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Plastic Surgery - Breast/Aesthetics > Breast Anatomy/Embryology - Board Review > Flashcards

Breast Anatomy/Embryology - Board Review Flashcards

1
Q

Smallest functional unit of the breast?

A

Acini cell

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2
Q

When do the mammary ridges develop in an embryo?

A

5-6 weeks

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3
Q

What is the path of the mammary ridge along the ventral aspect of an embryo?

A

Base of the forelimb (future axilla) to the base of the hindlimb (inguinal area)

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4
Q

What is the result of incomplete involution of the mammary ridge?

A

accessory breast tissue and super numerary nipples

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5
Q

What is the difference between accessory and ectopic breast tissue?

A

Accessory breast tissue is along the mammary ridge and ectopic is elsewhere

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6
Q

What is polymastia?

A

Accessory breast tissue, usually found in axilla

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7
Q

What is polythelia?

A

Accessory nipples (along the milk line)

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8
Q

What is amazia?

A

Nipple development without breast development

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9
Q

What is athelia?

A

Breast development without nipple development

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10
Q

Is amastia more common unilateral or bilateral?

A

Unilateral

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11
Q

What is the cause of unilateral amastia?

A

Arrested mammary ridge development during the sixth week of fetal development

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12
Q

Where is the most common site of aberrant breast tissue?

A

axilla

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13
Q

Which is more concerning, unilateral or bilateral inverted nipples?

A

Unilateral may be associated with cancer; bilateral is usually associated with benign congenital conditions.

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14
Q

What is the most common site for supernumerary nipples?

A

Inframammary area

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15
Q

The breast overlies which ribs?

A

2-6

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16
Q

Each cluster of alveoli leads to a milk duct that empties into a lactiferous sinus. Each lactiferous sinus drains into one lobe of the breast.
How many lobes are in the breast?

A

15-25 lobes

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17
Q

What is the difference between a breast lobule and a breast lobe?

A

Lobes consist of multiple lobules and their respective interlobular ducts. Lobules are composed of glandular tissue containing acini cells that produce milk.

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18
Q

Which quadrant of the breast contains the most glandular tissue?

A

Upper outer

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19
Q

What is the most common bacteria cultured from breast tissue?

A

Staph epidermidis

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20
Q

Which vessel provides the dominant blood supply to the breast?

A

Internal mammary

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21
Q

The internal mammary artery is a branch of which vessel?

A

Subclavian artery (left) and brachiocephalic (right)

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22
Q

Usually, what vessel is the largest artery entering the pectoralis major muscle and the overlying breast parenchyma?

A

The second intercostal mammary perforator

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23
Q

Name three branches of the axillary artery (from medial to lateral) that serve as blood supply to the breast

A

Thoracoacromial, lateral thoracic, and thoracodorsal

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24
Q

During dissection of the axilla, if you cut the intercostobrachial nerve, where will you lose sensation?

A

upper medial aspect of the arm and axilla

25
Q

The intercostobrachial nerve is a branch of which nerve?

A

Lateral branch of the second intercostal nerve

26
Q

Axillary nodes are noted as level I, level II and level III. What anatomic structure determines their level?

A

Pectoralis minor muscle

27
Q

Where are Level I axillary nodes located?

A

Lateral/below pectoralis minor muscle

28
Q

Where are Level II axillary nodes located?

A

Behind pectoralis minor muscle

29
Q

Where are Level III axillary nodes located?

A

Medial/Above border of pectoralis minor muscle

30
Q

Where is a Rotter’s node?

A

Interpectoral

31
Q

What is the primary innervation of the NAC?

A

Lateral branch of the fourth intercostal nerve

32
Q

What is the course of the lateral branch of the fourth intercostal nerve?

A

It pierces the deep fascia in the mid axillary line and takes an inferomedial course within the pectoral fascia. On reaching the mid clavicular line, it turns 90° and continues through the glandular tissue toward the posterior surface of the nipple.

33
Q

What is the normal diameter of the NAC?

A

35-45mm

34
Q

What is the dominant blood supply to the NAC?

A

perforators from the internal mammary artery

35
Q

What is the function of the Montgomery glands?

A

They are sebaceous glands that produce a waxy substance to assist with lubrication and protection of the NAC

36
Q

What ligaments provide support to the breast tissue and what do they connect?

A

Cooper’s ligaments; between deep pectoralis fascia and the skin (dermis)

37
Q

What are the borders of the breast?

A

Latissiumus dorsi (lateral), clavicle(superior), lateral sternum(medial), IMF (inferior) pectoralis major (deep)

38
Q

What is the major component of the anterior axillary fold?

A

Pectoralis major muscle

39
Q

What is the origin of the pectoralis major muscle?

A

Medial sternal half of the clavicle and lateral aspect of the sternum/costochondral region, from sternal notch down to the 6-7 costal cartilage

40
Q

The insertion of the pectoralis major muscle lies between which muscles?

A

coracobrachialis (posterior) and deltoid (anterior)

41
Q

Which nerve provides motor innervation to the lateral and inferior pectoralis major muscles?

A

Medial pectoral nerve

42
Q

Serratus anterior origin and insertion, innervation

A

Origin: the costal attachments of the anterolateral aspects of the first through 8th ribs.
Insertion: Deep medial surface of the scapula
Innervation: Long thoracic nerve

43
Q

What is the clinical manifestation of injury to the long thoracic nerve?

A

Winged scapula

44
Q

Where is the long thoracic nerve located?

A

Positioned laterally, superficial to the external surface of the serratus anterior muscle in the mid axillary line

45
Q

Which nerves supply innervation to the medial breast?

A

The 2nd-6th intercostal nerves

46
Q

What is Poland Syndrome ?

A

Associated with congenital absence of the pectoralis major muscle, usually sternal component, and breast/areolar hypoplasia, costal cartilage and rib defects, hypoplasia of the subcutaneous tissues of the chest wall, brachysyndactyly

47
Q

Following efferent lymphatic drainage pathway of the breast, what are the nodal basins in order?

A

Deep pectoral, subscapular, central axillary, apical axillary, supraclavicular nodes

48
Q

If lymphatic drainage takes a medial pathway (vs draining into the axilla), what is the primary nodal basin?

A

Internal mammary/parasternal nodes

49
Q

T/F: Axillary nodes drain the lateral breast and medial nodes drain medial breast?

A

FALSE. Both nodal basins receive drainage from the whole breast

50
Q

Which hormone is principally responsible for ductal development and maintenance of the glandular elements during reproductive years?

A

Estrogen

51
Q

Which hormone is principally responsible for lobular development and differentiation of the epithelial cells?

A

progesterone

52
Q

Which hormone stimulates the differentiation of milk-producing components?

A

Prolactin

53
Q

Which hormone, produced by the pituitary gland, causes ductal contraction with lactation?

A

Oxytocin

54
Q

What tanner stage is the adult breast?

A

Tanner 5

55
Q

What is the etiology of a congenital inverted nipple? What is its incidence?

A

Failure of the mammary pits to elevate above the skin during infancy; 2-4%

56
Q

What are the normal measurements for a non-ptotic breast?
Location of NAC
SN to Nipple
Nipple to IMF

A

Above IMF
17-21cm
7-8cm

57
Q

What is the average diameter and projection of the nipple?

A

5-8mm

5mm

58
Q

What is the anatomic abnormality with tuberous breast deformity?

A

NAC hypertrophy, constricted breast/lower pole, herniation of the breast tissue into the NAC, high IMF

Plastic Surgery - Breast/Aesthetics (18 decks)

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