Tail of Spence

a.     laterally into axilla. 

2^nd and 6^th ribs. From sternum to midaxillary line

Areola

Montgomery’s glands

                                               i.     small elevated sebaceous glands that secrete protective lipid during lactation found on areola. 

 glandular tissue

                                               i.     15-20 lobes radiating from the nippleà lobulesà clusters of alveoli that produce milk

                                              ii.     lobe empties into 15-20 lactiferous ductsà collecting duct systemà ampullae (sinuses behind nipple that are reservoirs for storing milk). 

suspensory ligaments

Cooper’s ligaments

                                               i.     bands that support the breast tissue vertically from surface to attach to chest wall.

                                              ii.     They become contracted in cancer = dimples and pits

Central axillary nodes

a.     high up in the middle of the axilla, over the ribs and serratus anterior muscle.

Pectoral (anterior):

a.     along the lateral edge of the pectoralis major muscle. 

Subscapular (posterior):

along the lateral edge of the scapula 

Lateral

along the humerus, inside the upper arm. 

supernumerary nipple

extra nipple along the track of the mammary ridge.

a.     Tanner staging 

                                               i.     Preadolescent: only small elevated nipple

                                              ii.     Breast bud stage: small mound breast and nipple, areola widens

                                            iii.     Breast and areola enlarge; flush nipple with breast surface

                                            iv.     Areola and nipple form secondary mound over breast

                                              v.     Mature breast

1.     Only nipple protrude, flush areola with breast contour

Gynecomastia

a.     during adolescence, common for breast tissue to temp enlarge.

                                               i.     Can also appear in aging male due to decreased testosterone

   Mammogram Screening facts 

a.     Screening begins age 40

b.     Every 2 years until 50

c.      Every year after 50 until 74 or as long as in good health. 

Mastalgia

pain that occurs with trauma, inflammation, infection and benign breast disease. 

Cyclic pain

a.     common with normal breasts, oral contra, benign fibrocystic disease 

Galactorrhea

a.     note medications that may cause clear nipple dischargeà oral contra, phenothiazines, diuretics, digitalis, steroids, calcium channel blocker

b.     Bloody discharge

A.     Risk factors for breast cancer that can't be changed 

                                               i.     Female, +50 years old

                                              ii.     Personal history of breast cancer

                                            iii.     Mutations

                                            iv.     1^st degree relative with breast cancer

                                              v.     early menarche (<12) or late menopause (>55) 

                                               i.     nulliparity or first child at age 30

                                              ii.     oral contracep use

                                            iii.     never breastfed child

                                            iv.     recent LT use of estrogen

                                              v.     alcohol intake >1

                                            vi.     obesity

                                           vii.     physical inactivity 

Vertical strip pattern

                                               i.     Start high in axilla and move down lateral to breastà end at sternal edge

Inflamammary ridge

feel a firm transverse ridge of compressed tissue in lower quadrants. Usually in large breasts

Premature thelarche

a.     early breast dev with no other hormone dependent signs 

A.     Dimpling

Skin tether, sign of skin retraction. Suggests cancer

A.     Nipple retraction

Looks flatter and broader, underlying crater

A.     Edema ( Peau d’ orange)

Lymphatic obstruction. Suggests cancer

A.     Fixation

a.     Asymmetry, distortion, and decreased mobility with elevated arms.

Fibrosis fixes the breast to pectoral muscles.

A.     Benign breast disease (fibrocystic breast disease) 

a.     Multiple tender masses

                                               i.     Swelling and tenderness (cyclic)

                                              ii.     Mastalgia (severe pain) – pain dull, heavy, cclic

                                            iii.     Nodularity (lumpiness)- bilaterally, regular, firm that are mobile, well demarcated, and rubbery.

1.     Not premalignant but hard to de

                                            iv.     Dominant lumps (cysts) – dscrete, fluid fill sacs.

                                              v.     Nipple discharge

                                            vi.     Infections and inflammation (subareolar abscess, lactational mastitis, breast abscess)

50% some form of benign breast disease

A.     Cancer 

a.     Solitary, unilateral nontender mass.

b.     Solid hard dense, fixed to tissues

c.      Borders irregular and poorly delineated

d.     Often painless.

e.     Common in upper outer quadrant

f.      Signs

                                               i.     Hard irregular axillary nodes

                                              ii.     Skin dimpling

                                            iii.     Nipple retraction

                                            iv.     Elevation

                                              v.     Discharge 

A.     Fibroadenoma 

a.     Benign tumors- solitary, nontender mass solid, firm, rubbery, elastic.

b.     Freely moveable, slippery, fingers slide it easily through tissue.

c.      Triple test- palpation, US, and needle biopsy. 

A.     Mammary duct ectasia 

a.     Subareolar ducts à sticky purulent discharge

b.     Caused by stagnation of cellular debris and secretions in ductsà infection inflammation

c.      Perimenopause.

d.     Itching, burning, drawing pain around nipple. 

A.     Intraductal papilloma 

a.     Serous or serosanguineous discharge

b.     Unilateral

c.      Lesion = tiny tumors 2-3mm.

d.     40-60 yro, benign.

A.     Paget’s disease (intraductal carcinoma) 

a.     Unilateral, clear, yellow discharge, dry scaling crusts at nipple apexà spreads to areola with red halo and crusted retracted nipple.

b.     Tingling, burning, itching. 

A.     Plugged duct 

a.     One section of the breast is tender and reddened.

b.     Common condition.

c.      Should nurse her baby frequently on affected side first

d.     Resolve less than 1 day 

A.     Mastitis 

a.     Uncommon inflammatory mass before abscess formation

b.     In one quadrant

c.      Area reddened swollen, tender, hot hard.

d.     Systemic symptoms: headache, malaise, fever, chills, sweating.

e.     During 4 months of lactation form infection or stasis from plugged duct.

f.      Treat with rest, local heat, antibiotics, frequent nursing to keep breast empty.

g.     Resolve 2-3 days 

A.     breast abscess 

a.     rare complication of generalized infection

b.     temporary discontinue nursing on affected breast.

c.      Antibiotics, surgery, drainage.