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Breasts and Regional Lymphatics
Terms in this set (17)
The breast is composed of what 3 tissues?
1. Glandular Tissue (lobules-milk production)
2. Fibrous Tissue (suspensatory ligaments aka Cooper's ligaments)
3. Adipose Tissue
What is Precocious Puberty?
-breast budding or pubic hair growth occurring younger than 8 years
A sign of skin retraction on the breast. Cancer causes fibrosis, which contracts the suspensory ligaments. The dimple may be apparent at rest, with compression, or with lifting of the arms. Also note the distortion of the areola as the fibrosis pulls the nipple toward it
The retracted nipple looks flatter and broader like an underlying crater. A recent retraction suggects cancer, which causes fibrosis of the whole duct system and pulls in the nipple.
Edema (Peau d'Orange)
Lymphatic obstruction produces edema. This thickens the skin and exaggerates the hair follicles, giving a pigskin or orange peel look. This condition suggests cancer. Edema usually begins in the skin around and beneath the areola, the most dependent area of the breast. Aslo note nipple infiltration
Asymmetry, distortion, or decreased mobility with the elevated arm maneuver. As cancer becomes invasive, the fibrosis fixes the breast to the underlying pectoral muscles.
Deviation in nipple pointing
An underlying cancer causes fibrosis in the mammary ducts which pulls the nipple angle toward it. Note any swelling behind the nipple and if the nipple tilts laterally.
Benign tumors, most commonly present as self-detected in late adolescence. Solitary nontender mass that is solid, firm, rubbery, and elastic. Round, oval, or lobulated; 1-5cm.
Benign Breast Disease (Formerly Fibrocystic Breast Disease)
Multiple tender masses. "Fibrocystic disease" is not accurate because, actually, six diagnostic categories exist, based on symptoms and physical findings:
•Swelling and tenderness (cyclic discomfort)
•Mastalgia (severe pain, both cyclic and noncyclic)
•Nodularity (significant lumpiness, both cyclic and noncyclic)
•Dominant lumps (including cysts and fibroadenomas)
•Nipple discharge (including intraductal papilloma and duct ectasia)
•Infections and inflammations (including subareolar abscess, lactational mastitis, breast abscess, and Mondor's disease)
About 50% of all women have some form of benign breast disease. Nodularity occurs bilaterally; regular, firm nodules that are mobile, well demarcated, and feel rubbery, like small water balloons. Pain may be dull, heavy, and cyclic or just before menses as nodules enlarge. Some women have nodularity but no pain, and vice versa. Cysts are discrete, fluid-filled sacs. Dominant lumps and nipple discharge must be investigated carefully and may need biopsy to rule out cancer. Nodularity itself is not premalignant but produces difficulty in detecting other cancerous lumps.
Solitary, unilateral, nontender mass. Single focus in one area, although it may be interspersed with other nodules. Solid, hard, dense, and fixed to underlying tissues or skin as cancer becomes invasive. Borders are irregular and poorly delineated. Grows constantly. Often painless, although the person may have pain. Most common in upper outer quadrant. Usually found in women 30 to 80 years of age; increased risk in ages 40 to 44 years and in women older than 50 years. As cancer advances, signs include firm or hard irregular axillary nodes; skin dimpling; nipple retraction, elevation, and discharge.
Mammary Duct Ectasia
Pastelike matter in subareolar ducts produces sticky, purulent discharge that may be white, gray, brown, green, or bloody. A light green, single duct discharge is shown here. Caused by stagnation of cellular debris and secretions in the ducts, leading to obstruction, inflammation, and infection. Occurs in women who have lactated; usually occurs in perimenopause.
Itching, burning, or drawing pain occurs around nipple. May have subareolar redness and swelling. Ducts are palpable as rubbery, twisted tubules under areola. May have palpable mass, soft or firm, poorly delineated. Not malignant, but needs biopsy.
Serous or serosanguineous discharge, which is spontaneous, unilateral, or from a single duct. Lesion consists of tiny tumors, 2 to 3 mm. Often there is a palpable nodule in the underlying duct (highlighted here). Papillomas affect women 40 to 60 years of age; most are benign. Refer any bloody discharge for careful evaluation, including biopsy, to rule out cancer.
Bloody nipple discharge that is unilateral and from a single duct requires further investigation. Although there was no palpable lump associated with the discharge shown here, mammography revealed a 1-cm, centrally located, ill-defined mass.
Paget's Disease (Intraductal Carcinoma)
Early lesion has unilateral, clear, yellow discharge and dry, scaling crusts, friable at nipple apex. Spreads outward to areola with erythematous halo on areola and crusted, eczematous, retracted nipple. Later lesion shows nipple reddened, excoriated, ulcerated, with bloody discharge when surface is eroded, and an erythematous plaque surrounding the nipple. Symptoms include tingling, burning, itching.
Except for the redness and occasional cracking from initial breastfeeding, any dermatitis of the nipple area must be carefully explored and referred immediately.
A fairly common and not serious condition. One milk duct is clogged. One section of the breast is tender; may be reddened. No infection. It is important to keep breast as empty as possible and milk flowing. The woman should nurse her baby frequently, on affected side first to ensure complete emptying, and manually express any remaining milk. A plugged duct usually resolves in less than 1 day.
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