Breast

Question 1

Where is the breast tissue found?

Answer 1

In subcutaneous tissue overlying muscles of anterior thoracic wall

Question 2

What type of gland is breast tissue?

Answer 2

Modified apocrine sweat gland

Question 3

Where do breasts develop?

Answer 3

Breasts can develop anywhere along the mammary ridge (milk line) which runs from axilla to groin

Question 4

What is polythelia?

Answer 4

Supernumerary nipples (extra nipples)

Question 5

What is polymastia?

Answer 5

Accessory breasts (secondary breast may develop)

Question 6

What factors affect the size/shape of the breasts?

Answer 6

Menstrual cycle / hormones​
Age & sexual maturity​
Inherited factors​
Pregnancy​
Lactation

Question 7

What muscles’ fascia does the base of the breast lie anterior to?

Answer 7

Base of breast lies anterior to the fascia of pectorals major and serratus anterior

Question 8

Where is the base of the breast?

Answer 8

The base of the breast sits over ribs 2-6 and extends from the sternum to the midaxillary line and superolaterally into the axilla (Tail of Spence)

Question 9

What are Cooper’s ligaments?

Answer 9

Fibrous suspensory ligaments that sit within and support the breast and attach to the dermis.

Question 10

What is the retromammary space and what is it’s function?

Answer 10

Retromammary space sits between breast tissue and pectoralis fascia. Filled with loose connective tissue and fat and allows free movement of breast.

Question 11

How do you check clinically if breast movement is independent to pectoralis major movement?

Answer 11

Ask patient to push their hands into hips.

Question 12

How many lactiferous ducts does the nipple receive?

Answer 12

15-20

Question 13

What are Montgomery glands?

Answer 13

Sweat and sebaceous glands that open onto areolar

Question 14

What happens to the areolar during/after pregnancy?

Answer 14

Often darkens

Question 15

What is the innervation of the breast?

Answer 15

T4-T6 intercostal nerves

Question 16

What are some non-breast origins of mastalgia (breast pain)?

Answer 16

Cardiac, respiratory, musculoskeletal, infective - shingles

Question 17

How can the breast be easily anaesthetised?

Answer 17

Local anaesthetic injection into the plane of serratus anterior and the interpectoral plane.

Question 18

What is the blood supply of the lateral breast?

Answer 18

Lateral mammary branches from the lateral thoracic artery (branch of axillary a) and posterior intercostal arteries

Question 19

What is the blood supply of the medial breast?

Answer 19

Medial mammary branches from the internal thoracic artery and anterior intercostal arteries

Question 20

What is the main lymphatic drainage of the nipple, areolar and breast tissue?

Answer 20

• Anterior (pectoral) and central AXILLARY nodes

- Parasternal (internal thoracic) nodes

Question 21

What are the additional routes of lymphatic drainage?

Answer 21

• Interpectoral (rotter) nodes
• Contralateral parasternal nodes
• Contralateral breast
• Subdiaphragmatic/hepatic nodes
• Inguinal lymph nodes

Question 22

What is the lymphatic drainage of the the breast SKIN?

Answer 22

Axillary, infraclavicular and deep cervical nodes

Question 23

What can happen following a mastectomy with axillary lymph node clearance?

Answer 23

Upper limb lymphoedema

Question 24

Define a gland

Answer 24

A gland is a collection of epithelial cells that secrete substances

Question 25

What quadrants can the breast be divided into for examination purposes?

Answer 25

Upper outer Upper inner Lower outer Lower inner

Question 26

What are some common presentations of breast problems/disease?

Answer 26

``` Pain lump Nipple discharge Nipple inversion Skin changes ```

Question 27

What are some observable changes of breast cancer?

Answer 27

Asymmetry New onset nipple retraction P'eau d'orange Dimpling of the skin

Question 28

What causes nipple retraction in breast cancer?

Answer 28

Cooper's ligaments are being pulled

Question 29

What causes p'eau d'orange?

Answer 29

P’eau d’orange is due to oedema and pitting of the skin due to blocked lymph drainage. Cancer has likely affected the lymphatic drainage of the breast.

Question 30

What causes gynaecomastia?

Answer 30

Normally caused by hormones or being overweight, both of these cause an increase in oestrogen which causes breast tissue to grow.

Question 31

What is the difference between gynaecomastia and breast cancer in men?

Answer 31

Gynaecomastia is bilateral. Breast cancer is unilateral.

Question 32

Define gynaecomastia

Answer 32

Gynaecomastia is enlargement of the male breast resulting from proliferation of the glandular component.