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BREAST DISEASE SYMPTOMS & WORKUP

Common Breast Symptoms & Exam Findings

The breast is made up of glands (lobules where breast milk is made and ducts where breast milk travels through to the nipple), fat and connective tissue including Cooper’s ligaments to maintain the shape of the breast, the overlying skin and nipple-areolar complex, and underlying chest wall muscles. The lymphatic channels of the breast usually drain to the ipsilateral axilla, although more medially in the breast, they can drain to the internal mammary lymph nodes. Figure 20–1 shows the structure of the breast.

Figure 20–1.

Breast anatomy and structure.

Common presenting symptoms of breast disorders include breast pain, nipple discharge, a palpable breast lump, redness, change in the skin or nipple of the breast, or a change in the contour/shape of the breast. In context with the patient’s history, risk factors, and exam, it is often possible to classify these symptoms as likely benign or concerning for malignancy to help with facilitating the next steps in workup and counsel the patient. Table 20–1 classifies common symptoms of benign and malignant breast disease. Many patients who present with breast disease are asymptomatic as small findings are often identified on routine screening mammogram.

Table 20–1.Common symptoms of benign and malignant breast disease.

Physical examination of the breast includes palpation of regional lymph nodes (supraclavicular, axillary) and visual inspection and palpation of the bilateral breasts. Any symptom of nipple discharge should be attempted to be elicited to evaluate color and whether it is from a single or multiple ducts and whether unilateral or bilateral in nature. Exam findings may include palpation of a breast mass. Masses that are well-circumscribed and freely mobile within the breast tissue may represent more benign entities such as a cyst or fibroadenoma. Irregularly shaped masses or those involving the overlying skin or fixed to the breast or underlying muscle are concerning for malignancy. Many women, especially young women, have physiologically nodular breast tissue and exam may be more difficult. Comparison with the contralateral breast is helpful in these cases to determine if a possible finding is symmetric. Imaging is always indicated in the setting of a new breast mass as a supplement to physical exam.

The breast skin can be affected by common dermatologic findings such as moles, keratosis, skin irritation, rashes, and ...

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