Chapter 6

Chapter 6:
Disorders of the Breasts

Copyright © 2017 Wolters Kluwer · All Rights Reserved
Benign Breast Disorders
• Noncancerous
• Not life-threatening
• Cause pain and discomfort
• Account large number visits to HCP

Common Benign Breast Disorders
•Fibrocystic breasts (lumpy)
•Fibroadenomas (solid)
•Mastitis

Fibrocystic Breast Changes
• Response of breast tissue to monthly
estrogen & progesterone levels.
• Most common breast disorder affecting
women btwn. 20-50 y.o.
• Rare in postmenopausal women.
• Therapeutic management:
– self-care
– medications for severe cases

Fibrocystic Breast Changes (cont.)
Nursing assessment:
• Lumpy tender breasts bilaterally
occurring primarily during week
before menses.
- Dull, aching fullness.
- Possible clear to yellow nipple
discharge.
• Fibrosis or thickening early on.
- cyst formation in later stages.
- cysts usually mobile and tender
without skin retraction.
• Mammography and ultrasound

Fibrocystic Breast Changes (cont.)
Nursing management:
– Education about condition
– Self-care tips
– Monthly breast self-
examination (BSE) after
menses for changes.

Question
Is the following statement True or False?
Fibrocystic breast changes are most common in
postmenopausal women.
a. True
b. False

Answer
b. False
Fibrocystic breast changes are most common in women
between the ages of 20 and 50 and are rare in
postmenopausal women.

Fibroadenomas
Nursing management:
-Reevaluation in 6 mo.
-Monthly BSE
-Annual clinical breast
exams
• Benign solid breast tumors
• Glandular and fibrous tissue
usually occurring in women ages
15 to 35.
• TX: “watchful waiting,” surgery,
cryoablation
• Nursing assessment:
– firm, rubbery
– well-circumscribed freely
mobile nodules.
– with or without tenderness

Mastitis
• Infection of CT primarily in lactating or engorged women.
• Types: lactational (peripheral) or nonlactational (central)
• TX: oral antibiotics, acetaminophen
• Nursing assessment:
– risk factors
– flu-like symptoms
– warm, red, tender, swollen breast
– cracked or abraded nipple

Nursing management:
• Breast-feeding or
continued emptying of
breast
• Medications
• Proper infant positioning
at nipple
• Warm compresses
• Handwashing
• Supportive bra
Mastitis

Breast Augmentation
Common surgical procedure:
– Aesthetic
– Reconstructive surgery
following a mastectomy
• Complications:
– Capsular contraction
– Rippling
– Implant rupture
– Infection
– Hematoma

Malignant Breast Disorder: Breast Cancer
• Most common cancer in women
• Second leading cause of cancer deaths.
• Etiology: result of complex interaction of environment,
genetic, and hormonal factors
• Pathophysiology: unregulated cell growth beginning in
epithelial cells of mammary ducts
• Noninvasive (or in situ) or invasive (or infiltrating)
• Invasive ductal carcinoma most common

Risk Factors for Breast Cancer
Nonmodifiable:
• Gender, age, race
• Genetic mutations
• Family or personal HX of breast cancer
• HX of ovarian or colon cancer
• Increased breast density
• Previous abnormal breast biopsy
• Exposure to chest radiation
• Previous breast radiation
• Early menarche or late menopause

Modifiable:
• Not having children or
childbearing after age 30
• Postmenopausal use of
estrogens and progestins
• Failing to breast-feed for up to
a year after pregnancy
• Alcohol use & smoking
• Obesity and high-fat diet
• Sedentary lifestyle
Risk Factors for Breast Cancer

Question
Which woman would be at greatest risk for developing
breast cancer?
a. One who had her first child at age 25
b. One with a family history of colon cancer
c. One who had her first period at age 10
d. One who is negative for BRCA-1 and BRCA-2 genes

Answer
c. One who had her first period at age 10
A woman who experiences an early menarche (such as before 12
y.o.) is at higher risk for developing breast cancer.
• Women who have children after age 30, have a personal history
of colon cancer, or test positive for the BRCA-1 and BRCA-2
genes are also at risk for breast cancer.

Diagnostic Tests
for Breast Cancer
• Diagnostic mammography
• Magnetic resonance mammography
(MRM)
• Fine-needle aspiration
• Stereotactic needle-guided biopsy
• Sentinel lymph node biopsy
• Hormone receptor status
• DNA ploidy status
• Cell proliferative indices
• HER-2/neu genetic marker

Therapeutic Management of Breast Cancer
• Surgical options
– Breast-conserving surgery
– Mastectomy: simple, modified, radical

• Adjunct therapy
– Radiation therapy
– Chemotherapy
– Endocrine therapy
– Immunotherapy
Therapeutic Management of Breast Cancer

Question
Is the following statement True or False?
Early breast cancer has no symptoms.
a. True
b. False

Answer
a. True
Early breast cancer has no symptoms. The earliest sign of
breast cancer is often an abnormality seen on a screening
mammogram before the woman or health care professional
feels it.

Later Signs of Breast Cancer
• Continued and persistent changes
in the breast
• Lump or thickening in one breast
• Persistent nipple irritation
• Unusual breast swelling or
asymmetry
• Lump or swelling in the axilla
• Changes in skin color or texture
• Nipple retraction, tenderness, or
discharge

Nursing Process for the Patient with Breast Cancer
• Assessment
– Often asymptomatic; possible changes in
breast appearance or contour
– Clinical breast examination
– Characteristics of mass

• Nursing diagnoses
– Disturbed body image
– Fear
– Deficient knowledge
• Nursing interventions
– Education
– Emotional support

– Postoperative care:
• Immediate postoperative care
• Pain management
• Affected arm care
• Wound care
• Mobility care
• Respiratory care
• Education
• Explain that ongoing surveillance is
needed to detect recurrence of cancer
or a new primary site.
– Follow-ups every 6 months.

Protection of the Arm with Lymphedema

• Nursing interventions
– Health promotion and disease prevention strategies
– Breast cancer screening
• Breast self-examination
• Clinical breast examination
• Mammography
– Nutrition

•Engaging in daily moderate exercise and weekly vigorous
physical activity
•Consuming at least 5 servings of fruits and vegetables daily
•Not smoking or using any tobacco products
•Keeping a max, BMI of 25 / limiting weight gain to <11 lb
since age 18.
•Consuming >7 daily portions of complex carbs, such as whole
grains and cereals
•Limiting intake of processed foods and refined sugar
•Avoiding use of dietary supplements which are unlikely to
improve prognosis
•Restricting red meat intake to approximately 3 oz daily
•Restricting intake of salty and fatty foods (particularly of
animal origin)
NUTRITION & EXERCISE

Teaching Topics for Breast Cancer Prevention
• Prevention
• Early detection
– Breast self-examination
– Clinical breast examination
– Mammography
• Screening
• Dispelling myths and fears
• Self-examination techniques

Changes to Assess During Breast Self-Exam
• Changes in shape, size, contour, or symmetry
• Skin discoloration or dimpling, bumps/lumps
• Sores or scaly skin
• Discharge or puckering of the nipple

Breast Self-Examination Techniques
• Patterns using a circular motion
– Spiral
– Pie-shaped wedges
– Up and down
• Types of palpation
– Light (move the skin without moving the tissue underneath)
– Medium (midway into the tissue)
– Hard (down to the ribs)

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