Breast Flashcards
Where is the breast located?
In superficial fascia
Extends from 2nd rib to 6th rib
Axillary tail of Spence pierces deep fascia
What is the axillary tail of spence?
superolateral extension of the breast
What is the name of the space in the fascia pierced by the axillary tail of spence?
foramen of langer
Explain the blood supply to the breast.
from 3 main arteries:
- Axillary artery; Highest thoracic, Thoracoacromial, and Lateral thoracic branches
- Internal thoracic artery; Perforating branches
- 2nd -4th posterior intercostal arteries
The inferomedial part of the breast can drain into 4 groups of lymph nodes. State them.
- Intercostal nodes
- Subperitoneal Plexus
- Subdiaphragmatic Plexus
- Ovary nodes
What is the extent of the breast?
Vertically: Rib 2-6
Horizontally: Lateral sternum (medially) to Midaxillary line (laterally)
State the relations of the breast from superficial to deep.
Retromammary space Pectoral fascia Pectoralis Major Serratus anterior External oblique
The most sensitive part of the breast is
a) Nipple
b) Areola
c) Ligament of Spence
d) Stroma
a) Nipple
What changes to the sebaceous glands of the areola undergo during pregnancy?
Enlargen and darken
When the areola glands enlargen during pregnancy, they are called
a) Montomory tubercles
b) Supramontgomery glands
c) Meibomian tubercles
d) Montgomery’s tubercles
d) Montgomery tubercles
Functions of the suspensory ligaments of cooper include;
- Maintain protuberance of breast
2. Connect dermis to breast and anchor it to pectoral fascia
True or false: The suspensory ligaments of cooper come from the connective tissue of the parenchyma.
FALSE; suspensory ligaments of cooper come from connective tissue of stroma
Describe the structure of parenchyma.
Divided into 15-20 lobes arranged like spokes of a wheel converging to nipple.
Each lobe has a lactiferous duct.
Each lactiferous duct continues into lactiferous sinus, has lobules which have acini
The site for storage of milk is the …
Lactiferous sinus
How can metastasis of the breast cancer reach the brain?
Cancer cells in breast blood drained into –> Posterior intercostal veins –> Vertebral venous plexus –> Intracranial dural sinuses –> BRAIN
Innervation of the breast is derived from…
Intercostal nerve (T2-T6) ; the same as the one supplying the skin of pectoral region below 2nd rib
The hormone that controls milk secretion is
a) Human Chorionic Gonadotropic hormone
b) Estrogen
c) Prolactin
d) Leptin
c) Prolactin; secreted by anterior pituitary gland
True or false; the sensory nerve endings in the nipple stimulate and regulate secretion of milk in response to suckling by the infant.
FALSE; they only stimulate, but not regulate
What are Rotter’s lymph nodes?
Also called interpectoral lymph nodes, located between pectoral muscles and drain breast
Describe the general major lymphatic drainage route of the breast.
From upper lateral quadrant of breast –> Anterior Lymph Nodes –> Central lymp nodes –> Deltopectoral Lymph Nodes –> Apical Lymph nodes –> Supraclavicular lymph nodes
Which part of the breast IS NOT drained by the superficial lymphatics?
The nipple and areola
The plexus of deep lymphatic vessels beneath the areola is called
a) Rotter’s plexus
b) Posterior intercostal plexus
c) Parasternal nodes
d) Subareolar plexus of Sappery
d) Subareolar plexus of Sappery; drains into anterior group of lymph nodes
Where do the deep lymphatics of the breast drain?
Directly into apical group
What structures are pierced by the deep lymphatics of the breast so they can reach the apical lymph nodes?
Pectoralis major, pectoral fascia, and clavipectoral fascia
75% of the lymph drains into ______, 20% into _____, and 5% into ______.
75% –> Axillary nodes (mostly anterior group)
20% –> Parasternal nodes
5% –> Posterior intercostal nodes
Which cells commonly are susceptible to breast cancer in the breast?
epithelial cells of the lactiferous ducts
Which quadrant of the breast is affected by cancer most of the time?
Upper lateral quadrant
What are the symptoms of the breast cancer and what is the reason behind each?
Breast is stiff - suspensory ligaments of cooper infiltrated
Retraction of skin - affected ligaments of cooper
Nipple retraction - fibrosis of lactiferous ducts
Peau d’orange appearance - obstruction of superficial lymphatics
What is the clinical basis of Krukenberg’s tumor?
A secondary tumor that is a metastastis of breast cancer. Cancer cells drained from inferomedial quadrant to subperitoneal lymph plexus –> ovaries
Peau d’orange appearance of breast is caused by
obstruction of superficial lymphatics
What is the difference between polymastia and polythelia?
In polymastia, whole breasts develop from persistence of milk ridge, while in polythelia only nipples develop and are usually mistaken for moles
