Prepared by:malek ahmad

University of Malaya

INTRODUCTION TO BREAST

Introduction Lie in the superficial fascia, superficial to pectoralis major

Each gland consist of about 20 lobules which contained alveoli

Secretion from alveoli (mammary glandular tissue) drains thru lactiferous ducts into the nipple

Nipple is the greatest prominence of the breast and surrounded by areola (circular pigmented area)

Base of breast lies between 2nd and 6th rib vertically and from midaxillary to lateral border of sternum horizontally

•Branches of internal thoracic artery, lateral thoracic, thoracoacromial arteries and posterior intercostal arteriesBlood

supply

•Into axillary and internal thoracic veinsVenous drainage

•Into subareolar plexus > either axillary nodes or internal thoracic nodes or other breast

•Axillary nodes receive 75% of superior and lateral part

•Inferior and medial part drain into LN along internal thoracic vessels and into lymphatic root of neck via bronchomediastinal lymph trunkLymphatic drainage

•Mammary glands: sympathetic and somatic innervation (dermatone T3-T5)Nervous innvervation

Axillary lymph nodes

Apical Medial

Posterior Anterior (behind pectoral major)

Lateral

Breast examinationGreet and explain procedure

Expose the whole upper half of patient

Relax the patient in semi recumbent (450) position

Inspection • At both breast, axillae, arms, supraclavicular fossae (patient

rest)• Look at breast with arms raised above head• When patient slowly raise her arms above her head• When patient press hands against her hips• Look for 3s: size, symmetry, skin (puckering, peau d’ orange,

nodules, discoloration and ulceration)

Palpation • Patient lie supine and flat with respective arm above head• Point site of pain/ lump• Feel normal side first with palmar surface of finger• Feel all quadrants including axillary tail • Palpate for the lump for the site, size, shape, surface,

tenderness, consistency, temperature and mobility (2direction)• Palpate the relationship of the skin to the lump, relation to the

muscle (relax the pectoralis muscle by putting hands on hips)• Palpate the nipple, ask patient to gently milk the nipple for any

discharge (single/multiple ducts, colour, amount)

Examine the axillae and arms• Sitting up at the edge of bed, examine right axilla using left

hand, patient flexed at elbow• Palpate systematically for apical, medial, posterior, anterior

(behind pectoralis major) and lateral content of axilla• Look for: number, size, consistency, mobile or matted nodes• Look for swelling in arms (lymphoedema, neurological deficits)

Examine the supraclavicular fossae• Sitting up at edge of bed and arms by her

sidesPalpate abdomen• Hepatomegaly• Ascites• Nodules in the pouch of Douglas

Examine the chest for pleural effusion

Examine the lumbar spine for pain• Percussion• Movement