SlideShare ist ein Scribd-Unternehmen logo
1 von 34
Downloaden Sie, um offline zu lesen
For 3rd Year Midwifery
By- Yosef A.
CHAPTER SIX
THE BREAST
 Anatomy & physiology of the breast
 Breast examination
 Teaching breast Self-examination to women (BSE)
 Benign & malignant tumors of the breast
 Management of breast disorders
 Mammography
 Nursing care consideration for a women with
mastectomy
2Done by Yosef A.
Objectives
At the end of this study the student will be able to
 Describe the gross structure of the breast.
 Describe the physiologies of breast.
 Discuss the development of breast and its congenital
anomalies.
 Give its blood supply and lymphatic drainage.
3Done by Yosef A.
THE BREAST
ANATOMY AND PHYSIOLOGY OF FEMALE BREAST
 Breasts are composed of mammary glands ,connective
tissue ,blood vessels , nerves and lymph vessels.
 The breasts are secondary reproductive glands of
ectodermal origin.
 The breast is the upper ventral region of the torso of
a primate, in left and right sides, containing
the mammary gland.
4Done by Yosef A.
Cont…
 Each breast consists of 12-20 conical lobes.
 Each lobe consists of a group of lobules.
 The lobules have several lactiferous ducts , which unit
to form a major duct
 Each of the major ducts widens to form an ampula
 The fatty tissue increases towards the periphery of the
lobule and gives the breast its bulk and hemispheric
shape and 80-85% of the normal breast is adipose
tissue.
Lobes---Lobules---Lactiferous ducts---Major duct---Ampula
5Done by Yosef A.
Cont…
 In non pregnant ,non lactating breast ,the alveoli are
small and tightly packed
 During pregnancy the alveoli hypertrophy and their
lining cells proliferate in number
 During lactation , the alveolar cells secret proteins and
lipids which comprise breast milk
6Done by Yosef A.
POSITION OF BREAST
 Extent: Vertical: 2nd to 6th rib (Base of the breast)
Horizontal: Lateral margin of the sternum to the mid
auxiliary line
 2/3rd of the breast lies in the superficial fascia
(Pectoral fascia) lying on Pectoralis major
 1/3rd of the breast lies in the superficial fascia lying
on Serratus Anterior
 The greater part of the gland lies in the superficial fascia.
7Done by Yosef A.
 A small part-axillary tail extends upward and laterally,
pierces the deep fascia at the lower border of the
pectoralis major muscle up to the apex of the axilla.
 The breast lies upon the deep pectoral fascia, which in
turn overlies pectoralis major and serratus anterior, and
inferiorly, external oblique and its aponeurosis as the
latter forms the anterior wall of the sheath of rectus
abdominis
8Done by Yosef A.
PARTS OF THE BREAST
 Nipple: Conical or Cylindrical prominence in the center of
Areola (Devoid of fat, hair & sweat gland)
 The nipple level in the thorax varies widely, but is at the fourth
intercostal space in most young women.
 Nipple is Usually everted
Surface anatomy: 4th intercostal space lateral to midclavicular
line!!!!
 Areola: Circular pigmented area of the skin surrounding
the base of the nipple, containing sebaceous glands.
 Axillary Tail : Small part of the breast extending to the
axilla. 9Done by Yosef A.
 Retromammary Space: Space filled with loose connective
tissue between breast and pectoral fascia
 Lactiferous ducts from each lobule open on the summit of the
nipple separately
 Lactiferous duct possesses a dilated Ampulla (Lactiferous
sinus) just before its termination
 Fibrous septa separates the lobes of the mammary gland
 Suspensory ligaments (of Cooper):
 Mammary gland is firmly attached to the dermis of the skin
by these fibrous septa forming suspensory ligaments
10Done by Yosef A.
11Done by Yosef A.
Layers of breast
 Mammary layer
 Subcutaneous layer
 Retromammary layer
Development and physiology
 The breasts develop as an invigilation of chest wall ectoderm
 Which forms a series of branching ducts. Shortly before birth
this site of invagination everts to form the nipple.
 At puberty, alveoli sprout from the ducts and considerable
fatty infiltration of the breast tissue takes place.
 With pregnancy there is tremendous development of the
alveoli which, in lactation, secrete the fatty droplets of milk. At
the menopause the gland tissue atrophies.
12Done by Yosef A.
 Neonates: Occasionally, gynaecomastia may occur in the neonatal
breast, with discharge of a colostrum-like material (‘witch’s milk’).
