Anatomy Of The Breast Flashcards
To what the breast belongs embryologiclly?
Belong to integument
What is the function of the breast?
Part of the reproductive system
Feeds
Found in male and female
What does the breast shape and size depend on?
Genetic Racial Dietary factors Parity Menopausal status of the individual
What makes breast different in female?
Size differences between women are due to amount of fat
How we divided into quadrants
The main bulk (mass) of breast tissue is usually localized to its upper outter quadrang
What quadrant is more often implicated in breast cancer
UOQ is the site of about half of all breast cancer
Where is the mamary gland located ?
Each mammary gland, is located within the anterior thoracic wall. Lateral aspect of pectoral region
At which ribs it is located?
Ribs 2/3
And 6/7
Extend to where to where
Extend from sternum to axilla
By what is the breast surrounded?
The breast is surrounded by supperficial fascia
How is the breast attached to surrounding breast?
It is fixed to skin and underlying fascia by fibrous C.T bands
What is the base of the mammary gland look like?
Is circular, either flattened or comcave
What separates the pectoralus major muscle by fascia?
Retromammary space
What is true about the left breast?
The left breast is usually slightly larger
What is the shape of the base of the breast?
Is circular, either flattened or concave
What separate the breast from the pectoralis major muscle by fascia
Retromammary space
The glands that lie in the pocket of superficial fascia is derivative of what?
Ectodermal derivative
Where does the superficial layer lies in the breast layers and it is composed of what?
The superficial layer lies immediately beneath the dermis
What is the significance of the superficial layer?
Enables skinflaps to be dissected from glandular mass of the breast quickly,neatly,and in a relatively avascular plane
Is thicker than the subcutaneous component and covers the deep aspect of the breastplate
Deep layer of the superficial fascia
What is beneath the deep layer of superficial fascia?
Beneath this sheath is a layer of filmy areolar tissue that allows the breast to move freely on the underlying facial covering of the pectoralis major and serrated anterior (pectoralis fascia)
What does the areolar layer beneath the deep layer of superficial fascia?
Retromammary space/ submammary space
Precise establishment of the plane of retromammary space enables rapid and relatively bloodless dissection of the deep aspect of the breast in simple mastectomy
Fibrous processes from deep layer extend to skin and to the nipple and are more developed over the upper part of the breast what will they will form?
The suspensory ligaments of cooper
Where the suspensory ligaments of cooper pass?
Ligaments run from clavicle and clavipectoral fascia —> branching out through and around breast tissue to the dermis of skin overlying breast
What is the function of suspensory ligaments of cooper?
Supporting breast in its normal position and maintaining its normal shape
What happens if there is no internal support with suspensory ligaments of cooper?
Without the internal support of this ligament, breast tissue (which is heavier than the surrounding fat) sags under its own weight, losing its normal shape and contour
What happens if there was contraction in cells surrounding the breast?
Contraction of this tissue by malignant in filtration results in the characteristic skin dimpling over carcinoma
Benign tumor or cyst
Aging
Mammary duct etasia—> pagers disease of breast
It is the suspensory ligaments of cooper give rise to the dimpling appearance that is seen following development of inflammatory carcinoma —> as lymphatic ducts become blocked by (lymphoedemz) the the skin remains tethered by the ligaments
Orange peel
PeauD’ ORANGE
It is used to describe the symptom in which the skin becomes thick And pitted with a texture and appearance similar to that of orange peel
Pequot d orange
How can carcinoma lead to dimpling?
By decreasing the length of cooper’s ligament
Is a pigmented ring of skin surrounding and covering the nipple ?
Areolar
What gives the areola it’s dark appearance?
Contains more melanin (melanocytes) than skin
What happens to the color of areola during pregnancy?
Color darkens during pregnancy and then returns to norma,
What does the areola lacks?
The areola is a skinned region lacking
Hairs
Sweat glands
What does the areola contain?
The areola contains:
- Sebaceous glands
- Abundant sensory nerves
- Circular and radial smooth muscle fibers (cause nipple erection)
What does radial and circular smooth muscle fibers cause ?
It causes nipple erection
How the areola surface appears?
