breasts and lymphatic system assessment

• Breast


  Paired mammary glands that lie over the muscles of the anterior chest wall, anterior to the pectoralis major and serratus anterior muscles

  
• Breast


  • Extend vertically from the 2nd to the 6th rib and horizontally from the sternum to the mid-axillary line

  
• Male and female breasts

  Similar until puberty, when female breast tissue enlarges in response to the hormones estrogen and progesterone
• Female breast


  Accessory reproductive organ with 2 functions: produce and store milk, aid in sexual stimulation
• Male breasts


  Have no functional capability
• Breast quadrants


  Upper outer quadrant (tail of Spence) is where most breast tumors occur

  
• Lymph nodes in breasts

  Drain lymph from the breasts to filter out microorganisms and return water and protein to the blood
• Nipple


  Located in the center of the breast, contains the tiny openings of the lactiferous ducts through which milk passes

  
• Areola


  Surrounds the nipple, contains elevated sebaceous glands (Montgomery glands) that secrete a protective lipid substance during lactation, hair follicles commonly appear, smooth muscle fibers cause the nipple to become more erectile during stimulation, pigmentation increases with pregnancy then decreases after lactation
• Milk line or ridge


  Extends from each axilla to the groin area during embryonic development, gradually atrophies and disappears, supernumerary nipples or other breast tissue may appear along this "milk line"

  
• Breast tissue types


  • Glandular
  • Fibrous
  • Fatty

  
• Glandular tissue


  Constitutes the functional part of the breast, allowing for milk production, arranged in 15 to 20 lobes that radiate in a circular fashion from the nipple

  
• Mammary ducts


  From the alveoli converge into a single lactiferous duct that leaves each lobe and conveys milk to the nipple, lactiferous sinus is a slight enlargement in each duct before it reaches the nipple where milk can be stored until stimulated
• Fibrous tissue


  Provides support for the glandular tissue largely by way of bands called Cooper's ligaments (suspensory ligaments)
• Fatty tissue

  Third component of the breast, subcutaneous and retromammary fat provides most of the substance to the breast, functional capability is not related to size but rather to the glandular tissue present

  
• Lymph nodes


  Major axillary lymph nodes: anterior (pectoral), posterior (subscapular), lateral (brachial), and central (mid-axillary)
• Gynecomastia


  Enlargement of breast in males

  
• If hormones is not enough, milk is not enough
• Lumps


  May be present with benign breast disease (fibrocystic breast disease), fibroadenomas, or malignant tumors
• Premenstrual breast lumpiness and soreness

  May indicate benign breast disease (fibrocystic breast disease)
• Lymphadenopathy


  Enlargement of lymph nodes
• Redness and warmth


  Indicate inflammation
• Dimpling or retraction of the nipple or fibrous tissue


  May indicate breast cancer
• Increase in the size of one breast

  May indicate inflammation or abnormal growth

  
• Decrease in the size and firmness of the breast

  As the client ages due to a decrease in estrogen levels, glandular tissue decreases whereas fatty tissue increases
• Symptoms of fibrocystic breasts


  • Breast pain or tenderness
  • Lumps or areas of thickening
  • Fluctuating size of breast lumps
  • Green or dark brown nonbloody nipple discharge
  • Changes in both breasts

  
• Blood or blood-tinged nipple discharge


  Requires referral to a physician for further evaluation
• Clear benign nipple discharge


  May be manually expressed from a breast that is frequently stimulated, certain medications can also cause this
• Personal history of breast cancer

  Increases the risk for recurrence of cancer
• Early menses (before age 13) or delayed menopause (after age 52)


  Increases the risk for breast cancer
• Never given birth or first child after age 30


  Increases the risk of breast cancer
• Hormones, contraceptives, and antipsychotic agents


  Can cause breast engorgement in women, hormones and oral contraceptives also increase the risk of breast cancer, haloperidol and medroxyprogesterone can cause galactorrhea
• Exposure to radiation, benzene, or asbestos

  Can increase the risk of breast cancer
• High-fat diet


  May increase the risk for breast cancer
• Alcohol intake exceeding two drinks per day


  Has been associated with a higher risk for breast cancer
• Caffeine


  Can aggravate fibrocystic breast disease
• Vigorous exercise


  Can cause breast tissue to lose its elasticity
• Condition of the breasts

  May significantly influence how a woman feels about herself, alterations in the breasts may threaten a woman's body image and feelings of self-worth, men may be embarrassed to have enlarged breasts
• The ACS recommends a clinical breast examination by a health care professional every 3 years for women ages 20 to 39 and every year for women age 40 and older
• The ACS recommends an annual mammogram for women age 40 and continuing for as long as a woman is in good health