 From birth until puberty, the breast consists of lactiferous ducts,
with no alveoli.
 At puberty, the ducts start to proliferate, and their terminations
form solid masses of cells—the future breast lobules.
 During pregnancy, secreting alveoli appear. During the early
weeks, ductal sprouting and lobular proliferation occur, with
increased nipple and areolar pigmentation.
 The alveoli now display a lumen surrounded by the secretory
cells.
 In the last days of pregnancy, the breasts secrete colostrum, a
yellow, sticky, serous fluid, which is then replaced by true secretion
of milk.
 After the menopause, the glandular tissue of the breast atrophies,
the connective tissue becomes less cellular, and the amount of
collagen decreases. In some women, breasts shrink considerably.
13Done by Yosef A.
Arterial Supply
 The blood supply of the breast is a rich anastomotic
network derived from
 Perforating branches (Internal thoracic artery)
 Lateral thoracic artery (Axillary artery)
 Thoracoacromial artery (Axillary artery)
 Intercostal arteries
 The largest vessels arise from the internal thoracic
artery, the perforating branches of which pierce the chest
wall adjacent to the sternal edge in the first to fourth
intercostal spaces. The vessel in the second space is
usually the largest of these.
14Done by Yosef A.
 second to fourth anterior intercostal arteries supply
perforating branches more laterally.
 The axillary artery supplies blood from several branches,
namely the superior thoracic, the pectoral branches of the
thoraco-acromial artery, the lateral thoracic artery.
Venous Drainage
 Superficial venous system lies within the subcutaneous fat
tissue; most distal veins line the superficial fascia and drain
blood centrally; provides connection between right and left
breast with potential for metastasis to occur between
breasts
 Deep venous system consists of veins that follow the
arterial system and communicates with the axillary vein,
subclavian vein and SVC
 Includes lateral thoracic, axillary, subclavian and
intercostal veins 15Done by Yosef A.
Nerve Supply
 Anterior and lateral cutaneous branches of the
4th – 6th intercostal nerves
Lymphatic Drainage
 75% drains to the axilla
 Lateral quadrants: Anterior Axillary or Pectoral nodes
 Medial quadrants: Internal thoracic group of Nodes
(Parasternal)
 Few lymph vessels drains into Posterior intercostal Nodes
 Inferior quadrants: May drain into abdominal lymph Nodes
 Some lymphatic vessels communicate with the lymphatic vessels of
the opposite breast
16Done by Yosef A.
Congenital Anomalies
 Nipple Inversion: usually bilateral if congenital; associated pathology
can be present if the nipple change is a new finding and/or occurs
unilaterally
 Athelia: absence of the nipple
 Polythelia: accessory nipples, can develop anywhere along the milk
line; most commonly seen just inferior to the normal nipple; #1
congenital anomaly of the breast in females and males
 Amastia: failure of the breast and nipple to develop
 Polymastia: accessory breast tissue; most commonly forms without a
nipple; usually found in the axilla
 Amazia: absence of development of the functional breast tissue
beneath a normal nipple/areola
17Done by Yosef A.
Developmental abnormalities of Breast
 The nipple may fail to evert .
 Supernumerary nipples or even breasts may occur along a vertical
‘milk line’
 the other hand, the breast on one or both sides may be small or even
absent (amazia).
 Accessory Breasts- is a health condition where the person afflicted
has extra breasts.
 The extra breast can be in various forms, from a fully functional
breast with a normal appearance and capable of producing milk to a
breast that does not lactate or have an areola.
 Both men and women can have accessory breasts, but the problem
is more commonly observed in women
18Done by Yosef A.
.
19
There is no known limit on
the amount of extra
nipples or breasts that can
develop on the human
body. Some women have
experienced as many as
eight nipples in addition to
the standard two.
Done by Yosef A.
Fascial relationships of the breast
 The fascial relationships of the breast are of practical
importance.
 As an ectodermal derivative, the gland lies in a pocket
of superficial fascia.
 Superficial fascia:
 Superficial layer
 Deep layer
 Fibrous processes of this layer of fascia extend to the