It’s surface appears uneven and grainy due to numerous sebaceous glands (glands of Montgomery) —> immediately internal to the surface that are often visible to naked eye
Why the surface of the areola appears uneven and grainy?
Due to numerous sebaceous glands ( glands of Montgomery) immediately internal to the surface that are often visible to naked eye
What are glands of Montgomery?
They are sebaceous glands
It is a small conical/ cylindrical prominence below center of the breast?
It is the nipple
What is the level of the nipple?
4th intercostal space in most women
What surrounds the nipple?
Surrounded by areola tissue
Has a connective tissue rich in smooth muscle fibers that run parallel to lactiferous sinuses and produce nipple erection when they contract
The nipple
What are normal types of nipples?
- Exerted (most common type)
- Flat
- Semi-inverted
- Inverted
- Wide or non-stretchable
What do we call the breast area that goes like axillary tail?
Tail of Spence
What is tail of Spence?
Is a prolongation of upper, outer quadrant in axillary direction
Under what the tail of Spence passes?
Passes under axillary fascia
With what tail of Spence is mistaken?
May be mistaken for axillary lymph nodes
What does each lobe contains?
Each lobe has one lactiferous duct
How are lobes and ducts of breast arranged?
They are arranged radially and they are embedded in CT and adipose of superficial fascia
From what the lobes of the breast are composed?
They are composed of lobules
From what the lobules of the breast are composed?
They are comprise of alveoli
From what each alveolus is composed?
Each alveolus consists of secretory epithelial cells, surrounded by Mayoepithelial cells
From what the parenchyma of the breast is composed?
Alveoli —> lobules —> lobes
What are the three tissue present in the parenchyma of the breast?
- Glandular epithelium
- Fibrous stroma And supporting structures
- Fat
What stimulates the secretory epithelium in the alveoli?
- Changes with hormonal signals
- Onset of menstrautioan
- Pregnancy (glands begin to enlarge at 2nd month)
- After birth, 1st secretion is colostrom (contain antibodies)
When the glands begin to enlarge during pregnancy?
At 2nd month
What is the first secretion after birth?
Colostrum contain antibody
What is the significance of fatty tissue in the breast?
- It surrounds surface
- Fills spaces between lobes
- Determines form and size of breast
Is there any fatty deposition bellow the nipples and areola?
No fatty deposition
Nipple may fail to evert congenital or due to cancer?
Inverted nipple o
A. “Polythelia” or “hyperthermia”
B. Additional nipples along milk line
Ectopic nipples
More common than supernumerary breasts
Found along milk line
May darken during pregnancy
Not dangerous
Supernumerary nipples
Breast on one or both sides may be small or absent
Amastia
A. Breast development of male in areolar region
B. Noted in males who smoke marijuana at puberty
Gynecomastia
What are the major routes of metastasis in breast?
- From medial lymphatics to parasternal nodes to mediastinal nodes
- Across the sternum in lymphatics to opposite side via cross — mammary pathways —> then to contralateral breast
- From sub-diaphragmatic lymphatics to nodes in abdomen —> then to liver, ovaries, peritoneum
To what surgeons define metastatic axillary node spread? And how many levels are they?
Pectoralis minor
Level 1/2/3
Level 1
Lateral bellow to pectoralis minor
Level 2
Along and behind pectorals minor
Level 3
Medial to pectoralis minor between upper border of pectoralis minor and lower border of clavicular
What are the arterial supply of the breast?
A rich anastomotic network derived from thoracic branches of 3 pairs of arteries
- Axillary artery
- internal mammary (thoracic arteries)
- Intercostal space
The axillary artery is a branch of what and gives rise to what?
- Continuous from subclavian artery
- Gives rise to
A. external mammary = also known as lateral thoracic artery
B. Superior thoracic
C. Pectoral branches of thoracic-acromial artery
From where the internal mammary (thoracic artery)?
1) first descending branch of subclavian artery
What does the internal mammary (thoracic) arteries 60%
Supply intercostal spaces and breast
For what internal mammary artery is used?
Used for coronary bypass surgery
From where the intercostal arteries arise?
Numerous branches from external and internal mammary arteries
What does the intercostal artery supply?
The intercostal artery supply the intercostal spaces and breast
What is the venous draining of the breast?
