ASSESSING BREASTS &

LYMPHATIC SYSTEM
Conical shape
Equal on both sides
Lies between the 2nd & 6th
ribs & between the sternal
edge & mid axillary line

Function
produce nourishment for
offspring
sexual stimulation
Approx. 2/3 – lies over
the pectoralis major
muscle
1/3 – superficial to the
serratus anterior
muscle
Tail of the
breast extends
into the axilla
Composed of connective
tissue, smooth muscle,
blood vessels & nerve
endings

Contraction of smooth
muscles makes nipple
firm & erect
Sexual stimulation
Darker tissue
surrounding
nipple
Contains
occasional hair
follicles & small
glands (lubricates
nipple)
Montgomery Gland
Elevated sebaceous
gland

Lipoidfluid secretions
(lubricates & protects
nipple)

Olfactory stimulus for

NB appetite
 INTERNAL BREAST ANATOMY

3 types of tissues
• Glandular - functional part: milk production
• Fibrous - support for glandular tissue
• Fatty (adipose) - provides most of the breast substance
Glandular tissue:
Composed of 15-20 lobes
Lobe – contain several lobules in which the secreting alveoli (acini
cells) are embedded
Lactiferous sinus (ampullae)- slight enlargement in each duct; stores
milk
Fibrous tissue:
Cooper’s Ligament -
composed of bands of
breast tissue fused
with outer layers of
superficial fascia

supports breasts
Fatty Tissue:
• Glandular tissue is embedded
• Determines the size of the breast

• Functional capability of breast is not related to size but

glandular tissue present.
Supplies blood
to the breast
 Anterior (pectoral) drain
anterior chest wall & breast
Posterior (subscapular)
posterior chest wall & part of
the arms
Lateral (brachial) most
of the arm
Central (mid-axillary)
receive drainage from APL
Supraclavicular & Infraclavicular
Often site for metastatic
breast Ca
Internal mammary
- Deep in anterior chest
- Drains mammary glands
Epitrochlear
- In depression above &
posterior to medial area of
elbow
- Drains arm
 
NEUROENDOCRINE
Sucking stimulates impulses
to the hypothalamus
anterior pituitary gland →
prolactin→milk production
posterior pituitary gland →
oxytocin→ muscle cells
surrounding the glandular tissue
→ milk extraction
REPRODUCTIVE
Breast development & function
Estrogen elongates the excretory ducts
Progesterone increases the number & size of
lobules
Progesterone increases breast cell growth& dilation
of blood vessels after ovulation.
INFANTS

❑Atbirth – elevated nipples

❑“witch’s milk”
❑Palpable breast tissue
❑Supernumerary nipples
PREGNANT PATIENTS

❑Breast becomes fuller &

firmer
❑Areola & nipples darken &
enlarge
❑3rd trimester – colostrum

Pregnancy is not the ideal

time for BSE
OLDER ADULTS
Glandular tissue is replaced
with adipose tissue & ducts
becomes fibrous
general reduction of muscle
mass & tone (less firm & more
pendulous, saggy)
Smaller, flatter, less erectile
nipples
Challenging BSE
Reluctant- “touching
yourself” (taboo)
Inframammary ridge
below the breast can be
mistaken for a mass
Ashkenazi Jews (Eastern Europe)–greater incidence
of breast cancer (gene)
Caucasian women- greater risk for breast Ca Dx.
Black women - greater risk for dying of breast Ca
Canadian - Breast Ca leading cause of mortality and
morbidity
BREAST LUMP OR
MASS
common complaint

May be normal
physiological nodularity
or neoplasm
mastalgia, mastodynia, mammalgia

Normal menstrual cycle

May be associated with metastatic disease

Rapidly enlarging cyst, infection or abscess,

mastitis, hematoma, trauma, fibrocystic disease
 May be normal or abnormal
Spontaneous or manually
expressed
Lactating – abnormal
spontaneous discharge
Medications: oral contraceptives,
phenothiazines, steroids, digitalis,
diuretics
Galactorrhea
anti ulcer, antipsychotic, Depo-
Provera
Pituitary tumor
Acanthosis nigricans -
velvety pigmentation of
axilla

Dimpling; retraction-
fibrosis or fixation of
tissue
Orange peel appearance
Edematous thickening &
pitting
Breast / axillary lymph node
infection
late sign of breast CA
Menstruation –
early menarche (<13); late
menopause (>52)
Surgery - implants
Chronic illness
-adrenal & pituitary tumors
Nursing stopped
Medications - HRT
 
 Fibrocystic Breast
Breast pain or tenderness
Lumps or areas of thickening
Fluctuating size of breast
lumps
Green or dark brown non
bloody nipple discharge
Changes in both breasts
Exacerbated by caffeine intake
Lipoma, fibroadenoma, milk
cyst, intaductal papilloma
Well defined mass or masses in breast
No pain
Mass is round, firm, discrete, movable, 1-5cm
Usually solitary, but may be multiple; bilateral
Teens, early 20’s, menopause
Pain accompanied by
breast tenderness
Firm,warm, & reddened
Hx of cracked nipples
Breast abscess
Painful enlarged axillary
nodes
3rd/ 4th wk. postpartum
 Intraductal Papilloma

Moderate pain
No palpable tumor or mass
Age 35-50
Serous or serosanguinous discharge from one nipple duct
unilaterally
Mammary duct becomes clogged
Nipple discharge & retraction
Pain in affected areas
Itching around nipple
Subareolar ducts feel like rubbery
lesions filled with pastelike
material
Possible enlargement of regional
nodes
Early stage menopause
affect nipple and areola
eczema-like rash
red, itchy and inflamed; flaky
or scaly
straw-colored or bloody
discharge
Nipple may turn inward
Tingling, increased sensitivity
to pain
nipple erosion, retraction ;
bloody discharge
Enlarged, shrunken or dimpled
breast with no pain
Nontender, firm or hard lump,
irregularly shaped & fixed to
skin or underlying tissue
Enlarged surrounding lymph
nodes
 RISK ASSESSMENT (Nonmodifiable)

Gender
NON MODIFIABLE
Age
Race/ethnicity
Personal Hx of breast Ca
Family history- 1st degree relative; >1 family member
Breast consistency - denser breast
Previous chest radiation before 40
Diethylstilbestrol exposure
 RISK ASSESSMENT (Modifiable)
Nulliparous; gave birth to 1st child after 30
Recent oral contraceptive use
Hormone Replacement Therapy
No Hx. of breastfeeding
Alcohol consumption; smoking
Obesity
Limited physical activity; inadequate rest
High fat diet
Caffeine intake