Plate 184: Thorax—Mammary Gland—Lymph Vessels and Nodes of Mammary Gland (sites of metastatic spread of breast carcinoma)
Fig. 3-2-1: Sagittal section through the right breast and underlying chest wall. In this dissection, the glandular structure of the breast cannot be distinguished. (From Gosling JA, Harris PF, Whitmore I, et al. Human Anatomy, 4th Edition Mosby, 2005, Fig 2.8, p. 30)
Fig. 3-2-2: Examination of the breast. Performed in a rotary fashion, the entire breast is gently palpated by compression against the chest wall. (From Hansen JT, Lambert DR. Netter's Clinical Anatomy. Elsevier Inc., 2006, p. 303)
The breast is palpated in a circular fashion, beginning with the nipple and moving outward. The palpation should extend into the axilla to palpate the axillary tails.
After palpation of one breast, the other should be palpated in the same way.
Examine the skin of the breast for a change in texture or dimpling (peau d'orange sign) and the nipple for retraction, since these signs may indicate an underlying pathology.
Box 3-2-2: Clinical Points
Pathology of the Breast
Fibroadenoma: benign tumor, usually a solid and solitary mass that moves easily under the skin. Often painless although sometimes tender on palpation. More common in young women but can occur at any age.
Intraductal carcinoma or breast cancer: the commonest type of malignancy in women but can also occur in men. Approximately 50% of cancers develop in the upper quadrant of the breast; metastases from these cancers often spread to the axillary lymph nodes. This malignancy presents as a palpable mass that is hard, immobile and sometimes painful. Additional signs can include bloody or watery nipple discharge if the larger ducts are involved.
Gynecomastia: enlargement of the breasts in males because of aging, drug treatment, and changes in the metabolism of sex hormones by the liver.