Breast and Axillae: Anatomy, Physiology, and Physical Assessment

This report provides a comprehensive overview of the anatomy, physiology, and diagnostic procedures related to the breasts and axillae. It begins with an introduction and delves into the anatomical structures and physiological functions of both the breast and axilla, including the distinctions between male and female breasts. The report emphasizes the importance of health history in assessing breast conditions and outlines various physical examination techniques, such as inspection and palpation, used to identify abnormalities. It includes a detailed comparative view of normal and abnormal findings, highlighting conditions like nipple discharge and the significance of breast self-examination (BSE) for early detection of breast cancer. The report concludes by summarizing the key roles of the breasts and axillae in the human body and their relationship to health, emphasizing the importance of early detection and diagnostic tests for maintaining breast health, especially in females.

BREAST AND AXILLAE
- The physiology and diagnostics

THIS STUDY WILL FOCUS ON THE FOLLOWING
1. INTRODUCTION
2. ANATOMY AND PHYSIOLOGY
3. HEALTH HISTORY
4. PHYSICAL EXAMINATION OF BREASTS AND AXILLAE
5. COMPARATIVE VIEW BETWEEN NORMAL AND ABNORMAL FINDINGS
6. SUMMARY
OBJECTIVES

INTRODUCTION
 Breast is the organ or specifically the tissue
enwrapping the chest cavity. Women's breasts are
significantly distinguished from that of their male
counterpart (Bickly & Szilagyi,2012) because of the
presence of a specialized glandular tissue that secretes
milk , along with the presence of fatty adipose tissue.
 Axilla , on the other hand, is the physiological term
used to refer to the armpit of the body , which directly
connects the forearm with the shoulder. These axillae
comprises of sweat glands as well as lymph
nodes(Bickly & Szilagyi,2012) which filters the toxins
and microorganisms , thereby helps in maintenance of
the Breast Health.

ANATOMY AND PHYSIOLOGY OF BREAST
The anatomical structure of (Female) Breasts can
be classified into three kinds of tissues :
Glandular Tissue – This, also referred to as the secretory gland (or
Mammary gland in females) comprises of secretory tubule-alveolar
glands as well as duct. They form 15 to 20 distinct lobes which again
subdivides into lobules and ducts that serves the role of milk
secretion(Pillay & Davis,2019)
Fibrous Tissue - This connective tissue provides structural support
to both the skin covering the surface and the underlying fascia in the
form of fibrous bands (Bickly & Szilagyi,2012)and suspensory
ligaments.
Adipose Tissue – This fatty tissue, surrounds the breast, in the
peripheral areas. The proportions and constituents of these tissue
changes with age , nutrition and other physiological conditions (like
pregnancy and lactation)
ACCESORY PARTS OF THE BREAST :
Areola has small, rounded elevations formed
by sebaceous glands, sweat glands, and
accessory areolar glands. It encompasses the
periphery of nipples.
The smooth muscles present in Nipple and the
Areola plays the role of evacuating milk
through let-down mechanism.

A COMPARATIVE VIEW OF MALE AND FEMALE
BREASTS

ANATOMY AND PHYSIOLOGY OF BREAST
Physiology of Male Breast
 The male breast comprises of a small nipple and
areola. The main distinguishing feature( Bickly &
Szilagyi, 2012) are under-developed breast tissue
consisting of ducts.
 Hormonal stimulation as well as lobular and ductal
segmentation are least in male breasts as they are not
associated with Milk secretion.
Lymphatic tissues
 These tissues acts as the juncture
between Breast and Axilla.
 Most of these lymph vessel subdivides
into lymphatic nodes that opens into the
Axilla as Axillary lymph nodes .

ANATOMY AND PHYSIOLOGY OF AXILLA
As earlier mentioned, Axilla is the medical term
allocated to Armpit .
The main function of Axilla, is operated by the
lymph nodes entering into the axillae(Bickly &
Szilagyi,2012) from that of the breast(Axillary
lymph nodes) .
These lymphatic vessels filters the toxic
constituents and metabolic waste products of
the mammary gland (breasts) .

HEALTH HISTORY
The physical assessment of the
variant conditions of the Breast
is based on a certain criterion .
These three conditions act as the
deciding element in the(Bickly
& Szilagyi,2012) diagnosis or
examination of any sort of any
concerning physiological
ailments of the breast
Breast lump
Breast pain or discomfort
Abnormal nipple discharge

HEALTH HISTORY
The basic emphasis of health history is to pay impetus to the concerning
symptoms which might culminate into a serious ailment in later stage.
Moreover, health history summarizes(Bickly & Szilagyi,2012) five main
questions regarding the criterion triad , which is being asked to the Subject.
Do you examine your
breasts?
How Often ?
Do you feel any pain or
discomfort in breast ?
Did you observe any
lump or soreness in
your breast ?
If yes, then what is the
shape or size of the
lump?
Any changes in it ?
Apart from any lump,
have u observed any
nipple discharge?
Is it regular or
occasional ?

