Breast disorders chapter 052

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

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.

 Diagnostic Studies

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.

Benign Breast Disorders

Mastalgia

Breast Infections
 Mastitis
 Lactational Breast Abscess

Fibrocystic Changes
Fig. 52-3. A, Normal breast tissue. B, Fibrocystic breast tissue.

Nursing and Collaborative Management:
Fibrocystic Changes

Fibroadenoma

Nursing and Collaborative Management:
Fibroadenoma
Fig. 52-4. Well-defined encapsulated fibroadenoma.

Nipple Discharge
 Intraductal Papilloma
 Ductal Ectasia

Gynecomastia in Men
 Senescent Gynecomastia

Gerontologic Considerations:
Age-Related Breast Changes

Breast Cancer
 Etiology and Risk Factors
 Pathophysiology

Breast Cancer
Table 52-3. Types of Breast Cancer.

Breast Cancer
 Pathophysiology, continued
• Noninvasive breast cancer
• Paget’s disease
• Inflammatory breast cancer
 Clinical Manifestations

Breast Cancer
Fig. 52-5. Distribution of where breast cancer occurs.

Breast Cancer

Breast Cancer
 Complications
 Diagnostic Studies

Breast Cancer
 Collaborative Care
• Surgical therapy
• Axillary node dissection

Breast Cancer
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.

Breast Cancer
• Surgical therapy, continued
• Breast-conserving surgery
• Modified radical mastectomy
• Follow-up and survivorship care
• Postmastectomy pain syndrome

Breast Cancer
 Collaborative Care, continued
• Adjuvant therapy
• Radiation therapy
• Primary radiation therapy
• High-dose brachytherapy

Breast Cancer
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.

Breast Cancer
• Adjuvant therapy
• Radiation therapy, continued
• Palliative radiation therapy
• Systemic therapy
• Chemotherapy
• Hormonal therapy
• Biologic and targeted therapy

Culturally Competent Care:
Breast Cancer

Nursing Management:
Breast Cancer
 Nursing Assessment
 Nursing Diagnoses
 Planning
 Nursing Implementation
• Acute intervention

Nursing Management:
Breast Cancer
Fig. 52-9. Postoperative exercises for the patient with a mastectomy or lumpectomy with axillary lymph node
dissection.

Nursing Management:
Breast Cancer
Fig. 52-7. Lymphedema. Accumulation of fluid in the tissue after excision of lymph nodes.

Nursing Management:
Breast Cancer
 Nursing Implementation
• Acute intervention, continued
• Psychologic care
• Ambulatory and home care
 Evaluation

Gerontologic Considerations:
Breast Cancer

Mammoplasty
 Breast Reconstruction
• Indications

Mammoplasty
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.

Mammoplasty
 Breast Reconstruction, continued
• Types of reconstruction
• Breast implants and tissue expansion

Mammoplasty
Fig. 52-11. A, Tissue expander with gradual expansion. B, Tissue expander in place after mastectomy.

Mammoplasty
• Types of reconstruction, continued
• Musculocutaneous flap procedure

Mammoplasty
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.

Mammoplasty
• Types of reconstruction, continued
• Nipple-areolar reconstruction
 Breast Augmentation
 Breast Reduction

Nursing Management:
Breast Augmentation and Reduction

Breast disorders chapter 052

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