skin and to the nipple and are more developed
over the upper part of the breast, where they form
the suspensory ligament of Cooper.
 Contraction of this tissue by malignant infiltration
results in the characteristic skin dimpling over a
carcinoma of
Done by Yosef A. 20
 The superficial layer lies immediately beneath the
dermis and enables skinflaps to be dissected from the
glandular mass of the breast quickly, neatly, and in a
relatively avascular plane.
 The deep layer of the superficial fascia is thicker than
the subcu- taneous component and covers the deep
aspect of the breastplate.
 Beneath this sheath is a layer of filmy areolar tissue
that allows the breast to move freely on the
underlying fascial covering of the pectoralis major
and the serratus anterior.(Pectoralis fascia)
Done by Yosef A. 21
Breast examination
 Two types of breast examination
Breast examination by a physician
Breast self examination (BSE)
Done by Yosef A. 22
Self Examination of the Breast
 90% of breast cancers are found by the woman or her
partner.
 During pregnancy there is no special time of the
month that is best to perform the examination.
 In non pregnant women 5days after cessation of
menstruation ,it is the optimum time to detect
changes.
• Inspection in the shower
• Inspection in the mirror
Done by Yosef A. 23
 stand in front of the mirror for further inspection
a. With arms at sides
b. Holding arms over the head ,inspect closely in the mirror
for masses and breast symmetry
c. Press hands firmly on hips ,below slightly forward . inspect
in m Each breast should be mirror image of the other
d . Each breast should be mirror image of the other
e . Gently squeeze the nipple of each breast between your
thumb and index finger to check for signs of discharge or
bleeding . irror for lumps or pulling of the skin
Done by Yosef A. 24
Inspection on lying down
lying flat on your back ,with your right hand under
your head and a pillow or towel under your right
shoulder ,use your left hand to gently feel your right
breast using concentric circles to cover the entire
breast and nipple . repeat on your left breast.
Steps to Diagnosis
 Clinical Exam
 Mammography
 Self Breast Exam
 Biopsy if indicated
Done by Yosef A. 25
Done by Yosef A. 26
Breast Self Examination
DISORDERS OF THE BREAST
Benign and malignant tumors of breast
 What does benign means?
 What does malignant means?
 What is cancer?
 Cancer is the name given to a large number of diseases.
 Breast cancer begins in the breast tissue
 Most kinds of cancer are named after the part of the
body where the cancer first start
27Done by Yosef A.
BENIGN BREAST CANCER
A. Fibrocystic breast disease
 It is common benign breast disease in women of all
ages
 It can occur as early as puberty when estrogen level
rises to adult level ,but is found most commonly in
women between the age of 20 and 45 year.
28Done by Yosef A.
Sign and symptoms
 Freely movable , well-delineated breast lump on
palpation
 Visible lump on the surface of breast
 Often occur on upper outer quadrant of the breast
 Consistency-firm and hard to soft and flexible
 Painful (may) and tender
 Round and fluid filled cyst.
29Done by Yosef A.
Cont…
Diagnosis
 Careful palpation
 Mammography
 biopsy
30Done by Yosef A.
Cont…
Management
 Analgesia
 Avoidance of substances containing caffeine ,
theophylline and theobromine
 Avoid smoking
 Aspiration of cyst under local anesthesia
31Done by Yosef A.
Cont…
B . Fibro adenoma
Fibro adenoma are tumors consisting of both fibrotic
and glandular components that occur in response to
estrogen stimulation.
They tend to occur in young women and rarely seen
after menopause and are non malignant.
The tumors may increase in size during adolescence
,pregnancy and lactation or when a woman takes an
estrogen sources such as oral contraceptives.
32Done by Yosef A.
Cont…
Sign and symptoms
 No pain(pain less) and freely movable
 Round and well delineated tumors
 Feel firmer and more rubbery
 Occasionally calcify and feel extremely hard
 Not cause skin retraction
 Management
 Surgical incision
33Done by Yosef A.
C. Carcinoma of the Breast
 The carcinoma of the breast commonly occurs from30-
60 years of age.
Signs and symptoms
 Lump and hard fixed mass
 Pain in the breast
 Blood stained discharge (late stage)
 Retracted nipple of cancer has spread to the lymph
 orange like colour of the skin .
34Done by Yosef A.

