BREAST & LYMPHATIC SYSTEM

• BREAST


  a pair of mammary glands located on the anterior chest wall the milk-producing gland of women
• Anatomic Breast Landmarks And Their Position In The Thorax

  extending vertically from the 2nd to the 6th rib and laterally from the sternal border to the axilla
• How the breasts change with age?

  - Occurs between ages 8-13 (Thelarche)

  - Breast and nipple as a single mound

  - Tender and full During the reproductive years

  - During pregnancy:  

  - pigmentation and enlargement

  - darkening of nipples and areola

  - corpus luteum and placenta – can cause breast sorenesss

  - Glandular tissue atrophy; Gradual decline of tissues on the mammary glands during menpoause
• FEMALE BREASTS - has 3 types of breast tissues:

  1. GRANDULAR - functional part of the breast, allowing for milk production.

  2.  FIBROUS - provide support to glandular tissue largely by way of bands called Copper Ligaments

  3. FATTY - glandular tissue is embedded in the fatty tissue
• MALE CONCERNS

  - composed of a well-developed areola and small nipple that has immature tissue underneath

  GYNECOMASTIA - enlargement of breasts in male
• Nipples


  - round, hairless pigmented protrusion of erectile tissue approximately 0.5 to 1.5 in diameter

  - located at the center of the breast
• LACTIFEROUS DUCTS - TINY OPENINGS


  there are 12 to 20 minute openings on the surface of the nipple
•  Areola


  a pigmented area surrounding the nipples approximately 2.5 to 10cm in diameter
• Montgomery's Tubercle


  ▪ appears rough because it contains modified sebaceous (oil) glands

  ▪ helps lubricate the nipple, lactation
• Axilla (armpit)


  the small hollow portion beneath the arm where it joins the body at the shoulders
• Axillary Tail (Tail of Spence)


  breast tissue extends to this tall superiolaterally
• Mammary Ridge (Milk LIne)


  primordial for the mammary gland on the breast in associated with breast development
• • Functions Of The Breasts

  1. synthesis, secretion and ejection of milk for the nourishment and protection of

  neonates and infants

  2. breastfeeding

  3. provides sensual pleasure during sexual foreplay

  4. provides some protection on the anterior chest wall
• ▪ Pectoral Nodes (anterior) - located along the lower border of the pectoralis major inside the anterior axillary fold

  ▪ Subscapular Nodes (posterior) - located along the lower border of the pectoralis major inside the anterior axillary fold

  ▪ Lateral Nodes (brachial) - located along the upper humerus
• ASSESSMENT PROPER

  Inspection

  • Color

  Deviations from normal:

  ▪ redness - associated with inflammation

   

  ▪ peau d’orange

  - pigskin-like or orange peel appearance

  - due to edema

  - due to blocked lymphatic drainage

   

  • Venous Pattern / Vascularity

  - Observe for visibility and pattern of breast veins
• Lesions or Masses

  Deviations from normal:

  Cancerous Tumors

  • irregular, firm, hard

  • not usually tender

  • usually occur after age 50

  • The most common symptom of breast cancer is a new lump or mass

   

  Fibroadenomas

  • lobular, ovoid, round

  • firm, well-defined, seldom tender

  • singular and mobile

  • usually occur between puberty and menopause

  • noncancerous breast lumps

  ▪ Fibrocystic breast disease (benign)

  • round, elastic, defined, tender, mobile cysts

  • common from age 30 to menopause

   

   

   
• • Discharge

  Normal

  ▪ no discharge

  • nonpregnant, nonlactating clients

  ▪ yellow discharge known as COLOSTRUM

  • white discharge of breast milk

  When assessing the breast think of the word DISC

  ▪ D – ischarge

  ▪ I – nversion

  ▪ S – kin changes

  ▪ C – ompare with the other side

   
• • Patterns of Palpation

  - circular or clockwise

  - spiral or concentric circles

  - wedge or spokes of a wheel

   

  VERTICAL STRIP

  - Best validated technique in detecting breast mass

  - bimanual technique

   

  - use the BIMANUAL TECHNIQUE if the client has large breasts

  - Support the breast with your nondominant hand and use your dominant hand to palpate
•  Vary The Levels Of Pressure As You Palpate

  ▪ light - superficial

  ▪ medium - mid level tissue

  ▪ firm - to the ribs
• Inspection and Palpation of Male Breast

  • done essentially in the same manner as that of the female breast

  • Every month

  • Every 1 – 3 years

  • 1% of all breast cancer is found in men
• The Upper Outer Quadrant Is the Area Most Targeted By Breast Cancer
• The breasts are paired mammary glands that lie over the muscles of the anterior chest wall, anterior to the pectoralis major and serratus anterior muscles.
• Depending on their size and shape, the breasts extend vertically from the second to the sixth rib and horizontally from the sternum to the mid-axillary line.
• 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.
• The female breast is an accessory reproductive organ with two functions: to produce and store milk that provides nourishment for newborns and to aid in sexual stimulation.
• The male breasts have no functional capability.
• The upper outer quadrant of breast, which extends into the axillary area, is referred to as the tail of Spence. Most breast tumors occur in this quadrant.
• Lymph nodes are present in both male and female breasts. These structures drain lymph from the breasts to filter out microorganisms and return water and protein to the blood.
• The skin of the breasts is smooth and varies in color depending on the client’s skin tones.
• The nipple, which is located in the center of the breast, contains the tiny openings of the lactiferous ducts through which milk passes.
• 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.
• Hair follicles commonly appear around the areola.
• Smooth muscle fibers in the areola cause the nipple to become more erectile during stimulation.
• The nipple and areola typically have darker pigment than the surrounding breast. Their color ranges from dark pink to dark brown, depending on the person’s skin color. The amount of pigmentation increases with pregnancy, then decreases after lactation. It does not, however, entirely return to its original coloration.
• During embryonic development, a milk line or ridge extends from each axilla to the groin area. It gradually atrophies and disappears as the person grows and develops. However, in some clients, supernumerary nipples or other breast tissue may appear along this “milk line”
• Female breasts consist of three types of tissue: glandular, fibrous, and fatty (adipose).
• Glandular tissue constitutes the functional part of the breast, allowing for milk production.
• Glandular tissue is arranged in 15 to 20 lobes that radiate in a circular fashion from the nipple. Each lobe contains several lobules in which the secreting alveoli (acini cells) are embedded in grape-like clusters.
• Mammary ducts from the alveoli converge into a single lactiferous duct that leaves each lobe and conveys milk to the nipple. The slight enlargement in each duct before it reaches the nipple is called the lactiferous sinus.
• The milk can be stored in the lactiferous sinus (or ampullae) until stimulated to be released from the nipple.