Professional Documents
Culture Documents
A REVIEW OF
1-EMBRYOLOGY
2-SURGICAL ANATOMY
3-PHYSIOLOGY
4-CLINICAL EXAMINATION
Rudimentary in male
BREAST DEVELOPMENT
EMBRYOLOGY
In 5th-6th wk of fetal development
Two
ventral bands of thickened
ectoderm(MAMMARY
RIDGES/MILK
LINES) are evident
Extent of milk line/mammary ridgefrom base of forelimb(future axilla)
to region of hind limb(inguinal area)
ridges disappear after short time
except in pectoral region
each
breast develops when an
ingrowth of ectoderm forms a
primary tissue bud in mesenchyme.
CONGENITAL ABNORMALITIES OF
THE BREAST
AMASTIA:-
bilateral
absence of breast tissue
and nipple,
When breast tissue is
absent unilaterally pectoral
muscles are often absent.
AMASTIA
CONGENITAL
ABNORMALITIES OF THE
BREAST
POLYMASTIA:-
(ACCESSORY
BREAST)
More than one breast on one
or both sides, anywhere
along milk ridge
POLYMASTIA
CONGENITAL
ABNORMALITIES OF THE
BREAST
SYMMASTIA:-
webbing between
the breasts across
midline
SYMMASTIA
CONGENITAL
ABNORMALITIES OF THE
BREAST
POLYTHELIA:-
(ACCESSORY NIPPLES)
Imperfect development of
mammary rudiment,so that
supernumerary nipples are
situated irregularly over
breast/or along milk ridge
POLYTHELIA
CONGENITAL
ABNORMALITIES OF THE
BREAST
ATHELIA
absence
nipple
of
CONGENITAL ABNORMALITIES
OF THE BREAST
INVERTED
NIPPLE
failure of
mammary pit to
elevate above skin
level
INVERTED NIPPLE
OTHER
ASSESSMENT
FINDINGS
PREGNANCY CHANGES
MASTITIS
PAGETS NIPPLE
ANATOMY
Extent:-
vertical-
2nd
to
6th
ribs
inclusive
Horizontal-
from
lateral
border
of
SUPERFICIAL ANATOMY
Anatomy
Anatomy
DEEP RELATIONS
Breast rests on
- fascia of pectoralis major muscle
- serratus anterior muscle
- ext. oblique abdominis muscle
- upper extent of rectus sheath
Retromammary
bursa
aspect of breast
identified
on
posterior
Anatomy
15-20 lobes
lobe:lobules, small
branch, and larger
ducts.
Radial fashion
Peripheral portions
of lobes often
overlap
ARCHITECTURE OF GLAND
Ducts surrounded
tissue & fat gives
by
loose connective
roundness.
Nipple
Pigmented
darker
physiological
changes
with
Areola
sebaceous, sweat,&
accessory glands.
produce small
elevations called
MONTGOMERY
TUBERCLES
perforating branch of
thoracic/mammary artery
lateral
branches
intercostal arteries
superior thoracic
lateral thoracic
of
pectoral
branch
thoracoacromial artery
internal
posterior
of
VENOUS DRAINAGE
NERVE SUPPLY
Sympathetic
nerves
reach
2nd
via
to
which
6th
intercostal nerves
Overlying
anterior
skin
supplied
LYMPHATIC DRAINAGE
central group
apical/subclavicular
interpectoral(Rotters node)
I
lymph node located lateral to
pectoralis minor. (lateral
axillary, external mammary,
subscapular).
Level II
deep to pectoralis minor.
(central and interpectoral).
Level III
medial to or above pectoralis
minor. (subclavicular).
PHYSIOLOGY
Pregnancy
diminution of fibrous stroma
lobular hyperplasia
hormones active are estrogen,
progesterone & prolactin
Lactation
prolactin & oxytocin
Menopause
irregularity & functional
nodularity
NURSING HISTORY
Major complaints
Pain
in breast.
Discharge from nipple.
Ulcer over breast.
Lump (mode of onset,
duration, rate of growth)
Discharge from nipple
Retraction of nipple
Loss of weight
COLDSP
A
Family History
History of breast cancer in the
Family
Lifestyle and Health
family
Practices
PHYSICAL
EXAMINATION
Position
sitting
position
semi-recumbent position
recumbent position
bending forward position
Inspection
With arms by side of body
With arms raised above her
head
Hands on her hips
Patient bending forwards from
the waist
Breasts
Position
Size
& shape
Any puckering or
dimpling
Any ulcer
& texture
Engorged veins
Peau d orange
Nodules
PEAU D ORANGE
Nipple
Presence
Position
Number
Size
& shape
Surface
Discharge
en cuirasse - a carcinoma
that involves a considerable portion
of the skin of one or both sides of the
thorax.
Brawny edema of arm
axilla & supraclavicular fossa
submammary fold must be
inspected
Palpation
Position
Normal breast 1st
With palmar surface of fingers
with the hand flat
Four quadrants
Axillary tail
Behind nipple
Examination of lump
Local temp & tenderness
Site as per quadrant
Number
Size & shape
Surface
Margin
Consistency
Fluctuation
Transillumination test
Fixity to skin
tethered to skin
fixed to skin
Fixity to breast tissue
Fixity to underlying fascia &
muscles
Fixity to chest wall & palpation of
nipple
group of lymph
nodes
pectoral group
brachial group
subscapular group
central group
apical group
Cervical lymph nodes
supraclavicular nodes
Sample Documentation:
Subjective data
Forty year-old woman,. No history of
breast disease, biopsies or surgery in
self or family. Takes hormone
replacement therapy for early onset
of menopause. Performs monthly BSE.
Reports no breast lesions, lumps,
swelling, pain, rashes or discharge.
Has yearly mammogram and breast
examination by gynecologist. Eats a
low-fat diet. Does not drink alcohol.
Exercises four times a week wearing
supportive, firm bra. Menstruation
started at age 14. has one adopted
child. Comfortable with discussing
Sample Documentation:
Objective data
Inspection
Bilateral breasts moderate in size,
pendulant and symmetric. Breast skin
pale pink with light brown areola.
Montgomery tubercles present. Nipples
everted bilaterally. Free movement of
breasts with position changes of arms
and hands. No dimpling, retraction,
lesions, or inflammation noted. Axillae
free of rashes and inflammation
Palpation
No masses or tenderness palpated.
Bilateral mammary ridge present. No
discharge from nipples. Axillary and
Nursing Diagnoses
Wellness Diagnoses:
Readiness for enhanced health management of
breasts
Health-Seeking Behavior: Requests information on
BSE
Risk Diagnoses
Risk for Ineffective Management of Therapeutic
Regimen related to busy lifestyle and lack of
knowledge of monthly BSE
Actual Diagnoses
Fear of breast cancer related to increased risk factors
Ineffective Individual Coping related to diagnosis of
breast cancer
Disturbed Body Image related to mastectomy
Anticipatory Grieving related to anticipation of poor
outcome of breast biopsy
Ineffective Management or Therapeutic Regimen
related to lack of knowledge of BSE