Breast and auxillae
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How findings in breasts should be described?
- Divide the breast into 4 quadrants, horizontal and vertical lines crossing the nipple.
- Note the tail of spence which extendes to anterior axillary fold.
- note findings depending using clock locations.
Older adults differences when breast examining?
- Gladular tissue atrophies and is replaced by fat, therfore, breasts become smaller.
- Lower edge of the breast thickens.
- hangs more loosely from the chest wall.
- Nipples smaller, flatter, and loose some erectile ability.
- Skin dry, thin, and loss of axillary hair.
- Lactiferous ducts proliferte and alveoli increases in size and number. (2 to 3 times pre-pregnancy size)
- Epithelial secretory activity increases, which leads to colostrum production (first fluid before milk comes)
- Areolae deeply pigmented and diameter increases.
- Nipple more prominent and darker.
- Mammary vascularization increases, veins engorge, and visible blue network.
- Colostrum secretion is normal in last trimester.
- Thelarche: breast development.
- Assymetry, it is possible bc breast can develop at different rates.
- Around or before 10 yrs of age, both male and female breast are similar.
What question should be asked when gathering health history?
- Breast discomfort or pain? (related to menses, character, associated symptoms, contributing factors, meds)
- Breast mass or lumps?
- Nipple discharge?
- Do u examine ur breasts? how often?
- * 5-7 days after onset of menses is the ideal time for examination.
How should the inspection be done?
- Compare breast: size, symmetry, skin texture, contour (conical, convex, pendulous, large pendulous, right larger than left and vice versa), retractions of dimpling.
- Compare areolae and nipples: nipple inversion, eversion, or retraction, all the others. -- Supernumary nipple is not unusual that runs along the milk ductus line.
- Position: arms at side, arms overhead, hands pressed against hips, leaning forward.
How should palpation be done?
- supine position w a pillow under shoulder of the breast being examined -- Hand at neck and elbow out.
- Palpate from the axillae downward using verival lines up and down over breast tissue. (3 mins per breast, 2nd, 3th, 4th finger pads, vertical techique)
- Palpate: tail of spence, lateral, medial, and nipple.
- * Most cancers are in tail of spence and upper quadrant.
what are finding that could Malignant?
- Hard consistency.
- Irregular shape.
- Dimpling or overlying skin.
- Associated retraction of nipple.
Breast exams recommendations?
- 20-40 yrs old should have breast examination every 3 yrs.
- Annually after 40.
- Breast self exam are optional.
- Mammograms recommended after 40. (new recommendations are after 50)
What are breast factor for breast cancer?
- Use of Hormonal replacement therapy (HRT)
- Alcohol use.
- Physical inactivity.
- Family History (1st degree relative specially if dx premenopausal CA)
- Late age for the 1st full term pregnancy.
- Early menarche (8-10 yrs)
- Late menopause.
- Breast density.
- BRCA 1 and BRCA 2 family.
- Never breast fed.
How to examine unique situations?
- Breast implants: firmly inwards at the edge of the implants, trying to feel the ribs -- decreased the chances or mortality bc lumps r hard to find.
- Mastectomy: Inspect the scar an axilla for possible return of malignancy. -- Lymphodema is normal.
How to examine male breast?
- inspect nipple and areola for swelling, nodules, and ulceration.
- Palpate areola and breast.
- Distinguish b/t fatty enlargements of obesity and firm disc of glandular (gynocomastia).
How to examine the axillae?
- pt sitting.
- inspect rash, infection, unusual pigmentation.
- fingers should be behind the pectoral muscles.
- one or more soft, small, nontender nodes is normal.
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