Chapter 18: Breasts & Axillae

Breasts & Axillae details the female breast's structural landmarks, extending from the clavicle to the sixth rib, while explaining the significance of glandular segments, lactiferous ducts, and the suspensory Cooper ligaments that maintain breast contour. Clinical markers such as the axillary tail of Spence and the clock-face method for localizing findings are established to ensure precise documentation. The material highlights how the breast is a dynamic, hormonally responsive tissue, where physiologic nodularity and premenstrual enlargement are common, yet must be differentiated from pathological conditions. For the health history, practitioners are taught to investigate common concerns like palpable masses, focal or diffuse pain, and various types of nipple discharge, ranging from benign galactorrhea to concerning unilateral bloody secretions. The physical examination section emphasizes a systematic approach, utilizing inspection in multiple positions—such as arms overhead and hands pressed against hips—to detect subtle skin dimpling or nipple retraction. Palpation is standardized using the vertical strip pattern and varying pressure levels to identify dominant masses or enlarged axillary lymph nodes, including the central, pectoral, and subscapular groups. Additionally, the chapter addresses the male breast, specifically distinguishing between firm glandular gynecomastia and pseudogynecomastia caused by adipose tissue. Essential health promotion topics are integrated throughout, covering breast cancer epidemiology, the use of the Gail model for risk assessment, and current screening guidelines from organizations like the USPSTF and ACS. By comparing the clinical features of fibroadenomas, cysts, and invasive carcinomas, the text prepares students to recognize critical diagnostic indicators, such as the hard, fixed nodules and the peau d'orange appearance associated with lymphatic blockade.