agents A persistent milk secretion (galactorrhea) from the breasts in a nonpregnant, nonlactating woman can be caused by the intake of hormones, contraceptives, and some antipsychotic agents, such as haloperidol (Haldol). Recent surgeries or trauma and exposure to chemicals are not known to cause persistent milk discharge. Excessive alcohol intake is a risk factor for the development of breast cancer.

The nurse is preparing to examine the breasts of a female client who had a left radical mastectomy 3 years ago. When examining the client, the nurse observes redness at the scar area. The nurse should explain to the client that this may be indicative of A. additional tumors. B. poor lymphatic drainage. C. an infectious process. D. metastasis to the right breast.

C. an infectious process. Redness and inflammation of the scar area may indicate infection.

A client denies performing breast self-examination however practices breast awareness. What is this client focusing on when following this practice? A. Size of the chest and bra B. Frequency of discharge from the nipples C. Amount of discomfort that occurs with menstruation D. Appearance, feel, and shape of the breasts and nipples

D. Appearance, feel, and shape of the breasts and nipples Because breast self-examination has been met with controversy, an alternative called breast self-awareness may be practiced. This is the act of becoming familiar with the appearance, feel, and shape of one's breasts and nipples. Breast self-awareness does not focus on the size of the chest and bra or the amount of breast discomfort with menstruation. Discharge from the nipples should be reported to the health care provider for evaluation.

While interviewing a client, the nurse asks her what her typical daily diet consists of. Which of the following is associated with an increased risk for breast cancer? A. A glass of wine daily B. Two cups of coffee per day C. High-sugar diet D. High-fat diet

D. High-fat diet A high-fat diet may increase the risk for breast cancer. Alcohol intake exceeding two drinks per day and tobacco use has been associated with a higher risk for breast cancer. Caffeine can aggravate fibrocystic breast disease, but is not associated with breast cancer. A high-sugar diet is not associated with breast cancer.

The nurse instructs a female client on breast self-examination. Why does the nurse recommend the pattern shown for the client to use? A. It takes the least amount of time B. It is easiest for the client to learn C. It causes the least amount of pain D. It is the best technique to detect masses

D. It is the best technique to detect masses The vertical stripping pattern is currently the best validated technique for detecting breast masses. It is not recommended because it takes the least amount of time, is the easiest for the client to learn, or because it causes the least amount of pain.

During the breast examination of a client, the nurse notes red, scaly, and crusty areas over the areola. The nurse understands that this appearance of the skin is due to what type of breast condition? A. Fibroadenoma B. Metastatic disease C. Fibrocystic lesions D. Paget disease

D. Paget disease Paget disease causes red, scaly, and crusty areas over the areola. A pigskin-like or orange-peel appearance is found in metastatic disease of the breast. It results from edema caused by blocked lymphatic drainage. A fibroadenoma is a round, firm, and well-defined mass, is seldom tender, and is usually singular and mobile. Fibrocystic lesions are benign and firm but rubbery lesions that tend to be bilateral and may become tender just before menses.

When performing a breast assessment on a clinic client, the nurse practitioner notes scaly lesions that begin at the nipple and move toward a lump behind the nipple well. The NP would know that further assessment for what would be necessary? A. Mastalgia B. Lipoma C. Fibroadenoma D. Paget's disease

D. Paget's disease Paget's disease produces scaly lesions that begin at the nipple and progress to a lump behind the nipple well. Severe pain (mastalgia) is more likely to result from trauma or infection. Single breast masses can indicate benign conditions (e.g., cysts, fibroadenoma, fat necrosis, lipoma) or more serious conditions (e.g., cancer).

The nurse instructs a client on breast self-examination techniques. Which observation indicates that teaching has been effective? A. Lays prone on a firm surface B. Feels the breasts with a warm wet washcloth C. Stands with arms extended to the sides of the body D. Palpates the breasts using an up and down approach

D. Palpates the breasts using an up and down approach When performing a breast self-examination, the client should be supine with the arm of the breast being examined under the head. The breasts should be palpated with the fingertips. The arms should be placed on the hips or extended above the head. One approach to palpate the breasts is to use an up and down approach.

Elevated sebaceous glands, known as Montgomery glands, are located in the breast's A. nipples. B. hair follicles. C. lactiferous ducts. D. areolas.