The veins of the breast form a ring around the base of the nipple (circulus venous)
Large veins pass from circulus venous to circumference of mammary gland then to?
A. External mammary (lateral thoracic vein) to axillary vein primary
B. To internal mammary to subclavian
The innervation of the breast is derived from where?
- Anterior and lateral cutaneous nerves of the thoracic
2. Spinal segment T3-T6
What are nerves related to the breast although not intimately involved with the innervation of the breast?
- Long thoracic nerve (serratus anterior)
- Thoracodorsal nerve (latissimus Dorsi)
- Intercostalbrachial nerve (lateral cutaneous : sensory to medial arm and axilla T2
- Medial and lateral pectoral nerves
What does the lymphatic drainage of the breast follow?
- Tributaries of axillary vessels to axillary lymph nodes
- Tributaries of internal thoracic vessels to internal mammary chain
- Intercostal lymph nodes 2-6 / 3-7
There is a tendency that the lateral breast will drain to?
Drain towards the axilla
There is a tendency for medial part of the breast to drain?
To internal mammary chain
What is the difference between breast clinical lymph nodes and anatomical lymph nodes?
Clinical lymph nodes? 1. Glandular lymphatics 2. Medial quadrants 3. Superficial regions of skin, areola, nipples Anatomical lymph nodes? 1. Anterior 2. Posterior 3. Lateral 4. Central 5. Apical
Where the glandular lymphatics drain?
They drain into anterior axillary (pectoral lymph nodes ) —> central axillary —> deep cervical nodes —> subclavicular (subclavian) nodes
Where do medial quadrants nodes drain?
Medial quadrants nodes drain into
Parasternal nodes
Where do superficial regions of skin, areola, nipples drains?
Pectoral nodes
What does the axillary lymph nodes drain?
- Lymphatics of the breast
- Pectoral region
- Upper abdominal wall
- Upper limb
What are the arrangement of axillary lymph nodes?
- Anterior
- Posterior
- Lateral
- Central
- Apical
Lying deep to pectoral is major along the lower border of pectoral is minor
Anterior axillary lymph nodes
Lies along the sub scapular vessels?
Posterior axillary lymph nodes
Along the axillary vein?
Lateral axillary lymph nodes
Located in the axillary fat?
Central axillary lymph nodes
Is a lymph node through which all the other axillary nodes drain at the apex of the axilla above the pectoralis minor and along the medial side of the axillary vein
Apical axillary lymph nodes
What emerges from the apical lymph nodes?
Subclavian lymph trunk
Subclavian lymph trunk on the left will drain ?
Directly into the thoracic duct
The subclavian lymph trunk on right drains?
Directly into subclavian
Or
Joins the right jugular trunk
It is a lymph node chain with minimal drainage and drains the medial breast and parasternal
Internal mammary chain
It is a lymph node between the pectoralis minor and major muscles?
Rotter’ s node
From where rotter’s recieves lymph drainage?
Receive lymph drainage directly from the breast —> draining into apical axillary and pectoral group
The intra -lobular ct stroma that surrounds the breast is made up of?
Dense and fibrocollagenous material
Intralobular CT has what?
Loose texture
What is the importance that the intralobular CT has a loose texture?
Allow rapid expansion of secretory tissue during pregnancy
What surrounds the glandular components of the breast and what is it benefit?
Fibrous tissue surrounds the glandular components and extends to the skin and nipple—> assessing in the mechanical coherence of the gland
What does the inter-lobular stroma contains?
The interlobular stroma contains —> variable amounts of adipose tissue, which contributes largely to the increase in breast size at puberty
Where is milk produced in breast?
Milk is produced by glandular epithelium
Milk continuously goes down and where is it collected?
It is collected in sinuses
Are dialated lactiferous ducts which stores milk?
Lactiferous sinus
What is the excretory part of the lactiferous sinus?
Lactiferous ducts
Where does the lactiferous ducts drain?
Independently drains from the nipple and are fed just deep to (converge toward ) areola
Where lactiferous duct becomes contracted?
At the base of the nipple
What happens when breast cells are stimulated?
They expel additional milk into the duct system (milk ejection reflex)
