Accessory Breast

The breasts are modified sweat glands. The stages in the development of the female breast are illustrated in Figure 2.50. The commonest site for nipple development is the fourth intercostal space on the midclavicular line, but accessory breast/nipple tissue may develop anywhere down

1 Pre-pubertal

1 Pre-pubertal

Groin Exercises For FemalesMedical Groin AnatomyAccessory Breast TissueMedical Groin AnatomyAccessory Axillary Breast Tissue

[lie nipple line (axilla lo groin) (Fig, 2.51). The adult breast may be divided into the nipple, the areola and four quadrants, upper and lower, inner and outer, with the axillary tail projecting from the upper and outer quadrant (Fig. 2.52), The nipple consists of erectile tissue covered wiih pigmented skin, which also covers the areola. The openings of the lactiferous ducts may be seen near the apex

Ectopic Breast Tissue Axilla
Fig, 2.51 Accessory breast tissue in the axilla.
Accessory Breast Pictures
Fig. 2.52 The adult right breast.

of the nipple. The size and shape of the breasts in healthy women vary widely, and are influenced by hereditary factors, sexual maturity, the phase of the menstrual cycle, parity, pregnancy and lactation and ihe general stale of nutrition. The amount of fat and stroma surrounding the glandular tissue largely determines the size of the breast, except during lactation, when the enlargement is almost entirely glandular.

The breast is a hormonally responsive gland, and in premenopausal women its consistency may vary considerably in response to fluctuations in oestrogen and progesterone levels during the menstrual cycle and in pregnancy. Swelling and tenderness due to fluid retention and prominence of the glandular elements of the breast are more common in the premenstrual phase. With age there is a reduction in the amount of glandular tissue with a

MACLEOD'S CLINICAL EXAMINATION

Breast Examination Macleods

Xtous POSi'i0nS f0r inSpeCtin9 the bre3S!S' ® Hand reStinS 0,1 thi9hS-0 Hand preSSed °nt0 hipS' 0 Ams above tead'm Leanil9forward with breasts corresponding increase in the relative amount of fat. The breasts are therefore softer in consistency and are more pendulous. The breasts of lactating women are swollen and engorged with milk and are best examined after breastfeeding or milk expression.

Examination sequence

LJ Take care to avoid upsetting any patient, particularly the more modest, by explaining the purpose of the examination. Male clinicians should be chaperoned.

□ Ask the patient to sit upright on a well-illuminated chair, undressed to the waist and with the hands resting on the thighs so that the pectoral muscles arc relaxed (Fig. 2.53A).

L I Sit facing the patient and carefully inspect the breasts for asymmetry, local swelling or changes in the skin or nipples.

□ Repeat the inspection with the patient's hands pressed firmly on the hips (Fig. 2.53B), thereby contracting the pectoral muscles, then with arms raised above the head (Fig. 2.53C) to stretch the pectoral muscles and the skin over the breasts, and finally leaning forward so that the breasts become pendulous (Fig. 2.53D). Such actions expose the whole breast and exacerbate skin dimpling.

□ Ask the patient to lie with the head supported on one pillow and with the hand on the side to be examined under the head (Fig. 2.54).

□ With the hand held flat to the skin, palpate the breast tissue using the palmar surface of the middle three fingers, compressing breast tissue gently against the chest wall.

Accessory Breast
Fig. 2.54 Position lor palpating of the right breast.

□ Consider the breast as the face of a clock and carefully examine each hour of the clock from outside towards the nipple, not forgetting the tissue directly under the nipple. Compare the texture of one hreast with that of the other.

□ Define the characteristic of any mass, including fixation to underlying tissues or tethering to skin, which may become apparent as a dimpling overlying the tumour when the breast is gently elevated by a hand.

□ To determine if a mass is fixed to underlying tissue, ask the patient to place her hands oil her hips. Holding the tumour between thumb and forefinger, then ask the patient to alternately contract and relax the pectoral muscles by pushing into her hips.

□ Examine the axillary tail between linger and thumb as it extends towards the axilla.

□ To palpate the nipple, hold it gently between index finger and thumb and attempt to express any discharge.

□ Complete the examination by palpating the regional lymph nodes, including the supraclavicular group. Examine the axillae with the arms relaxed in order to expose the apex of the axilla and then with the hands on the hips to tense the pectoral fascia and contract the pectoral muscles.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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