Weitere ähnliche Inhalte

Was ist angesagt?

Cardinal movements-of-labour-1
Cardinal movements-of-labour-1Cardinal movements-of-labour-1
Cardinal movements-of-labour-1aishamuddasser
 
Information about Breast Biopsy
Information about Breast BiopsyInformation about Breast Biopsy
Information about Breast Biopsyiangould64
 
Hysterosalpingography
Hysterosalpingography Hysterosalpingography
Hysterosalpingography drpradosh
 
The Pelvis - Bones and Joints
The Pelvis - Bones and JointsThe Pelvis - Bones and Joints
The Pelvis - Bones and Jointsmeducationdotnet
 
Mammary gland and its birth anomalies with characteristics in other mammalian...
Mammary gland and its birth anomalies with characteristics in other mammalian...Mammary gland and its birth anomalies with characteristics in other mammalian...
Mammary gland and its birth anomalies with characteristics in other mammalian...Visith Dantanarayana
 
Development of the female reproductive system
Development of the female reproductive systemDevelopment of the female reproductive system
Development of the female reproductive systemSahar Hafeez
 
Decidua & Chorionic Velli (General Embryology)
Decidua & Chorionic Velli (General Embryology)Decidua & Chorionic Velli (General Embryology)
Decidua & Chorionic Velli (General Embryology)Dr. Sherif Fahmy
 
Transverse lie and cord prolapse
Transverse lie and cord prolapseTransverse lie and cord prolapse
Transverse lie and cord prolapsehemnathsubedii
 
ULTRASOUND EXAMINATION OF Uterine and ovarian pathology by DR ABHIJIT R SINGH
ULTRASOUND EXAMINATION OF Uterine and ovarian pathology by DR ABHIJIT R SINGHULTRASOUND EXAMINATION OF Uterine and ovarian pathology by DR ABHIJIT R SINGH
ULTRASOUND EXAMINATION OF Uterine and ovarian pathology by DR ABHIJIT R SINGHDrABHIJITRSINGH
 
Physiology of lactation
Physiology of lactationPhysiology of lactation
Physiology of lactationVarsha Hirani
 

Was ist angesagt? (20)

Cardinal movements-of-labour-1
Cardinal movements-of-labour-1Cardinal movements-of-labour-1
Cardinal movements-of-labour-1
 
Breast
BreastBreast
Breast
 
Information about Breast Biopsy
Information about Breast BiopsyInformation about Breast Biopsy
Information about Breast Biopsy
 
Hysterosalpingography
Hysterosalpingography Hysterosalpingography
Hysterosalpingography
 
Benign ovarian tumours
Benign ovarian tumoursBenign ovarian tumours
Benign ovarian tumours
 
The Pelvis - Bones and Joints
The Pelvis - Bones and JointsThe Pelvis - Bones and Joints
The Pelvis - Bones and Joints
 
Mammary gland and its birth anomalies with characteristics in other mammalian...
Mammary gland and its birth anomalies with characteristics in other mammalian...Mammary gland and its birth anomalies with characteristics in other mammalian...
Mammary gland and its birth anomalies with characteristics in other mammalian...
 
Embryology
EmbryologyEmbryology
Embryology
 
Ovaries
OvariesOvaries
Ovaries
 
Development of the female reproductive system
Development of the female reproductive systemDevelopment of the female reproductive system
Development of the female reproductive system
 
Fetus in utero
Fetus in uteroFetus in utero
Fetus in utero
 
female breast anatomy and physiology
female breast anatomy and physiology female breast anatomy and physiology
female breast anatomy and physiology
 
Decidua & Chorionic Velli (General Embryology)
Decidua & Chorionic Velli (General Embryology)Decidua & Chorionic Velli (General Embryology)
Decidua & Chorionic Velli (General Embryology)
 
anatomy,physiology of breast
anatomy,physiology of breast anatomy,physiology of breast
anatomy,physiology of breast
 
Transverse lie and cord prolapse
Transverse lie and cord prolapseTransverse lie and cord prolapse
Transverse lie and cord prolapse
 
Normal labour
Normal labourNormal labour
Normal labour
 
Embryology and congenital anomalies of female reproductive system for underg...
Embryology and congenital anomalies of female reproductive system  for underg...Embryology and congenital anomalies of female reproductive system  for underg...
Embryology and congenital anomalies of female reproductive system for underg...
 
ULTRASOUND EXAMINATION OF Uterine and ovarian pathology by DR ABHIJIT R SINGH
ULTRASOUND EXAMINATION OF Uterine and ovarian pathology by DR ABHIJIT R SINGHULTRASOUND EXAMINATION OF Uterine and ovarian pathology by DR ABHIJIT R SINGH
ULTRASOUND EXAMINATION OF Uterine and ovarian pathology by DR ABHIJIT R SINGH
 
Physiology of lactation
Physiology of lactationPhysiology of lactation
Physiology of lactation
 
Breast part 1
Breast part 1Breast part 1
Breast part 1
 

Andere mochten auch (7)

Anatomy of the breast
Anatomy of the breastAnatomy of the breast
Anatomy of the breast
 
Benign breast disease
Benign breast diseaseBenign breast disease
Benign breast disease
 
Morphology of the mammary gland
Morphology of the mammary glandMorphology of the mammary gland
Morphology of the mammary gland
 
Mammary glands
Mammary glandsMammary glands
Mammary glands
 
Benign diseases of breast
Benign diseases of breastBenign diseases of breast
Benign diseases of breast
 
Benign breast disorders
Benign breast disordersBenign breast disorders
Benign breast disorders
 
Breast ultrasound
Breast ultrasoundBreast ultrasound
Breast ultrasound
 

Ähnlich wie 1

Anatomy of Breast in clinical perspective-Dr.Gosai
Anatomy of Breast in clinical perspective-Dr.GosaiAnatomy of Breast in clinical perspective-Dr.Gosai
Anatomy of Breast in clinical perspective-Dr.GosaiDr.B.B. Gosai
 
