Chapter 20

Breast and Lymphatic system

A. Breast structure & function

Breast= Paired mammary glands

Location: 2 6 rib & sternum mid-axillary line
4 quadrants intersect at nipple
o Upper outer quadrant extends into axillary area-tail of spencer: breast
cancer target
External: nipples (lactiferous ducts), areola (Montgomery glands, hair
follicles)
o Supernumera nipples: milk line: axilagroin. Develop during
embryonic period & may disappear
Internal 3 tissues:
a. Fibrous: coppers ligaments- support
b. Fatty: breast substance, shape, size
c. Grandular: functional part, milk production
- Lobes lobulesacini cellsmammary ducts laciferous duct
lactiferous sinus (store milk) nipple
Female breast
o Enlargement: puberty-estrogen & progesterone
o Accessory reproductive organ
o Function: milk production & storage, sexual stimulation
nd

th

Changes in aged breasts: decrease in size, firmness, and fatty tissue

increase
Male breast
o No functional capability
o Soft, fatty enlargement of breast tissue is seen in obesity.
o Gynecomastia, a smooth, firm, movable disc of glandular tissue, seen
in one breast during puberty, usually temporary. However, it may also
be seen in hormonal imbalances, drug abuse, cirrhosis, leukemia, and
thyrotoxicosis.
o Irregularly shaped, hard nodules occur in breast cancer.
B. Major axillary lymph nodes:

1.
2.
3.
4.

Function: drain lymphfilter out microbes & return H2O+protein to blood

Anteriorpectorial: drain anterior chest wall & breast
Posteriorsubscapular: drain posterior chest wall & part of arm
Lateralbrachial: drain most arm
Centralmid-axillary: receives drainage from 1-3

C. Examination
Equipment: Gloves, Centimeter ruler, Small pillow, Specimen slide, BSE
handout examination
o BSE: start in 20s 1/month pros: detect changes cons: small role in
cancer detection & stressful
o Mammogram: 40s:1/year, 50-74: biennial
Normal findings:
Upon inspection (pt: sitting upright) bilateral breasts same size, pendulant,
and symmetric. Breast skin & areola same/darker skin tone, smooth
texture. Venous patterns present or not. Montgomery tubercles present.
Nipples everted/ inverted/flat bilaterally, no dryness, lesions, or discharge.
Free movement of breasts with position changes of arms/hands. No

dimpling, retraction, lesions, or erythema. Axillary skin free of redness,

rashes, or irritation bilaterally.
Upon palpation (pt:supine) breast tissue smooth, rm, elastic with
generalized nodularity and tenderness bilaterally. No distinct mass.
Bilateral mammary ridge firm & present. Temperature of breast tissue
same as chest wall. No palpable axillary nodes bilaterally/ 1-2 small in
central area, movable & nontender.
Breast Cancer & Risk Factors:
-most common cancer among women
-RF: gender, age>50, genetics, hormones and oral contraceptives, early
menses<13/ delayed menopause>52, never given birth/first child >30, environmental
hazards: radiation, benzene, or asbestos, high-fat diet, alcohol, tobacco