Adulthood. The normal adult breast may be soft, but it often feels granular, nodular, or lumpy. This uneven texture is normal and may be termed physiologic nodularity. It is often bilateral. It may be evident throughout the breast or only in parts of it. The nodularity may increase premenstrually—a time when breasts often enlarge and become tender or even painful. For breast changes during adolescence and pregnancy, see p. 409 and pp. 699-700.
Aging. The breasts of an aging woman tend to diminish in size as glandular tissue atrophies and is replaced by fat. Although the proportion of fat increases, its total amount may also decrease. The breasts often become flaccid and more pendulous. The ducts surrounding the nipple may become more easily palpable as firm, stringy strands. Axillary hair diminishes.
Lymphatics from most of the breast drain toward the axilla. Of the axillary lymph nodes, the central nodes are palpable most frequently. They lie along the chest wall, usually high in the axilla and midway between the anterior and posterior axillary folds. Into them drain channels from three other groups of lymph nodes, which are seldom palpable:
■ Pectoral nodes—anterior, located along the lower border of the pectoralis major inside the anterior axillary fold. These nodes drain the anterior chest wall and much of the breast.
■ Subscapular nodes—posterior, located along the lateral border of the scapula; palpated deep in the posterior axillary fold. They drain the posterior chest wall and a portion of the arm.
■ Lateral nodes—located along the upper humerus. They drain most of the arm.
Lymph drains from the central axillary nodes to the infraclavicular and supraclavicular nodes.
Not all the lymphatics of the breast drain into the axilla. Malignant cells from a breast cancer may spread directly to the infraclavicular nodes or into deep channels within the chest.
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