Breast and it's benign diseases
Breast and it's benign diseasesBreast and it's benign diseases
Breast and it's benign diseasesDrPoojaPandey4
 
Surgical Anatomy of the chest
Surgical Anatomy of the chest Surgical Anatomy of the chest
Surgical Anatomy of the chest Rushi Dave
 
Evaluation and Management of Carcinoma Breast
Evaluation and Management of Carcinoma BreastEvaluation and Management of Carcinoma Breast
Evaluation and Management of Carcinoma BreastDavinder Pal Singh
 
ANATOMY OF MAMMARY GLAND
ANATOMY OF MAMMARY GLANDANATOMY OF MAMMARY GLAND
ANATOMY OF MAMMARY GLANDSubhashini N
 
surgical anatomy of breast & management of advanced carcinoma breast
surgical anatomy of breast & management of advanced carcinoma breastsurgical anatomy of breast & management of advanced carcinoma breast
surgical anatomy of breast & management of advanced carcinoma breastguest6231090
 
BREAST - ANATOMY AND PHYSIOLOGY.pptx
BREAST - ANATOMY AND PHYSIOLOGY.pptxBREAST - ANATOMY AND PHYSIOLOGY.pptx
BREAST - ANATOMY AND PHYSIOLOGY.pptxCaraoten
 
PECTORAL_MUSCLES.pptx
PECTORAL_MUSCLES.pptxPECTORAL_MUSCLES.pptx
PECTORAL_MUSCLES.pptxEasyrexjunior
 
Ovaries & fallopian tube
Ovaries & fallopian tubeOvaries & fallopian tube
Ovaries & fallopian tubeDr. sana yaseen
 
Female reproductive system.pdf
Female reproductive system.pdfFemale reproductive system.pdf
Female reproductive system.pdfdipinbhandari
 
anatomy of breast
anatomy of breast anatomy of breast
anatomy of breast ssuser2b0ef3
 

Ähnlich wie 1 (20)

Anatomy of Breast in clinical perspective-Dr.Gosai
Anatomy of Breast in clinical perspective-Dr.GosaiAnatomy of Breast in clinical perspective-Dr.Gosai
Anatomy of Breast in clinical perspective-Dr.Gosai
 
Breast and it's benign diseases
Breast and it's benign diseasesBreast and it's benign diseases
Breast and it's benign diseases
 
Breast
BreastBreast
Breast
 
Surgical Anatomy of the chest
Surgical Anatomy of the chest Surgical Anatomy of the chest
Surgical Anatomy of the chest
 
Breast
BreastBreast
Breast
 
The Breast
The BreastThe Breast
The Breast
 
Evaluation and Management of Carcinoma Breast
Evaluation and Management of Carcinoma BreastEvaluation and Management of Carcinoma Breast
Evaluation and Management of Carcinoma Breast
 
Lecture of Breast
Lecture of BreastLecture of Breast
Lecture of Breast
 
Anatomy of breast
Anatomy of breastAnatomy of breast
Anatomy of breast
 
ANATOMY OF MAMMARY GLAND
ANATOMY OF MAMMARY GLANDANATOMY OF MAMMARY GLAND
ANATOMY OF MAMMARY GLAND
 
THE BREAST
THE BREASTTHE BREAST
THE BREAST
 
Breast
BreastBreast
Breast
 
surgical anatomy of breast & management of advanced carcinoma breast
surgical anatomy of breast & management of advanced carcinoma breastsurgical anatomy of breast & management of advanced carcinoma breast
surgical anatomy of breast & management of advanced carcinoma breast
 
BREAST - ANATOMY AND PHYSIOLOGY.pptx
BREAST - ANATOMY AND PHYSIOLOGY.pptxBREAST - ANATOMY AND PHYSIOLOGY.pptx
BREAST - ANATOMY AND PHYSIOLOGY.pptx
 
PECTORAL_MUSCLES.pptx
PECTORAL_MUSCLES.pptxPECTORAL_MUSCLES.pptx
PECTORAL_MUSCLES.pptx
 
Benign breast disease
Benign breast diseaseBenign breast disease
Benign breast disease
 
Ovaries & fallopian tube
Ovaries & fallopian tubeOvaries & fallopian tube
Ovaries & fallopian tube
 
Female reproductive system.pdf
Female reproductive system.pdfFemale reproductive system.pdf
Female reproductive system.pdf
 
anatomy of breast
anatomy of breast anatomy of breast
anatomy of breast
 
Chapter 15
Chapter 15Chapter 15
Chapter 15
 

Mehr von Mesfin Mulugeta (20)

