Breast Anatomy and Pathology, Exams of Nursing

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Breast Anatomy and Pathology

Breast Anatomy and Physiology

Suspensory Ligaments

Suspensory ligaments, also known as Cooper's ligaments, are fibrous connective tissue that extend vertically from the skin surface to attach to the chest wall muscles. They function to support the breast tissue.

Adipose Tissue

Adipose tissue, or fat tissue, is present in the breast and contributes to its size and shape.

Areola

The areola is the area surrounding the nipple, with a radius of 1-2 cm. It contains smooth muscle fibers that cause the nipple to erect when stimulated. Both the nipple and areola are more darkly pigmented than the rest of the breast surface.

Gynecomastia

Gynecomastia is a benign growth of breast tissue, making it distinguishable from the other tissues in the chest wall. It feels like a smooth, firm, movable subareolar fibrous mass and is common in adolescence.

Lactiferous Ducts

Each breast lobe empties into a lactiferous duct. The 15 to 20 lactiferous ducts form a collecting duct system converging toward the nipple.

Mastitis

Mastitis is an inflammatory mass before abscess formation. The affected area is red, swollen, tender, very hot, and hard, forming outward from the upper edge of the areola in the right breast. It may occur during the first 4 months of lactation from infection or from stasis from a plugged duct.

Montgomery Glands

In the areola, there are small elevated sebaceous glands called Montgomery glands. These secrete a protective lipid material during lactation.

Peau d'Orange

Peau d'orange, or "orange peel" skin, results from skin infiltration of cancer and skin edema. Lymphatic obstruction produces edema, which thickens the skin and exaggerates the hair follicles, giving a pigskin or orange-peel look.

Retraction

Retraction is when the nipple looks flatter and broader, like an underlying crater. A recent retraction suggests cancer, which causes fibrosis of the whole duct system and pulls in the nipple. It may also occur with benign lesions such as ectasia of the ducts.

Supernumerary Nipple

A supernumerary nipple is an extra nipple along the embryonic "milk line" on the thorax or abdomen. Usually, it is 5 to 6 cm below the breast near the midline and has no associated glandular tissue.

Tail of Spence

The tail of Spence is a cone-shaped breast tissue that projects up into the axilla, close to the pectoral group of axillary lymph nodes.

Thelarche

Thelarche is the beginning of breast development.

Paget Disease

Paget disease starts with a small crust on the nipple apex and spreads. The early lesion has unilateral, clear yellow discharge and dry, scaling crusts, friable at the nipple apex. It spreads outward to the areola with an erythematous halo on the areola and a crusted, eczematous, retracted nipple. The later lesion shows a reddened, ulcerated nipple with bloody discharge and an erythematous plaque surrounding the nipple.

Colostrum

Colostrum is a thick, yellow fluid that forms the precursor for milk, containing the same amount of protein and lactose but practically no fat.

Breast Tumor Locations

The most common site for breast tumors is the upper outer quadrant.

Breast Self-Exams

The best time for a woman to perform self-breast exams is right after the menstrual period (day 4 to 7 of the cycle), as the breasts are the smallest and least congested during this period.

Breast Cancer Screening Recommendations

The current recommendations for breast cancer screening related to mammograms are: - Optional annual screening for those at average risk at ages 40 to 44 years - Annual mammography beginning at age 45 years.

Benign Breast Masses

Characteristics of a benign mass in the breast include: - Nodularity occurring bilaterally - Regular, firm nodules that are mobile, well- demarcated, and feel rubbery like small water balloons - Possible dull, heavy, and cyclic pain as nodules enlarge - Nodularity may be present without pain

• Discrete, fluid-filled cysts

Malignant Breast Masses

Characteristics of a malignant mass in the breast include: - Solitary, unilateral, 3-dimensional, usually nontender mass - Solid, hard, dense, and fixed to underlying tissues or skin as cancer becomes invasive - Irregular and poorly delineated borders

Axillary Lymph Nodes

The four groups of axillary nodes in the breast tissue are: - Central axillary nodes - Pectoral (anterior) nodes - Subscapular (posterior) nodes - Lateral nodes

Tanner Sexual Maturity Rating Stages

Stage 1 (Preadolescent): Only a small elevated nipple Stage 2 (Breast bud stage): A small mound of breast and nipple develops; the areola widens Stage 3: The breast and areola enlarge; the nipple is flush with the breast surface Stage 4: The areola and nipple form a secondary mound over the breast Stage 5 (Mature breast): Only the nipple protrudes; the areola is flush with the breast contour (the areola may continue as a secondary mound in some normal women)

Genetic Risk of Breast Cancer

Women who inherit a mutation on one or both BRCA1 and BRCA2 genes have a higher risk of developing breast or ovarian cancer compared to women in the general population. Ashkenazi Jewish women had a

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significantly higher prevalence of these gene mutations compared to other Caucasians.

Relative Risk Factors

According to the chart on page 385, the following relative risk factors are 1.1-2.0: - Height (tall) - High socioeconomic status - Never breastfed a child - No full-term pregnancies