BREAST AND LYMPHATIC SYSTEM

• Supernumerary Nipples

  ● is an additional nipple

  ● minor birth defect

  ● nonfunctional, without accompanying mammary glands

  ● similar to the location of nipples on mammals that have multiple nipples along the underbelly
• Corpus luteum and placenta – can cause breast soreness during pregnancy
• Male Concerns - Composed of a well-developed areola and small nipple that has immature tissue underneath
• Gynecomastia - describes the enlargement of male breast tissue and may occur normally in adolescent and in elderly 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

  • There are 12 to 20 minute openings on the surface of the nipple
  • collects milk and carries it to the nipple
• Areola

  • A pigmented area surrounding the nipples approximately 2.5 to 10cm in diameter
• Axilla

  • The small hollow portion beneath the arm where it joins the body at the shoulders
  • Also called the armpit
• Central Nodes

  • most frequently palpable of the axillary lymph nodes
  • lie along the chest wall, usually high in the axilla and midway between the anterior and posterior axillary folds into them drain channels from three other groups of lymph nodes, which are seldom palpable
• 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 OF BREAST

  Normal Findings

  • areolar areas and nipples are darker in pigmentation
  • terminal hairs on the areola
  • color varies depending on the client’s skin tone
  • smooth texture, no lesions
  • linear stretch marks may be seen during and after pregnancy
• ASSESSMENT OF BREAST

  Deviations from normal

  Redness

  • associated with inflammation

  Peau d’orange

  • pigskin-like or orange peel appearance
  • due to edema
  • due to blocked lymphatic drainage
  • common to patients with edema and metastatic breast diseases
  • Indication that there could be a blocked lymphatic drainage
• VENOUS PATTERN / VASCULARITY

  ○ Normal

  ▪ normal superficial vascular patterns are diffuse

  and symmetrical

  ▪ VEINS are more prominent during pregnancy

  ○ Deviations from normal

  ▪ asymmetric venous pattern

  ▪ may be due to malignancy
• CONTOUR

  ○ Normal

  ▪ the breast is normally convex, without flattening

  ▪ No retractions or dimpling

  ○ Deviations from normal

  Retracted Nipple

  • suggest malignancy

  Retracted Breast Tissue

  • suggest malignancy

  Dimpling

  • suggest malignancy
• 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

  1. nonpregnant, nonlactating clients

  ▪ yellow discharge known as COLOSTRUM

  1. white discharge of breast milk
  2. rich in antibodies

  ○ When assessing the breast think of the word DISC

  ▪ D – discharge

  ▪ I – inversion

  ▪ S – skin changes

  ▪ C – compare with the other side
• Patterns of Palpation

  ○ Circular or clockwise

  ○ Spiral or concentric circles

  ○ Wedge or spokes of a wheel

  ○ Vertical strip
• Vertical strip

  • Best validated technique in detecting breast mass
• Bimanual technique

  • Use 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 (if palpating superficial area of the breast)

  ▪ Medium (if palpating for mid-level tissues of the

  breast)

  ▪ Firm (if palpating for an area near the ribs)
• EVALUATION OF BREAST MASS

  Note for the following:

  ○ Breast Lump

  ○ Demarcation

  ○ Mobility

  ○ Tenderness

  ○ Retraction