Breast

Question 1

Where is the breast located?

Answer 1

In superficial fascia
Extends from 2nd rib to 6th rib
Axillary tail of Spence pierces deep fascia

Question 2

What is the axillary tail of spence?

Answer 2

superolateral extension of the breast

Question 3

What is the name of the space in the fascia pierced by the axillary tail of spence?

Answer 3

foramen of langer

Question 4

Explain the blood supply to the breast.

Answer 4

from 3 main arteries:

1. Axillary artery; Highest thoracic, Thoracoacromial, and Lateral thoracic branches
2. Internal thoracic artery; Perforating branches
3. 2nd -4th posterior intercostal arteries

Question 5

The inferomedial part of the breast can drain into 4 groups of lymph nodes. State them.

Answer 5

1. Intercostal nodes
2. Subperitoneal Plexus
3. Subdiaphragmatic Plexus
4. Ovary nodes

Question 6

What is the extent of the breast?

Answer 6

Vertically: Rib 2-6
Horizontally: Lateral sternum (medially) to Midaxillary line (laterally)

Question 7

State the relations of the breast from superficial to deep.

Answer 7

Retromammary space 
Pectoral fascia
Pectoralis Major
Serratus anterior 
External oblique

Question 8

The most sensitive part of the breast is

a) Nipple
b) Areola
c) Ligament of Spence
d) Stroma

Answer 8

a) Nipple

Question 9

What changes to the sebaceous glands of the areola undergo during pregnancy?

Answer 9

Enlargen and darken

Question 10

When the areola glands enlargen during pregnancy, they are called

a) Montomory tubercles
b) Supramontgomery glands
c) Meibomian tubercles
d) Montgomery’s tubercles

Answer 10

d) Montgomery tubercles

Question 11

Functions of the suspensory ligaments of cooper include;

Answer 11

1. Maintain protuberance of breast

2. Connect dermis to breast and anchor it to pectoral fascia

Question 12

True or false: The suspensory ligaments of cooper come from the connective tissue of the parenchyma.

Answer 12

FALSE; suspensory ligaments of cooper come from connective tissue of stroma

Question 13

Describe the structure of parenchyma.

Answer 13

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

Question 14

The site for storage of milk is the …

Answer 14

Lactiferous sinus

Question 15

How can metastasis of the breast cancer reach the brain?

Answer 15

Cancer cells in breast blood drained into –> Posterior intercostal veins –> Vertebral venous plexus –> Intracranial dural sinuses –> BRAIN

Question 16

Innervation of the breast is derived from…

Answer 16

Intercostal nerve (T2-T6) ; the same as the one supplying the skin of pectoral region below 2nd rib

Question 17

The hormone that controls milk secretion is

a) Human Chorionic Gonadotropic hormone
b) Estrogen
c) Prolactin
d) Leptin

Answer 17

c) Prolactin; secreted by anterior pituitary gland

Question 18

True or false; the sensory nerve endings in the nipple stimulate and regulate secretion of milk in response to suckling by the infant.

Answer 18

FALSE; they only stimulate, but not regulate

Question 19

What are Rotter’s lymph nodes?

Answer 19

Also called interpectoral lymph nodes, located between pectoral muscles and drain breast

Question 20

Describe the general major lymphatic drainage route of the breast.

Answer 20

From upper lateral quadrant of breast –> Anterior Lymph Nodes –> Central lymp nodes –> Deltopectoral Lymph Nodes –> Apical Lymph nodes –> Supraclavicular lymph nodes

Question 21

Which part of the breast IS NOT drained by the superficial lymphatics?

Answer 21

The nipple and areola

Question 22

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

Answer 22

d) Subareolar plexus of Sappery; drains into anterior group of lymph nodes

Question 23

Where do the deep lymphatics of the breast drain?

Answer 23

Directly into apical group

Question 24

What structures are pierced by the deep lymphatics of the breast so they can reach the apical lymph nodes?

Answer 24

Pectoralis major, pectoral fascia, and clavipectoral fascia

Question 25

75% of the lymph drains into ______, 20% into _____, and 5% into ______.

Answer 25

75% –> Axillary nodes (mostly anterior group)
20% –> Parasternal nodes
5% –> Posterior intercostal nodes

Question 26

Which cells commonly are susceptible to breast cancer in the breast?

Answer 26

epithelial cells of the lactiferous ducts

Question 27

Which quadrant of the breast is affected by cancer most of the time?

Answer 27

Upper lateral quadrant

Question 28

What are the symptoms of the breast cancer and what is the reason behind each?

Answer 28

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

Question 29

What is the clinical basis of Krukenberg’s tumor?

Answer 29

A secondary tumor that is a metastastis of breast cancer. Cancer cells drained from inferomedial quadrant to subperitoneal lymph plexus –> ovaries

Question 30

Peau d’orange appearance of breast is caused by

Answer 30

obstruction of superficial lymphatics

Question 31

What is the difference between polymastia and polythelia?

Answer 31

In polymastia, whole breasts develop from persistence of milk ridge, while in polythelia only nipples develop and are usually mistaken for moles