Chapter 20Breast and Lymphatic system

A. Breast structure & function

Breast= Paired mammary glands Location: 2nd 6th rib & sternum mid-axillary line 4 quadrants intersect at nipple. Upper outer quadrant extends into axillary area-tail of spencer: breast cancer target External: nipples (lactiferous ducts), areola (Montgomery glands, hair follicles). Supernumera nipples: milk line: axilagroin. Develop during embryonic period & may disappear Internal 3 tissues:a. Fibrous: coppers ligaments- supportb. Fatty: breast substance, shape, sizec. Grandular: functional part, milk production- Lobes lobulesacini cellsmammary ducts laciferous duct lactiferous sinus (store milk) nipple Female breast . Enlargement: puberty-estrogen & progesterone. Accessory reproductive organ. Function: milk production & storage, sexual stimulationChanges in aged breasts: decrease in size, firmness, and fatty tissue increase Male breast. No functional capability . Soft, fatty enlargement of breast tissue is seen in obesity. . Gynecomastia, a smooth, firm, movable disc of glandular tissue, seen in one breast during puberty, usually temporary. However, it may also be seen in hormonal imbalances, drug abuse, cirrhosis, leukemia, and thyrotoxicosis. . Irregularly shaped, hard nodules occur in breast cancer.

B. Major axillary lymph nodes:

Function: drain lymph filter out microbes & return H2O+protein to blood1. Anteriorpectorial: drain anterior chest wall & breast2. Posteriorsubscapular: drain posterior chest wall & part of arm3. Lateralbrachial: drain most arm4. Centralmid-axillary: receives drainage from 1-3

C. Examination Equipment: Gloves, Centimeter ruler, Small pillow, Specimen slide, BSE handout examination. BSE: start in 20s 1/month pros: detect changes cons: small role in cancer detection & stressful . Mammogram: 40s:1/year, 50-74: biennial Normal findings:Upon inspection (pt: sitting upright) bilateral breasts same size, pendulant, and symmetric. Breast skin & areola same/darker skin tone, smooth texture. Venous patterns present or not. Montgomery tubercles present. Nipples everted/ inverted/flat bilaterally, no dryness, lesions, or discharge. Free movement of breasts with position changes of arms/hands. No dimpling, retraction, lesions, or erythema. Axillary skin free of redness, rashes, or irritation bilaterally. Upon palpation (pt:supine) breast tissue smooth, rm, elastic with generalized nodularity and tenderness bilaterally. No distinct mass. Bilateral mammary ridge firm & present. Temperature of breast tissue same as chest wall. No palpable axillary nodes bilaterally/ 1-2 small in central area, movable & nontender.Breast Cancer & Risk Factors:-most common cancer among women-RF: gender, age>50, genetics, hormones and oral contraceptives, early menses52, never given birth/first child >30, environmental hazards: radiation, benzene, or asbestos, high-fat diet, alcohol, tobacco