Anatomy of the Breast Flashcards
most important fx of the hand
pincer-like action of the thumb
blood supply and lymphatic drainage of the breast is largely into the
armpit
are small and surrounded by areola
nipples
colored area of skin surrounding the nipples
areola
the breast tissue consists of a system of ducts embedded in connective tissue that does not extend beyond margin of
areola
breast enlarge by the influence of
ovarian hormones
increased size of the breast glands is mainly from the
deposition of fats
location of the breasts
base extends from 2nd to 6th rib
lateral margin of sternum to midaxillary line
the greater part of the mammary gland lies in this layer
superficial fascia
this part of the breasts extends upward and laterally, pierces the deep fascia at the lower border of the pectoralis major muscle, and enters the axilla
axillary tail
each breast consists of
15-20 lobes
the main duct from each lobe (of mammary gland) opens separately on the summit and possesses a ____ just before termination
dilated ampulla
the base of the nipple is surrounded by the
areola
tiny ____ on the areola are produced by underlying areolar glands
tubercles
serve as suspensory ligaments of the breast
fibrous septa
separates the lobes of the mammary gland are separated by
fibrous septa (suspensory ligaments)
behind the breast
filled by loose connective tissue
retromammary space
the atrophy of the mammary gland, after menopause is caused by
the absence of ovarian estrogens and progesterone
arteries supplying breasts
perforating branches of the ITA (internal thoracic artery) and intercostal arteries
axillary artery - lateral thoracic and thoracoacromial branches
veins supplying the breasts
perforating branches of the ITV (internal thoracic veins) and intercostal veins
axillary veins - lateral thoracic and thoracoacromial branches
significance of the lymph drainage of the mammary gland
frequent development of cancer and subsequent dissemination of the malignant cells along the lymph vessels to the lymph nodes
lateral quadrants of breast drain into
anterior axillary or pectoral group of nodes
the medial quadrants of the breasts enter the
internal thoracic group of nodes (along the course of the internal thoracic artery)
lymph drainage of the breast
anterior axillary group of nodes
internal thoracic group of nodes
posterior intercostal nodes (along posterior intercostal arteries)
some lymph vessels communicate with LV of the OPPOSITE BREAST and the anterior abdominal wall
the milky fluid expressed from the breasts of the newborns due to the maternal hormones that crossed the placental barrier and caused proliferation of the duct epithelium
witch’s milk
the shoulder girdle consists of the
clavicle
scapula
clavicle and scapula articulate at the
acromioclavicular joint
long, slender bond that lies horizontally across the root of the neck just beneath the skun
clavicle
clavicle articulates what structures medially
sternum
1st costal cartilage
clavicle articulates this structure laterally
scapula
breast examination
- sitting upright, undressed to the waist - symmetry
- some asymmetry is common as a result of unequal breast development - any swelling should be noted
- underlying tumor, cyst, abscess formation - nipples - retraction
- carcinoma - pulling on the lactiferous ducts - lying down - breasts palpated against the underlying thoracic wall
- sit up raise both arms above her head - dimpling of skin or retraction of nipple caused by carcinoma
radiographic examination of the breast used for screening for benign and malignant tumors and cysts
mammography
advantage of using mammography
lesion measuring few mm in diameter can be detected long before it felt by clinical examination
nipples that occur along a line extending from the axilla to the groin, that may or may not be associated with breast tissue
frequently mistaken as warts or moles
supernumerary nipple
long-standing retracted nipple is usually
congenital deformity caused by a failure in the complete development of the nipple
clinical significance of fibrous septa
if it becomes involved with a scirrhous carcinoma or breast abscess, the septa will be pulled on -> dimpling of skin
due to this structure, the infection can remain in one compartment or lobe (of mammary glands)to begin with
breast abscess
breast abscess should be drained with this type of incision to avoid spreading of infection into neighboring compartments
also minimizes damage to radially arranged ducts`
radial incision
lymph vessels from the medial quadrants of breast pierce _____ intercostal spaces
drain into ____
2nd, 3rd, 4th intercostal spaces
enter thorax
drain into LN along side internal thoracic artery (ITA)
lateral quadrant breast
lymph vessels drain into
anterior or pectoral group of axillary nodes
lateral -> axillary nodes
60% of breast carcinomas occur in this quadrant
upper lateral quadrant (60%)
if the normal lymphatic pathways by malignant cells or destruction of LV by surgery or radiotherapy
cancer will spread via lymphatic vessels to
opposite breast, abdominal cavity,
root of the neck
surgery tx
localized cancer of the breast
simple mastectomy or lumpectomy
followed by
radiotherapy to the axillary LN and/or hormone therapy
localized cancer of breast
early metastases in axillary LN
radical mastectomy
breast cancer + metastases beyond the LN (thorax etc)
TOC
simple mastectomy
radiotherapy
hormone therapy
designed to remove the primary tumor + LV + LN that drain the area
removed en bloc : breast, associated structures containing LV and LN
radical mastectomy
excised mass of radical mastectomy
large area of skin overlying the tumor +
nipple +
all breast tissue +
pectoralis major, associated fascia (internal thoracic nodes)
pectoralis minor, associated fascia (axilla nodes)
fat, fascia, LN in axilla +
fascia covering upper part of rectus sheath
serratus anterior
subscapularis
latissimus dorsi
preserved: axillary BV, brachial plexus, nerves to serratus anterior, and latissimus dorsi
modified form of radical mastectomy
clinically localized cancer
involves
simple mastectomy
pectoral muscles are left intact
axillary LN, fat, fascia removed
(removal of primary tumor, pathologic examination of LN)
carcinoma of male breast accounts for ___% of all carcinomas of the breast
1%
prognosis of breast cancer in male patients
poor prognosis
because of the small amount of intervening tissue, the carcinoma cells can rapidly metastasize