2nd quarter report 2007 revised
2nd quarter report 2007 revised2nd quarter report 2007 revised
2nd quarter report 2007 revised
 
Outbreak invest. last
Outbreak invest. lastOutbreak invest. last
Outbreak invest. last
 
Evaluation of evidence [compatibility mode]
Evaluation of evidence [compatibility mode]Evaluation of evidence [compatibility mode]
Evaluation of evidence [compatibility mode]
 
Meas.association [compatibility mode]
Meas.association [compatibility mode]Meas.association [compatibility mode]
Meas.association [compatibility mode]
 
5.1
5.15.1
5.1
 
4
44
4
 
3
33
3
 
2
22
2
 
Maternity 2013
Maternity 2013Maternity 2013
Maternity 2013
 
Lunch
LunchLunch
Lunch
 
Jokes
JokesJokes
Jokes
 
Jokebox
JokeboxJokebox
Jokebox
 
Obs.mx guideline jush body
Obs.mx guideline jush bodyObs.mx guideline jush body
Obs.mx guideline jush body
 
Ob
ObOb
Ob
 
Ip ppt
Ip pptIp ppt
Ip ppt
 
Bifocals 2
Bifocals 2Bifocals 2
Bifocals 2
 
Bifocals 1
Bifocals 1Bifocals 1
Bifocals 1
 
Bifocals 4
Bifocals 4Bifocals 4
Bifocals 4
 
The da vinci code
The da vinci codeThe da vinci code
The da vinci code
 
Lijinet 3
Lijinet 3Lijinet 3
Lijinet 3
 

Kürzlich hochgeladen

SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 

Kürzlich hochgeladen (20)

SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 

1

  • 1. For 3rd Year Midwifery By- Yosef A.
  • 2. CHAPTER SIX THE BREAST  Anatomy & physiology of the breast  Breast examination  Teaching breast Self-examination to women (BSE)  Benign & malignant tumors of the breast  Management of breast disorders  Mammography  Nursing care consideration for a women with mastectomy 2Done by Yosef A.
  • 3. Objectives At the end of this study the student will be able to  Describe the gross structure of the breast.  Describe the physiologies of breast.  Discuss the development of breast and its congenital anomalies.  Give its blood supply and lymphatic drainage. 3Done by Yosef A.
  • 4. THE BREAST ANATOMY AND PHYSIOLOGY OF FEMALE BREAST  Breasts are composed of mammary glands ,connective tissue ,blood vessels , nerves and lymph vessels.  The breasts are secondary reproductive glands of ectodermal origin.  The breast is the upper ventral region of the torso of a primate, in left and right sides, containing the mammary gland. 4Done by Yosef A.
  • 5. Cont…  Each breast consists of 12-20 conical lobes.  Each lobe consists of a group of lobules.  The lobules have several lactiferous ducts , which unit to form a major duct  Each of the major ducts widens to form an ampula  The fatty tissue increases towards the periphery of the lobule and gives the breast its bulk and hemispheric shape and 80-85% of the normal breast is adipose tissue. Lobes---Lobules---Lactiferous ducts---Major duct---Ampula 5Done by Yosef A.
  • 6. Cont…  In non pregnant ,non lactating breast ,the alveoli are small and tightly packed  During pregnancy the alveoli hypertrophy and their lining cells proliferate in number  During lactation , the alveolar cells secret proteins and lipids which comprise breast milk 6Done by Yosef A.
  • 7. POSITION OF BREAST  Extent: Vertical: 2nd to 6th rib (Base of the breast) Horizontal: Lateral margin of the sternum to the mid auxiliary line  2/3rd of the breast lies in the superficial fascia (Pectoral fascia) lying on Pectoralis major  1/3rd of the breast lies in the superficial fascia lying on Serratus Anterior  The greater part of the gland lies in the superficial fascia. 7Done by Yosef A.
  • 8.  A small part-axillary tail extends upward and laterally, pierces the deep fascia at the lower border of the pectoralis major muscle up to the apex of the axilla.  The breast lies upon the deep pectoral fascia, which in turn overlies pectoralis major and serratus anterior, and inferiorly, external oblique and its aponeurosis as the latter forms the anterior wall of the sheath of rectus abdominis 8Done by Yosef A.
  • 9. PARTS OF THE BREAST  Nipple: Conical or Cylindrical prominence in the center of Areola (Devoid of fat, hair & sweat gland)  The nipple level in the thorax varies widely, but is at the fourth intercostal space in most young women.  Nipple is Usually everted Surface anatomy: 4th intercostal space lateral to midclavicular line!!!!  Areola: Circular pigmented area of the skin surrounding the base of the nipple, containing sebaceous glands.  Axillary Tail : Small part of the breast extending to the axilla. 9Done by Yosef A.
  • 10.  Retromammary Space: Space filled with loose connective tissue between breast and pectoral fascia  Lactiferous ducts from each lobule open on the summit of the nipple separately  Lactiferous duct possesses a dilated Ampulla (Lactiferous sinus) just before its termination  Fibrous septa separates the lobes of the mammary gland  Suspensory ligaments (of Cooper):  Mammary gland is firmly attached to the dermis of the skin by these fibrous septa forming suspensory ligaments 10Done by Yosef A.
  • 12. Layers of breast  Mammary layer  Subcutaneous layer  Retromammary layer Development and physiology  The breasts develop as an invigilation of chest wall ectoderm  Which forms a series of branching ducts. Shortly before birth this site of invagination everts to form the nipple.  At puberty, alveoli sprout from the ducts and considerable fatty infiltration of the breast tissue takes place.  With pregnancy there is tremendous development of the alveoli which, in lactation, secrete the fatty droplets of milk. At the menopause the gland tissue atrophies. 12Done by Yosef A.
  • 13.  Neonates: Occasionally, gynaecomastia may occur in the neonatal breast, with discharge of a colostrum-like material (‘witch’s milk’).  From birth until puberty, the breast consists of lactiferous ducts, with no alveoli.  At puberty, the ducts start to proliferate, and their terminations form solid masses of cells—the future breast lobules.  During pregnancy, secreting alveoli appear. During the early weeks, ductal sprouting and lobular proliferation occur, with increased nipple and areolar pigmentation.  The alveoli now display a lumen surrounded by the secretory cells.  In the last days of pregnancy, the breasts secrete colostrum, a yellow, sticky, serous fluid, which is then replaced by true secretion of milk.  After the menopause, the glandular tissue of the breast atrophies, the connective tissue becomes less cellular, and the amount of collagen decreases. In some women, breasts shrink considerably. 13Done by Yosef A.
  • 14. Arterial Supply  The blood supply of the breast is a rich anastomotic network derived from  Perforating branches (Internal thoracic artery)  Lateral thoracic artery (Axillary artery)  Thoracoacromial artery (Axillary artery)  Intercostal arteries  The largest vessels arise from the internal thoracic artery, the perforating branches of which pierce the chest wall adjacent to the sternal edge in the first to fourth intercostal spaces. The vessel in the second space is usually the largest of these. 14Done by Yosef A.
  • 15.  second to fourth anterior intercostal arteries supply perforating branches more laterally.  The axillary artery supplies blood from several branches, namely the superior thoracic, the pectoral branches of the thoraco-acromial artery, the lateral thoracic artery. Venous Drainage  Superficial venous system lies within the subcutaneous fat tissue; most distal veins line the superficial fascia and drain blood centrally; provides connection between right and left breast with potential for metastasis to occur between breasts  Deep venous system consists of veins that follow the arterial system and communicates with the axillary vein, subclavian vein and SVC  Includes lateral thoracic, axillary, subclavian and intercostal veins 15Done by Yosef A.
