Chapter 17 Breasts And Regional Lymphatics

Front 1

Axillary Tail of Spence

Back 1

extension of breast tissue into axilla

Front 2

Breast is made of

Back 2

Glandular Tissue, Fibrous Tissue, and Adipose tissue

Front 3

Glandular Tissue

Back 3

15-20 lobes that radiate from nipple made of lobules that are made of clusters of alveoli that produce milk

Lobes empty into lactiferous duct

Lactiferous duct forms collecting system that converge towards nipple where they form ampullae which are reservoirs for storing milk

Front 4

Suspensory ligaments or Cooper's ligaments

Back 4

fibrous bands extending from surface to attach on chest well muscles. Support breast tissue. BEcomes contracted during breast cancer producing pits/dimples

Front 5

Four Quadrants

Back 5

Upper Outer, Upper Inner, Lower Outer, Lower Inner, AND TAIL OF SPENCE


Site of most breast tumors: Upper Outer

Front 6

Lymphatics: Central Axillary Nodes

Back 6

High up in middle of axilla over ribs and serratus anterior muscle. Receive lymph from other 3 groups of nodes

Front 7

Lymphatics: Pectoral (anterior)

Back 7

Along lateral edge of pectoralis major muscle, inside anterior axillary fold, drains towards central axillary node

Front 8

Lymphatics: Subscapular (posterior)

Back 8

Along lateral edge of scapula, deep in posterior axillary fold

Drains towards Central Axillary Node

Front 9

Lymphatics: Lateral

Back 9

Along humerus, inside upper arm. Flows up to infraclavicular and supraclavicular nodes.

Front 10

Cross Cultural: Breast Cancer

Back 10

Lower in AA women but mortality is higher

Lower in countries where diet is low in fat

Front 11

Lymphatics: Central Axillary Nodes

Back 11

High up in middle of axilla over ribs and serratus anterior muscle. Receive lymph from other 3 groups of nodes

Front 12

Lymphatics: Pectoral (anterior)

Back 12

Along lateral edge of pectoralis major muscle, inside anterior axillary fold, drains towards central axillary node

Front 13

Lymphatics: Subscapular (posterior)

Back 13

Along lateral edge of scapula, deep in posterior axillary fold

Drains towards Central Axillary Node

Front 14

Lymphatics: Lateral

Back 14

Along humerus, inside upper arm. Flows up to infraclavicular and supraclavicular nodes.

Front 15

Cross Cultural: Breast Cancer

Back 15

Lower in AA women but mortality is higher

Lower in countries where diet is low in fat

Front 16

If lump or mass is present, note

Back 16

Location (clock and cm), size (cm), shape, consistency, mobility, distinctness (solitary or multiple), nipple (displaced or retracted), overlying skin, tenderness, lymphadenopathy, temperature and color

Front 17

When to do BSE

Back 17

4th to 7th day of menses

Start in shower and next do while supine

Front 18

Dimpling

Back 18

Skin retraction due to fibrosis which contracts suspensory ligaments -> sign of cancer

Front 19

Fixation

Back 19

asymmetry, distortion, or decreased mobility with elevated arm maneuver
fibrosis fixes breast to underlying pectoral muscles
sign of cancer

Front 20

Edema (peau d'orange)

Back 20

Orange peel appearance of breast due to edema produced by lymphatic obstruction. Thickens skin and exaggerates hair follicles. This suggests cancer. Edema usually begins in skin around and beneath areola.

Front 21

Deviation in Nipple Pointing

Back 21

Cancer causes fibrosis in mammary ducts which pull nipple angle toward it.

Front 22

Nipple Retraction

Back 22

Retracted nipple is flatter broader, like underlying crater. May suggest cancer which cause fibrosis of duct system and pull in nipple. Can also be benign lesions such as ectasia of the ducts.

Front 23

Benign breast disease

Back 23

Multiple tender masses, bilateral nodularity, regular firm nodules that are mobile, demarcated, rubbery, small like water balloons. Dull pain, heavy, cyclic, or just before menses.Cysts are discrete, fluid-filled.

Front 24

Cancer

Back 24

solitary unilateral nontender mass. Single focus in ONE area, solid, hard, dense, fixed, irregular borders and poorly delineated. Grows constantly, painless often, UOQ, 30-80 y/o, esp 40 to 44 and >50.

Front 25

Fibroadenoma

Back 25

Solitary nontender mass. Benign breast disease. Solid, firm, rubbery, elastic, round, oval, or lobulated (1-5cm), freely movable, slippery, most common 15-30 y/o, grows quickly and constantly

Front 26

Paget's Disease

Back 26

Early lesion has unilateral, clear, yellow d/c and dry, scaling crusts, friable at nipple apex. Spreads outward to areola with erythematous halo on areola and crusted, eczema-tous, retracted nipple. Later lesions shows nipple reddened, excoriated, ulcerated, bloody d/c, erythematous plaque surrounding nipple.

Tingling, burning, itching

Front 27

Plugged Duct

Back 27

common, not serious; one milk duct clogged, one section of breast is tender, may be reddened, no infection. Usually resolves <1 day

Front 28

Breast Abscess

Back 28

Rare complication of generalized infection if untreated. Pocket of pus accumulates in one local area. Extensive nipple edema and abscess is pointing.

Front 29

Mastitis

Back 29

Inflammation of breast; inflammatory mass before abscess formation, occurs in single quadrant; area is red, swollen, tender, hot, and hard. May have headache, malaise, fever, chills, sweating, increased pulse, and flulike symptoms. First few months of lactation and may turn into abscess if untreated

Front 30

Gynecomastia

Back 30

Noninflammatory enlargment of male breast tissue. Physiologic at puberty, unilateral, mild, and transient. Common amongst aging males.

Front 31

Carcinoma in men

Back 31

Hard, ireggular, nontender mass, most often directly under areola, fixed to area, and may have nipple retraction. Mass is noticeable early because of minimal breast tissue.