breast

Question 1

structure of the breast

Answer 1

mammary glands are modified sweat glands - in superficial facia anterior to the pectoral muscles and anterior thoracic wall
mammary glands made of ducts and secretory lobules -> 20 lactiferous ducts - open independently onto nipple
connective tissue surround duct and lobules - condenses to form ligaments - continuous with the dermis of the skin and support the breast

Question 2

describe nipple

Answer 2

surrounded by a circular pigmented area of skin - aerola

Question 3

effect of carcinoma on the ligaments

Answer 3

creates tension - pitting

Question 4

main components in breast in non-lactating women

Answer 4

fat

Question 5

main components in breast in lactating women

Answer 5

glandular tissue

Question 6

relations of the breast

Answer 6

lie on deep fascia

connective tissue - retromammary space separates the breast from deep fascia - provides degree of movement

Question 7

base of breast

Answer 7

rib 2-6 to mid axillary line

Question 8

arterial supply of the breast

Answer 8

laterally - axilliary artery: superior thoracic, thoracoacromial, lateral thoracic and subscapular

medially - branch of internal thoracic artery

second to 4th IC artery via branches that perforate thoracic wall and overlying muscle

Question 9

venous drainage of the breast

Answer 9

parallel arteries

eventually drain into axillary, internal thoracic and inter-costal veins

Question 10

innervation of the breast

Answer 10

anterior and lateral cutaneous branches of 2nd and 6thh IC nerves

nipple - innervated by the 4th IC nerve

Question 11

lymphatic drainage of the breasr

Answer 11

75% - laterally and superiorly to the axillary nodes

parasternal nodes - deep to anterior thoracic wall and associated with internal thoracic artery

vessels that follow the lateral branches of the posterior intercostal arteries - connect with intercostal nodes situated near the head and the neck of the ribs

Question 12

drainage of axillary nodes

Answer 12

subclavian trunks

Question 13

drainage of the parasternal nodes

Answer 13

bronchiomediastinal trunks

Question 14

intercostal nodes drainage

Answer 14

thoracic duct or broncomediastinal trunks

Question 15

breast in men

Answer 15

rudimentary
small ducts
composed of cords of cells
don’t extend beyond the areola

Question 16

where does breast cancer occur

Answer 16

cells in acini, lactiferous ducts and lobules of the breast

Question 17

how do breast tumours spread

Answer 17

lymph
veins
direct invasion

Question 18

what is peau d’orange

Answer 18

lymph blockage and tumour pull on ligaments = orange peel texture

Question 19

what is cancer en cuirasse

Answer 19

manifestation = hard woody texture

Question 20

Anatomy of breast

Answer 20

under hormonal influence
modified sweat gland
15-20 ductal globular units - drain into main duct
fat interspersed
divided by fibrous septae that radiate from centre outwards - suspensory ligaments of cooper
made of glandular tissue, fat and fibrous tissue
from 2nd - 6th rib space
breast parenchyma extends into anterior axillary fold a axillary tail of spence
upper half of breast contains the most breast tissue
complex network behind the nipple
4-18 ducts open on summit of nipple/areola

Question 21

coopers ligament

Answer 21

connective tissue strands connect anterior and posterior fascial planes
supporting structure
provides shape and consistency of parenchyma
cooper’s droop

Question 22

blood supply of breast

Answer 22

branch of lateral thoracic artery, internal thoracic artery, thoracoacromial artery, thoracodorsal artery and intercostal arteries
skin supplied by subdermal plexus - communicates with deep parenchymal vessels
nipple areola - receive branch from internal thoracic artery
dominant blood supply form medial aspect

Question 23

venous drainage of the breast

Answer 23

3 groups veins: perforating branches of internal mammory vein, tributaries of auxillary vein, perforating branch of posterior intercostal veins
in continuity with Batson plexus of veins - posterior
conduit for dissemination of breast cancer to spine, pelvis and elsewhere

Question 24

innervation of the breast

Answer 24

anterolateral and anteromedial branches of thoracic intercostal nerves T3-6
innervation from supraclavicular nerves to upper and lateral parts of breast
nipple - dominant supply from lateral cutaneous branch of T4

Question 25

lymphatic drainage of the breast

Answer 25

predominant lymph supply in the axilla
lymph nodes arranges like a square based pyramid - pectoral, subscapular, humeral, central, apical
pyramid contain cutanius nerve, motor nerve, artery and vein
some lymph drain into interpectoral, deltopectoral, supraclavicular or deep cervical
75% drain into lymphatics in axilla
25% into internal mammary node

Question 26

thoracic nerve

Answer 26

damage causes winging of the scapular

supplies serratus anterior

Question 27

thoracodorsal pedical

Answer 27

nerve runs down with artery and vein

damage causes paralysis of latissimus dorsi