D. areolas. The areola surrounds the nipple (generally 1 to 2 cm radius) and contains elevated sebaceous glands (Montgomery glands) that secrete a protective lipid substance during lactation.

The nurse is working with a community group to set up teaching programs to increase awareness among African American women about preventive screening techniques for breast cancer. In the teaching program, the nurse should plan to include A. local female physicians who work with cancer clients. B. hospital clinic workers from various racial backgrounds. C. nurses who work in outpatient centers. D. breast cancer clients of the same race.

D. breast cancer clients of the same race. Black women were found to have various perceptions on the risks of breast cancer related to existing knowledge stigmatization, as well as spiritual and religious beliefs, which can decrease their engagement in breast cancer screening.

The nurse is caring for an adult female client when the client tells the nurse that she has had a clear discharge from her nipples for the past month. The nurse should ask the client if she has been taking A. nonsteroidal anti-inflammatory drugs. B. antibiotics. C. insulin. D. contraceptives.

D. contraceptives. Discharge may be seen in endocrine disorders and with certain medications (i.e., antihypertensives, tricyclic antidepressants, and estrogen).

A client has had a recent mastectomy and visits the clinic for postoperative evaluation. The client tells the nurse that she has been depressed and feels as if she is less of a woman. The most appropriate nursing diagnosis for this client is A. ineffective individual coping related to mastectomy. B. fear of additional breast cancer related to the presence of risk factors. C. PC: hematoma after mastectomy. D. disturbed body image related to mastectomy.

D. disturbed body image related to mastectomy. When interviewing clients - especially females - about the breasts, keep in mind that this topic may evoke a wide spectrum of emotions from the client. Explore your own feelings regarding body image, fear of breast cancer, and the influence of the breasts on self-esteem. Disturbed body image is the most appropriate nursing diagnosis.

The size and shape of the breasts in females are related to the amount of A. glandular tissue. B. fibrous tissue. C. lactiferous ducts. D. fatty tissue.

D. fatty tissue. Fatty tissue is the third component of the breast. The glandular tissue is embedded in the fatty tissue. This subcutaneous and retromammary fat provides most of the substance to the breast, determining the size and shape of the breasts.

The nurse plans to instruct an adult female client with regular menstrual cycles, who is not taking oral contraceptives, about breast self-examination. The nurse should plan to instruct the client to perform breast self-examination A. during menstruation. B. on the same day every month. C. midway between the cycles. D. right after menstruation.

D. right after menstruation. BSE is usually performed monthly after the period.

A mother brings her adolescent son into the clinic because she is concerned about his development of breast tissue. Her son denies use of any medications and is slender in appearance. What should be the nurse's next action? A. Palpate for any irregular or hard masses. B. Provide dietary teaching. C. Advise the mother that these hormonal changes are normal. D. Recommend continued observation for the next 1-2 years.

A. Palpate for any irregular or hard masses. Gynecomastia (firm, glandular tissue in the breasts) in males may occur when there is an imbalance of estrogen and androgen. An ulcer or hard, irregular mass suggests cancer and should be palpated for upon initial assessment. Gynecomastia also occurs with use of anabolic steroids, diseases, and as an adverse effect of some medications; however this boy denies any medication use. Gynecomastia also occurs in overweight or obese males; however this client is slender; therefore dietary teaching is not the next, best action. These hormonal changes can be expected; but first the nurse should assess for a serious condition such as cancer by palpating for hard or irregular masses. Uncomplicated gynecomastia does tend to resolve with time; but the nurse must assess for signs of abnormalities such as cancer first.

A client asks why the nurse touches the area near the arm pit when conducting a breast examination. What should the nurse respond to this client? A. "The mammary ducts are in this region." B. "I'm checking the integrity of your fibrous tissue." C. "This is where most of the fatty breast tissue is located." D. "The upper outer quadrant of the breast extends into the axillae."

D. "The upper outer quadrant of the breast extends into the axillae." The upper outer quadrant extends into the axillary area and is referred to as the tail of Spence. This is the location for most breast tumors. The mammary ducts are located closer to the glandular tissue. The fibrous tissue provides support for the glandular tissue. Fatty tissue provides most of the substance of the breast.