A nurse is examining the breasts of a 75-year-old woman. Which of the following are normal findings in the breasts of an older adult? Select all that apply.

Age-related breast changes occur due to declining estrogen levels, progressive glandular atrophy, and increased adipose replacement, resulting in reduced breast density, altered structural support, and changes in skin and nipple morphology without necessarily indicating pathology in geriatric populations. Rationale: A. Smaller, flatter nipples occur due to tissue atrophy and reduced estrogen stimulation in older adults. The nipple-areolar complex becomes less prominent and less erect with aging. This is a normal involutional change in breast anatomy in the geriatric population. B. Pendulous breasts result from loss of connective tissue elasticity and replacement of glandular tissue with fat. Gravity and decreased structural support cause breast sagging. This is a common age-related finding and considered a normal physiologic change. C. Peau d’orange skin indicates lymphatic obstruction, commonly associated with inflammatory breast carcinoma. It presents as thickened, dimpled skin resembling orange peel. This is a pathological finding and not a normal age-related breast change. D. Spontaneous nipple discharge is a pathologic sign, especially in older adults, and may indicate malignancy or intraductal disease. Normal aging does not cause spontaneous discharge. Any unexpected discharge requires further diagnostic evaluation to rule out breast pathology.