  • 16. Nerve Supply  Anterior and lateral cutaneous branches of the 4th – 6th intercostal nerves Lymphatic Drainage  75% drains to the axilla  Lateral quadrants: Anterior Axillary or Pectoral nodes  Medial quadrants: Internal thoracic group of Nodes (Parasternal)  Few lymph vessels drains into Posterior intercostal Nodes  Inferior quadrants: May drain into abdominal lymph Nodes  Some lymphatic vessels communicate with the lymphatic vessels of the opposite breast 16Done by Yosef A.
  • 17. Congenital Anomalies  Nipple Inversion: usually bilateral if congenital; associated pathology can be present if the nipple change is a new finding and/or occurs unilaterally  Athelia: absence of the nipple  Polythelia: accessory nipples, can develop anywhere along the milk line; most commonly seen just inferior to the normal nipple; #1 congenital anomaly of the breast in females and males  Amastia: failure of the breast and nipple to develop  Polymastia: accessory breast tissue; most commonly forms without a nipple; usually found in the axilla  Amazia: absence of development of the functional breast tissue beneath a normal nipple/areola 17Done by Yosef A.
  • 18. Developmental abnormalities of Breast  The nipple may fail to evert .  Supernumerary nipples or even breasts may occur along a vertical ‘milk line’  the other hand, the breast on one or both sides may be small or even absent (amazia).  Accessory Breasts- is a health condition where the person afflicted has extra breasts.  The extra breast can be in various forms, from a fully functional breast with a normal appearance and capable of producing milk to a breast that does not lactate or have an areola.  Both men and women can have accessory breasts, but the problem is more commonly observed in women 18Done by Yosef A.
  • 19. . 19 There is no known limit on the amount of extra nipples or breasts that can develop on the human body. Some women have experienced as many as eight nipples in addition to the standard two. Done by Yosef A.
  • 20. Fascial relationships of the breast  The fascial relationships of the breast are of practical importance.  As an ectodermal derivative, the gland lies in a pocket of superficial fascia.  Superficial fascia:  Superficial layer  Deep layer  Fibrous processes of this layer of fascia extend to the skin and to the nipple and are more developed over the upper part of the breast, where they form the suspensory ligament of Cooper.  Contraction of this tissue by malignant infiltration results in the characteristic skin dimpling over a carcinoma of Done by Yosef A. 20
  • 21.  The superficial layer lies immediately beneath the dermis and enables skinflaps to be dissected from the glandular mass of the breast quickly, neatly, and in a relatively avascular plane.  The deep layer of the superficial fascia is thicker than the subcu- taneous component and covers the deep aspect of the breastplate.  Beneath this sheath is a layer of filmy areolar tissue that allows the breast to move freely on the underlying fascial covering of the pectoralis major and the serratus anterior.(Pectoralis fascia) Done by Yosef A. 21
  • 22. Breast examination  Two types of breast examination Breast examination by a physician Breast self examination (BSE) Done by Yosef A. 22
  • 23. Self Examination of the Breast  90% of breast cancers are found by the woman or her partner.  During pregnancy there is no special time of the month that is best to perform the examination.  In non pregnant women 5days after cessation of menstruation ,it is the optimum time to detect changes. • Inspection in the shower • Inspection in the mirror Done by Yosef A. 23
  • 24.  stand in front of the mirror for further inspection a. With arms at sides b. Holding arms over the head ,inspect closely in the mirror for masses and breast symmetry c. Press hands firmly on hips ,below slightly forward . inspect in m Each breast should be mirror image of the other d . Each breast should be mirror image of the other e . Gently squeeze the nipple of each breast between your thumb and index finger to check for signs of discharge or bleeding . irror for lumps or pulling of the skin Done by Yosef A. 24
  • 25. Inspection on lying down lying flat on your back ,with your right hand under your head and a pillow or towel under your right shoulder ,use your left hand to gently feel your right breast using concentric circles to cover the entire breast and nipple . repeat on your left breast. Steps to Diagnosis  Clinical Exam  Mammography  Self Breast Exam  Biopsy if indicated Done by Yosef A. 25
  • 26. Done by Yosef A. 26 Breast Self Examination
  • 27. DISORDERS OF THE BREAST Benign and malignant tumors of breast  What does benign means?  What does malignant means?  What is cancer?  Cancer is the name given to a large number of diseases.  Breast cancer begins in the breast tissue  Most kinds of cancer are named after the part of the body where the cancer first start 27Done by Yosef A.
  • 28. BENIGN BREAST CANCER A. Fibrocystic breast disease  It is common benign breast disease in women of all ages  It can occur as early as puberty when estrogen level rises to adult level ,but is found most commonly in women between the age of 20 and 45 year. 28Done by Yosef A.
  • 29. Sign and symptoms  Freely movable , well-delineated breast lump on palpation  Visible lump on the surface of breast  Often occur on upper outer quadrant of the breast  Consistency-firm and hard to soft and flexible  Painful (may) and tender  Round and fluid filled cyst. 29Done by Yosef A.
  • 30. Cont… Diagnosis  Careful palpation  Mammography  biopsy 30Done by Yosef A.
  • 31. Cont… Management  Analgesia  Avoidance of substances containing caffeine , theophylline and theobromine  Avoid smoking  Aspiration of cyst under local anesthesia 31Done by Yosef A.
  • 32. Cont… B . Fibro adenoma Fibro adenoma are tumors consisting of both fibrotic and glandular components that occur in response to estrogen stimulation. They tend to occur in young women and rarely seen after menopause and are non malignant. The tumors may increase in size during adolescence ,pregnancy and lactation or when a woman takes an estrogen sources such as oral contraceptives. 32Done by Yosef A.
  • 33. Cont… Sign and symptoms  No pain(pain less) and freely movable  Round and well delineated tumors  Feel firmer and more rubbery  Occasionally calcify and feel extremely hard  Not cause skin retraction  Management  Surgical incision 33Done by Yosef A.
  • 34. C. Carcinoma of the Breast  The carcinoma of the breast commonly occurs from30- 60 years of age. Signs and symptoms  Lump and hard fixed mass  Pain in the breast  Blood stained discharge (late stage)  Retracted nipple of cancer has spread to the lymph  orange like colour of the skin . 34Done by Yosef A.