Lecturer/ Hanaa Eisa

o Function: o Milk production.

o Tail of Spence o Cooper’s ligaments o Nipple o Lactiferous ducts o Areola o Montgomery’s tubercles o Lobes o Lobules

o Alveoli or acini o Lymphatic drainage o Axillary nodes: central, pectoral, subscapular, lateral o Internal mammary chain

o Usually begins at 10 to 11 years of age o Stimulated by estrogen release during puberty

Patient profile o Age o Gender o Race

Common chief complaints o Breast mass, tenderness, discharge o Assess the following characteristics Location Quality Quantity Associated manifestations Aggravating factors Alleviating factors

Past health history o Breast specific vs. Systemic o Medical o Surgical o Medications o Allergies

Family history o Breast cancer o Benign breast disease

Social history o Alcohol use o Tobacco use o Work environment o Home environment o Economic status o Ethnic background

Health maintenance activities o Diet o Exercise o Breast self-exam o Mammogram

 Equipment o Towel o drape o centimeter ruler o teaching aid for breast self-exam  General approach  Inspection  Patient positions

Assess the following areas o Breasts o Areolar areas o Nipples o Axillae

Assess the following characteristics 1. Color 2. Vascularity 3. Thickening/edema 4. Size and symmetry 5. Contour 6. Lesions/masses 7. Discharge

1. Sequential manner 2. Supraclavicular and Infraclavicular nodes 3. Breasts, arms at side, arms raised 4. Axillary nodes 5. Breasts, supine position

1. Location 2. Size 3. Shape 4. Number 5. Consistency

1. Definition 2. Mobility 3. Tenderness 4. Erythema 5. Dimpling or retraction

1. Breast and axillae are flesh colored 2. Areolar areas and nipples are darker in pigmentation 3. Moles and nevi are normal variants 4. No thickening or edema

1. Minor size variation in the breasts and areolar areas 2. Usually breast on dominant side is larger 3. Nipples should point upward and outward, may point outward and downward

1. Breasts, areolar areas, nipples should be symmetrical 2. Breasts are convex, without flattening, retractions, or dimpling 3. Free from masses, tumors, primary or secondary lesions

1. No discharge from nipples in nonpregnant, nonlactating female 2. Usually, palpable lymph nodes less than 1 cm in diameter are clinically insignificant 3. Palpation should not elicit pain

1. Consistency of breast tissue is highly variable depending upon age, time in menstrual cycle, and proportion of adipose tissue 2. Breasts are usually nodular or granular prior to menses 3. Variation with breast augmentation— breasts feel fluid filled or firm throughout

1. Age > Personal history of breast CA 3. Mother, grandmother, or sister with breast CA 4. Menarche at an early age 5. Menopause at advanced age 6. Obesity 7. Alcohol intake > 3 servings per day

1. American or European descent 2. Urban dweller 3. Estrogen therapy 4. Nulliparous 5. First birth after age Higher education and socioeconomic status 7. Atypical hyperplasia

1. Mammography 2. X- ray 3. Ultrasonography 4. Magnetic resonance imaging

1. Breast tissue atrophy 2. Decreased glandular tissue, resulting in granular feeling 3. Breasts become smaller, pendulous, and flatter 4. Ductal tissue becomes more palpable. Stringy feeling

1. Performed once a month 2. Performed on a fixed date each month, or eight days after menses 3. Avoid completing during menstruation or ovulation 4. Use calendar for monthly reminder 5. Include significant other in examination process

Bed (B): supine position 1. Use palmar surface of fingers 2. Place right arm over head and palpate right breast 3. Move in concentric circles from the periphery inward 4. Squeeze the nipple to examine for discharge 5. Use same procedure to check left breast

Standing (S) o Repeat previous process in standing position Examination (E) o Stand before mirror, arms at side o Assess for symmetry, retractions, dimpling, inverted nipples, or nipple deviation o Repeat with arms above head, and hands pressed into hips