Breast Anatomy + History + Examination

Question 1

What are the anatomical landmarks for the breasts?

Answer 1

Vertically: 2nd rib to 6th costal cartilage

Horizontally: midline/lateral border of sternum to mid-Axillary line

Question 2

Where is the nipple-areola complex located?

Answer 2

Between 4th and 5th ribs

Question 3

What are the natural lines around the breast and what are their significance?

Answer 3

Langer lines - extend outwards circumferentially from nipple-areole complex

Particular interest for surgeons - determining where to place incision for better cosmetic outcomes

Question 4

What does the breast overlie?

Answer 4

2/3 of pectoralis major and 1/3 on serratus anterior

Question 5

What forms the floor of the breast?

Answer 5

Deep pectoral fascia

Question 6

What is Coopers ligament?

Answer 6

Extends from skin to pectoralis fascia and provides support to the breast

Question 7

Which three nerves may be damaged in breast surgery involving the Axilla?

Answer 7

Long thoracic nerve
Thoracodorsal nerve
Intercostobachial and axillary nerve

Question 8

What is the arterial supply of the breast?

Answer 8

Mainly from lateral thoracic artery and internal thoracic artery (internal mammary)

Question 9

What is the venous drainage of the breasts?

Answer 9

Sub-areolar venous plexus into the internal thoracic vein

Posterior intercostal veins drain into axillary vein (communicates with internal vertebral venous plexus veins - therefore cancer may spread to vertebra and cause back pain)

Question 10

What is the lymphatic drainage of the breast?

Answer 10

Axillary (85%) - anterior, posterior, central, apical, lateral, inter pectoral

Internal mammary / parasternal (10%)

Other - supraclavicular, lateral-cervical, subdiaphragmatic

Question 11

What symptoms are important to ask in breast history?

Answer 11

Pain
Itching 
Skin changes 
Nipple change and discharge 
Association with menstrual cycle?
Trauma

Question 12

What are the risk factors for breast cancer?

Answer 12

Female 
Age>50 yrs 
FH 
Oral contraceptive/HRT 
Cycles (early menarche or late menopause) 
Pregnancy/breast feeding 
Smoking, alcohol 
High fat diet

Question 13

What is the rule of 6 S for breast lumps?

Answer 13

Site 
Size 
Shape 
Symmetry 
Overlying skin 
Associated scars

Question 14

Where do most carcinomas present on breast?

Answer 14

Upper outer quadrant