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- are paired mammary glands that lie over the External Breast Anatomy
muscles of the anterior chest wall, anterior to Nipple- located in the center of the breast,
the pectoralis major and serratus anterior contains the tiny openings of the lactiferous
muscles. Depending on their size and shape, ducts through which milk passes.
the breasts extend vertically from the second Areola –surrounds the nipple (generally 1 to
to the sixth rib and horizontally from the 2 cm radius) and contains elevated sebaceous
sternum to the mid-axillary line glands (Montgomery glands) that secrete a
-The male and female breasts are similar until protective lipid substance during lactation.
puberty, when female breast tissue enlarges Hair follicles commonly appear around the
in response to the hormones estrogen and areola. Smooth muscle fibers in the areola
progesterone, which are released from the cause the nipple to become more erectile
ovaries. during stimulation
Female breast-is an accessory reproductive The nipple and areola typically have darker
organ with two functions: to produce and pigment than the surrounding breast. Their
store milk that provides nourishment for color ranges from dark pink to dark brown,
new-borns and to aid in sexual stimulation. depending on the person’s skin color. The
amount of pigmentation increases with
Male breasts have no functional capability. pregnancy, then decreases after lactation. It
does not, however, entirely return to its
Breasts are divided into four quadrants by original coloration
drawing horizontal and vertical imaginary
lines that intersect at the nipple. The upper During embryonic development, a milk line
outer quadrant, which extends into the or ridge extends from each axilla to the groin
axillary area, is referred to as the tail of area. It gradually atrophies and disappears as
Spence. Most breast tumors occur in this the person grows and develops. However, in
quadrant some clients, supernumerary nipples or other
breast tissue may appear along this “milk
A projection of breast tissue from this line”
quadrant extends into the axilla, called the
axillary tail of Spence Internal Breast Anatomy
Female breasts consist of three types of
tissue: glandular, fibrous, and fatty
(adipose)
Inspect the areola area for size, Round or oval and bilaterally Any asymmetry, mass, or
shape, symmetry, color, surface the same lesion
characteristics, and any masses or Color varies widely, from
lesions. light pink to dark brown
Irregular placement of
sebaceous glands on the
surface of the areola
(Montgomery’s tubercles)
Inspect the nipples for size, shape, Round, everted, and equal in Asymmetrical size and color
position, color, discharge, and size; similar in color; soft and Presence of discharge, crusts,
lesions smooth; both nipples point or cracks
in same direction (out in Recent inversion of one or
young women and men, both nipples
downward in older women)
No discharge, except from
pregnant or breast-feeding
females
Inversion of one or both
nipples that is present from
puberty
Palpate the axillary, subclavicular, No tenderness, masses, or Tenderness, masses, or
and supraclavicular lymph nodes nodules nodules
❹ while the client sits with the
arms abducted and supported on
the nurse’s forearm. See discussion
on palpation of clavicular lymph
nodes in Skill 30-10. Use the flat
surfaces of all fingertips to palpate
the four areas of the axilla:
The edge of the greater
pectoral muscle (musculus
pectoralis major) along the
anterior axillary line
The thoracic wall in the
midaxillary area
The upper part of the
humerus
The anterior edge of the
latissimus dorsi muscle
along the posterior axillary
line.
Palpate the breast for masses, No tenderness, masses, Tenderness, masses, nodules,
tenderness, and any discharge from nodules, or nipple discharge or nipple discharge
the nipples. Palpation of the breast If you detect a mass, record the
is generally performed while the following data:
client is supine. a) Location: the exact
Rationale: In the supine position, location relative to the
the breasts flatten evenly against quadrants and axillary
the chest wall, facilitating tail, or the clock ❺
palpation. For clients who have a and the distance from
history of breast masses, who are at the nipple in
high risk for breast cancer, or who centimeters
have pendulous breasts, b) Size: the length, width,
examination in both a supine and a and thickness of the
sit-ting position is recommended mass in centimeters. If
If the client reports a breast you can determine the
lump, start with the discrete edges, record
“normal” breast to obtain this fact
baseline data that will serve c) Shape: whether the
as a comparison to the mass is round, oval,
reportedly involved breast lobulated, indistinct, or
To enhance flattening of irregular
the breast, instruct the d) Consistency: whether
client to abduct the arm the mass is hard or soft
and place her hand behind e) Mobility: whether the
her head. Then place a mass is movable or
small pillow or rolled towel fixed.
under the client’s shoulder. f) Skin over the lump:
For palpation, use the whether it is reddened,
palmar surface of the dimpled, or retracted.
middle three fingertips g) Nipple: whether it is
(held together) and make a displaced or retracted
gentle rotary motion on the h) Tenderness: whether
breast palpation is painful
Choose one of three
patterns for palpation:
a. Hands-of-the-clock or
spokes-on-a-wheel ❺
b. Concentric circles ❻