YUNITA HAPSARI

2019
 ANATOMY OF BREAST
EXTERNAL ANATOMY
• SHAPE AND SIZE:considerable individual variation
• BASE:
vertically - from 2nd to 6th rib in midclavicular line
horizontally - from the midline of the sternum
almost to the midaxillary line
superolaterally- extends as the axillary tail of
spence through the foramen of langer
• THE AREOLA
pigmented circular area of skin around the
base of the nipple
It contains a number of subcutaneous glands
which enlarge during pregnancy and are
called tubercles of Montgomery
• THE NIPPLE {papilla mammaria}
cylindrical or conical structure projecting from
the center of the areola
It contains an elaborate subcutaneous
network of of smooth muscle cells & elastic
fibers
BREAST GLANDS

Each breast has 8 to 10

sections (lobes) arranged
like the petals of daisy
Inside each lobe are many
smaller structures called
lobules
At the end of each lobule
are tiny sacs (bulbs) that
can produce milk
 ARTERIAL SUPPLY
It is supplied by:
• Lateral thoracic branch of 2nd part of
axillary artery
• Medial mammary branches of internal
thoracic artery
• Superior thoracic branch of axillary artery
• Lateral branches of 2nd,3rd,4th posterior
intercostal arteries
 VENOUS DRAINAGE
• Circular venosus -an anastamotic venous
plexus deep to the areola at the base of
the nipple.
• From this plexus two sets of veins are
formed :
1. superficial set- ends in internal thoracic
vein
2. deep set - ends in internal thoracic ,axillary
and post intercostal veins
 • ANTERIOR (PECTORAL) SET:
Situated along the lateral thoracic
vein under the ant axillary fold, they
lie mainly on the 3rd rib
• POSTERIOR (SCAPULAR) SET:
Lies on the post axillary fold in
LYMPHATIC relation to the subscapular vessels
DRAINAGE • LATERAL (AXILLARY VEIN) SET:
Along the upper part of humerus
5 in relation to the axillary vein
• CENTRAL SET:
Situated in the fat of the upper Axilla
• APICAL or INFRACLAVICULAR SET:
Lie deep to the clavipectoral fascia
along the axillary vesels
• Introduce yourself to the patient
• Ask Permission to perform the examination
• Assure privacy
• Ask for chaperone to be present
• Explain what you want to do
• Expose the patient adequately
• Position the patient correctly
.

• If sores visible,wear gloves

 skin
Skin retraction

Dimpling
 skin
Redness
Peau d'orange (ca)
Veins: congestion
Inflammatory ca

mastitis
 Nipples
•Nipple number, positio n
•Inversion retraction;
(fibrosis, CA, normal)

Slit like
 Nipples
•Red, bleeding
•(Paget's dz of nipple).
•Discharge
 Inspect whole skin
• Raise the breast to inspect
the undermined skin.
 Examine
axilla Axillary tail
Inspect while
pt's
the axilla arms
are Axillary LNs
raised;

Any mass, ulcer

Edema,nodules

Cancer en cuirase
• Ask patient to raise arms
and place hands behind
head
• Change in a mass's
relative position.
• Nipple or skin tethering
 • Use fingerpads of middle 3 fingers
Palpation • Palpation should not elicit pain
• Consistency is highly variable
Others Palpation Methods;

-Wedge

-Parallel lines

-Concentric lines
Evaluation of Breast
Mass Characteristics
• Location
• Size
• Shape
• Number
• Consistency
• Mobility
• Tenderness
• Erythema
• Dimpling or
retraction
• Lymphadenopath
 Comparison of Breast Lumps
Benign Breast Disease
• Multiple or single
• Rubbery texture
• Mobile / slippery
• Regular borders
• Tenderness (cyclic)
• No retraction
• May increase/decrease in
size rapidly
Cancer
• Unilateral
• Firm texture
• Fixed firmly
• Irregular border
• Usually painless
• Usually w/retraction
• Grows constantly
 BREAST SELF EXAM
• GOAL: Early detection
• IN PREPARATION FOR TEACHING:
Assess: knowledge base , motivation
fears and concerns
family history
risk factors
• TEACHING: Use show and tell; use finger
pads
• EXAM: monthly, day 5-7 of menstrual cycle;
after menopause same day each month
• Use in conjunction with mammography & CBE
Breast Self Exam - Step 1
• Begin by looking at your breasts in
the mirror with your shoulders
straight and your arms on your
hips.
• Here's what you should lookfor:
• Breasts that are their usual size,
shape, and color.
• Breasts that are evenly shaped
without visible distortion or
swelling.
• If you see any of the following
changes, bring them to your
doctor's attention:
• Dimpling, puckering, or bulging of
the skin.
• A nipple that has changed position
or become inverted (pushed
inward instead of sticking out).
• Redness, soreness, rash, or
swelling
Breast Self Exam - Step 2 and 3
• Raise your arms and look
for the same changes.
• While you're at the mirror,
gently squeeze each
nipple between your finger
and thumb and check for
nipple discharge (this
could be a milky or yellow
fluid or blood).
Breast Self Exam - Step 4
• Feel your breasts while
lying down, using your right
hand to feel your left breast
and then your left hand to
feel your right breast. Use a
firm, smooth touch with the
first few fingers of your
hand, keeping the fingers
flat and together.
• Cover the entire breast from
top to bottom, side to side—
from your collarbone to the
top of your abdomen, and
from your armpit to your
cleavage
Breast Self Exam - Step 5
• Finally, feel your breasts
while you are standing or
sitting. Many women find
that the easiest way to
feel their breasts is when
their skin is wet and
slippery, so they like to do
this step in the shower.
Cover your entire breast,
using the same hand
movements described in
Step 4.
Phylloides tumor