1. Nursing Management: Breast Disorders Chapter 52 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Assessment of Breast Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Fig. 52-1. Breast self-examination and patient instruction. 1, Lie down and place your left arm behind your head. Lying down spreads the breast tissue evenly and thinly over the chest wall, making it easier to feel the tissue. 2, Use finger pads of the three middle fingers on your right hand to feel for lumps in the left breast. Use overlapping dime-sized circular motions to feel the breast tissue. Use three different levels of pressure to feel the breast tissue. Light pressure to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal. 3, The up-and-down (vertical) pattern is recommended for examining the entire breast. Move around the breast in an up-and-down pattern starting at an imaginary line straight down your side from the underarm and moving across the breast to the middle of the sternum. Examine the entire breast going down until you feel only ribs and up to the neck or clavicle. Repeat the procedure while examining your right breast. 4, Stand in front of a mirror. Place your hands firmly on your hips, which will tighten the pectoral muscles. Look at your breasts for size, shape, redness, scaliness, or dimpling of the breast skin or nipple. 5, Examine each underarm while standing or sitting with arm slightly raised. Check for any lump, hard knot, or thickening of tissue.

3. Assessment of Breast Disorders Diagnostic Studies Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3

4. Assessment of Breast Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Fig. 52-2. Screening mammogram showing dense breast tissue and benign, scattered microcalcifications of a 57-year-old. A, Using conventional x-rays. B, Using digital x-rays.

5. Benign Breast Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5

6. Mastalgia 6

7. Breast Infections Mastitis Mastitis Lactational Breast Abscess Lactational Breast Abscess Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7

8. Fibrocystic Changes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Fig. 52-3. A, Normal breast tissue. B, Fibrocystic breast tissue.

9. Nursing and Collaborative Management: Fibrocystic Changes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9

10. Fibroadenoma 10

11. Nursing and Collaborative Management: Fibroadenoma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Fig. 52-4. Well-defined encapsulated fibroadenoma.

12. Nipple Discharge Intraductal Papilloma Intraductal Papilloma Ductal Ectasia Ductal Ectasia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12

13. Gynecomastia in Men Senescent Gynecomastia Senescent Gynecomastia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Gerontologic Considerations: Age-Related Breast Changes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14

15. Breast Cancer Etiology and Risk Factors Etiology and Risk Factors Pathophysiology Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

16. Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Table 52-3. Types of Breast Cancer.

17. Breast Cancer Pathophysiology, continued Pathophysiology, continued Noninvasive breast cancerNoninvasive breast cancer Paget’s diseasePaget’s disease Inflammatory breast cancerInflammatory breast cancer Clinical Manifestations Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17

18. Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Fig. 52-5. Distribution of where breast cancer occurs.

19. Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19

20. Breast Cancer Complications Complications Diagnostic Studies Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20

21. Breast Cancer Collaborative Care Collaborative Care Surgical therapySurgical therapy Axillary node dissectionAxillary node dissection Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21

22. Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Fig. 52-6. Lymph nodes and drainage in the axilla. The sentinel lymph node is usually found in the external mammary nodes. A complete axillary dissection would remove all nodes.

23. Breast Cancer Collaborative Care Collaborative Care Surgical therapy, continuedSurgical therapy, continued Breast-conserving surgeryBreast-conserving surgery Modified radical mastectomyModified radical mastectomy Follow-up and survivorship careFollow-up and survivorship care Postmastectomy pain syndromePostmastectomy pain syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23

24. Breast Cancer Collaborative Care, continued Collaborative Care, continued Adjuvant therapyAdjuvant therapy Radiation therapyRadiation therapy Primary radiation therapyPrimary radiation therapy High-dose brachytherapyHigh-dose brachytherapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 24

25. Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Fig. 52-8. High-dose brachytherapy for breast cancer. The MammoSite system involves the insertion of a single small balloon catheter (B) at the time of the lumpectomy or shortly thereafter into the tumor resection cavity—the space that is left after the surgeon removes the tumor. A tiny radioactive seed (A) is inserted into the balloon, connected to a machine called an afterloader (C), and delivers the radiation therapy.

26. Breast Cancer Collaborative Care Collaborative Care Adjuvant therapyAdjuvant therapy Radiation therapy, continuedRadiation therapy, continued Palliative radiation therapyPalliative radiation therapy Systemic therapySystemic therapy ChemotherapyChemotherapy Hormonal therapyHormonal therapy Biologic and targeted therapyBiologic and targeted therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 26

27. Culturally Competent Care: Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 27

28. Nursing Management: Breast Cancer Nursing Assessment Nursing Assessment Nursing Diagnoses Nursing Diagnoses Planning Planning Nursing Implementation Nursing Implementation Acute interventionAcute intervention Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 28

29. Nursing Management: Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Fig. 52-9. Postoperative exercises for the patient with a mastectomy or lumpectomy with axillary lymph node dissection.

30. Nursing Management: Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Fig. 52-7. Lymphedema. Accumulation of fluid in the tissue after excision of lymph nodes.

31. Nursing Management: Breast Cancer Nursing Implementation Nursing Implementation Acute intervention, continuedAcute intervention, continued Psychologic carePsychologic care Ambulatory and home careAmbulatory and home care Evaluation Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 31

32. Gerontologic Considerations: Breast Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 32

33. Mammoplasty Breast Reconstruction Breast Reconstruction IndicationsIndications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 33

34. Mammoplasty Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Fig. 52-10. A, Appearance of chest following bilateral mastectomy. B, Postoperative breast reconstruction before nipple-areolar reconstruction. C, Postoperative breast reconstruction after nipple-areolar reconstruction.

35. Mammoplasty Breast Reconstruction, continued Breast Reconstruction, continued Types of reconstructionTypes of reconstruction Breast implants and tissue expansionBreast implants and tissue expansion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 35

36. Mammoplasty Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Fig. 52-11. A, Tissue expander with gradual expansion. B, Tissue expander in place after mastectomy.

37. Mammoplasty Breast Reconstruction Breast Reconstruction Types of reconstruction, continuedTypes of reconstruction, continued Musculocutaneous flap procedureMusculocutaneous flap procedure Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 37

38. Mammoplasty Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 38 Fig. 52-12. TRAM flap. A, TRAM flap is planned. B, The abdominal tissue, while attached to the rectus muscle, nerve, and blood supply, is tunneled through the abdomen to the chest. C, The flap is trimmed to shape the breast. The lower abdominal incision is closed. D, Nipple and areola are reconstructed after the breast is healed.

39. Mammoplasty Breast Reconstruction Breast Reconstruction Types of reconstruction, continuedTypes of reconstruction, continued Nipple-areolar reconstructionNipple-areolar reconstruction Breast Augmentation Breast Augmentation Breast Reduction Breast Reduction Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 39

40. Nursing Management: Breast Augmentation and Reduction Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 40