Physical Assessment: Breasts

Front 1

External Anatomy of the Breast

Back 1

-lies btw 2nd and 6th ribs btw sternal edge to mid axillary line
-nipple is just below center
-superior lateral corner (Tail of spence) projects up into axilla

Front 2

Internal Anatomy of Breast

Back 2

breast tissue composed of:
-glandular tissue located 15-20 loves around nipple
-fibrous bands of tissue of suspensory ligaments
-fat or adipose tissue surrounding breast and predominates

Front 3

Four quadrants

Back 3

upper inner quadrants, upper outter quadrants, lower inner quadrant, lower outter quadrant
-or use clock around nip

Front 4

Lymphatics of the breast area

Back 4

axillary nodes:
*central axillary nodes
*pectoral nodes
*subscapular nodes
*lateral axillary nodes

Front 5

Significant health history

Back 5

-mammogram-should start at 40-every 2 years and 1 year at 50
-breast cancer and cervical diseases increases w age
-noperity (not pregnant) or child bearing after 50

Front 6

Inspection of breast

Back 6

-normal for one to be smaller than other
dimpling-suspensatory ligaments tight (not good)
mastitis-infection of breast (discolor)
venous pattern-if one breast has more-->question a tumor

Front 7

Retraction maneuvers

Back 7

-arms held stright above head and hands pressing down on hips
-move pectoral muscle
-anything attached to muscle shows up

Front 8

Inspection of nipple

Back 8

-note size, shape, direction they point, rashes, ulceration, discharge
-should be symmetrical and places same area on each breast
-should NOT be pointing in diff directions

Front 9

Development of breasts with age

Back 9

-sometimes infants have enlarged breasts bc maternal estrogen
-adolescence-btw 8 and 10-->breasts change
-older breast-more pendulous, flattened against chest wall-different feel (glandular

Front 10

Supernumerary nipple

Back 10

-milk line develops en utero
-third nipple->along milk line
-6 cm below reg nipple
-no significants, glandular tissue
-just an extra nipple

Front 11

Palpate breasts

Back 11

-best position when tissue is flattned
-should take 3 minutes per breast
-use fingertips
-light, medium, deep pressure
-spider or spiral pattern
-bimanual palpation (standing up-one above and below)

Front 12

Breast Cancer in Gender

Back 12

female-often upper outter quadrant or tail spense
men-under nipple

Front 13

If any lumps-what to note

Back 13

location
size in cm
shape
consistency (soft, firm, or hard like a pearl)
mobility
distinctiveness
nipple retraction
overlying skin
tenderness
lymphaedenopathy

Front 14

Palpate nipple

Back 14

squeeze nipple-see if secretions come out

Front 15

Breast Self-Examination

Back 15

-schedule of self exeam day 5 of menstrual cycle
-correct technique
-return demonstration

Front 16

Fibroadenomas

Back 16

-age 15-25
usually puberty/young adult but up to 55
usually single, sometimes multiple
-round, disclike, lobular
-soft or firm (solid)
-well dilineated
-very mobile
-usually nontender
-usually follows ultrasound
-not cancerous

Front 17

Fibrocystic breast disease

Back 17

age 30-50-regress after menopause except w estrogen therapy
-single or multiple
-round
-soft to firm, usually elastic
well dilineated
mobile
often tender
not canceorus

Front 18

Breat Cancer

Back 18

-30 and older-most common 50
-usually single, sometimes w other nodules
-irregular or stellate
-firm or hard
-not very dillineated-from surrounding tissues->not soft edge when felt
-may be fixed to skin or surrounding tissues
-usually nontender

Front 19

Edema of breast (Peau d'orange)

Back 19

swelling of breast
looks like orange

Front 20

Breast Retraction

Back 20

Skin pulled in and dimpled
suspensory ligaments tightened up

Front 21

Tanner Stages

Back 21

1-pre adolescent-elevated nipple only
2-bread bud stage-nipple small mound-alveolar starts to widen
3-further enlargement of breast and areola
4-projection of areola and secondary mound forming
5-mature stage-projection of nipple only-areola receded to contour

stage breasts by developmental phase

Front 22

Male breast assessment

Back 22

can be done sitting
-breast is underdeveloped under nipple
gynecomastia-enlargement of tissue
-normal during puberty
-temporary
seen in anabolic steroids or liver disease

Front 23

Older breasts

Back 23

pendulous
flattened and sagging
more granular in touch