DIFFERENT ABNORMALITIES
RELATED TO BREAST PHYSIOLOGY

PHYSICAL EXAMINATION OF BREASTS
The physical examination is based on two primary key-criteria – Inspection and
Palpation
A Proper Inspection of the breast includes careful examination for skin changes, size
of breasts , skin colour and retraction on the basis of following four elements :
Arms at sides – the symptomatic features :
Skin colour and appearance of the Breasts (Changes in colour , abnormal thickening
of skin along with unusual pores resulting in probable lymphatic blockage)
Symmetry (some changes in size of breast)
Contour ( presence of any flattened mass or any lump on the breast surface)
Nipple charecteristics ( Abnormal changes regarding size and shape, any rashes or
ulceration, or any discharge or abnormal secretion from the nipples )

PHYSICAL EXAMINATION OF BREASTS
Arms over Head
This posture helps in identifying any lump or
abnormal mass on the breasts.
For example, any signs of Lumping or dimpling
indicates Breast Cancer(Bickly & Szilagyi, 2012)
Hands pressed against hips
This posture helps in locating the signs which might
be associated with benign lesions
Leaning Forward
This form of positional inspection , generally
indicates sub-clinical signs , such as lack of
symmetry of the breast or nipple .
A retrieval tendency of the nipple and areola
suggests the chances of a probable subclinical
breast cancer.
Inspection techniques: Arms Over Head ; Hands Pressed Against Hips & Leaning forward

PHYSICAL EXAMINATION OF BREASTS
Palpation is best performed when the breast
tissue is flattened.
Palpation is done through a rectangular area of
the breast surface using the finger-pads of the
second , third and fourth fingers respectively.
Proper examination requires 3 minutes
approximately.
Also , for palpating , the patient need to be in a
sitting or in a lying position.
Criteria for Palpation :
For clinically examining through
palpation, the breast is generally
dissected into four quadrants or
sections, represented by horizontal
and vertical lines crossing at the
nipple

PHYSICAL EXAMINATION OF AXILLAE
INSPECTION
Inspection of each axilla is done to detect
any presence of:
● Rash
● Infection
● Unusual pigmentation
This may indicate any infection of the
sweat glands (Jaglan , Dass & Duhan et
al.,2019) or hyper pigmentation of axillary
lymph nodes due to any infection in breast
or arms.
PALPATION
This mode of examination deals with
examining axilla or more specifically
the functioning of the Axillary lymph
nodes.
It is done by pressing the pectoral
muscles near the chest cavity , softly
with the left hand , for feeling the
central lymph nodes or other
accessory ones- Subscapular , Pectoral
or Lateral.

PHYSICAL EXAMINATION OF BREASTS:
NIPPLE DISCHARGE
If spontaneous nipple discharge is being
reported, it is determined by pressing the
areola with the index finger in a circular
positions(Henderson & Ferguson et
al.,2019) around the nipple.
The color, consistency, as well as quantity
of abnormal discharge should be noticed.
The discharge can be from a single duct or
multiple duct based
The reasons behind untimely and abnormal
discharge is non-puerperal galactorrhoea
which again results from hormonal
imbalance or drug actions.

PHYSICAL EXAMINATION : ANOTHER DIAGNOSTIC
PROCEDURE
Breast self examination
(BSE).
Women examining their own breasts through
this methods , has been beneficial in self
diagnosis(Bashirian et al.,2019) of any
abnormal lump in breasts .
BSE is beneficial for early detection of breast
cancer and is most effective for examination ,
especially after menstruation, due to low
secretion of Oestrogen hormone.
This method is also one of the convenient and
expense-free techniques for evaluating breast
health.

COMPARATIVE VIEW BETWEEN THE OBSERVATIONS
OF THE PHYSICAL EXAMINATIONS

COMPARATIVE VIEW BETWEEN THE OBSERVATIONS OF THE
PHYSICAL EXAMINATIONS

SUMMARY
Breasts and Axilla plays a coordinative role in Human body While Breasts
are mainly associated with secretory functions (in females) , Axilla are
responsible for draining out the toxic metabolites which are formed as a
result of the metabolic processes in Breasts.
Any abnormality in Breasts (especially in females) – pain , formation of any
abnormal lump, untimely nipple discharge , swelling of axillary lymph
nodes, any rashes or infections in breast skin. All these accounts for Self
examination or other diagnostic tests which also enables in detection of
Breast cancer.
For males , the abnormalities can be detected in the same way but the
chances of developing breast cancer or any abnormality is rare.

REFERENCES
Bickley, L., & Szilagyi, P. G. (2012). Bates' guide to physical examination and history-
taking. Lippincott Williams & Wilkins.
Henderson, J. A., & Ferguson, T. (2019). Breast Examination Techniques.
Pillay, J., & Davis, T. J. (2019). Physiology, lactation. In StatPearls [Internet].
StatPearls Publishing.
Jaglan, P., Dass, R., & Duhan, M. (2019). Breast cancer detection techniques: issues
and challenges. Journal of The Institution of Engineers (India): Series B, 1-8.
Bashirian, S., Barati, M., Mohammadi, Y., Moaddabshoar, L., & Dogonchi, M. (2019).
An application of the protection motivation theory to predict breast self-examination
behavior among female healthcare workers. European journal of breast health, 15(2),
90.