Breast AP with mammography Flashcards
What are Supernumerary nipples?
A extra nipple that will form along the milk line
What is the milk line?
Lactogenic Ridges, its a line that forms from the axially to the groan (there are 2) Most of this tissue atrophies, leaving only a single island. However, sometimes extra nipples and accessory breast tissue may form along this line.
What does atrophy mean?
(of body tissue or an organ) waste away, especially as a result of the degeneration of cells, or become vestigial during evolution.
Embryology -
Gestational Timeline
Milk Line Develops
Milk line atrophies leaving single island of lactogenic tissue
15-20 buds grow from island down into tissue
Buds form channels which form the ducts.
Nipple develops as shallow indentation
Connective tissue and fibres form – suspensory ligaments
Ductal & Lobular System structure
lined with epithelial
The duct has channels that go to the lobule
The ducts that split off to the lobule are called “Extra-lobular terminal duct”
The area of the lobule and extra-lobular terminal duct are called “Terminal Ductal Lobular Unit TDLU”
Terminal Ductal Lobular Unit TDLU, why are they important? mammo appearance? and structure
Normal Physiological function - lactation
Breast disease
TDLUs are seen as dense on mammo – 1mm
Superimposition of TDLUs and ductal system forms overall density
The “Extra-lobular terminal duct” is the outside part that joins to the lobule, the “Intra-lobular terminal duct”
Lobules look bumpy and these bumps are called “Ductule”
these are lined with with epithelial cells
The mature breast has what tissue?
Glandular Tissue (Ductal and Lobular System)
Fatty tissue
Fibrous/ Connective Tissue (Connective tissue and suspensory (Cooper’s) Ligaments)
Anatomy of breast
Chest Wall
Pectoral Muscle
Lobules
Nipple
Areola
Ducts (Lactiferous sinus*)
Fatty Tissue
Infra-mammary fold
Coopers Ligaments
Lymph nodes and vessels*
Retromammary space
Breast & Nipple rib Position
between 2nd and 6th rib
Areas of breast
Areas of the breast
It is split into 4 parts but there is a tail of spence that is in the axially.
Upper inner, Upper outer
Lower inner, Lower outer
Hormonal Changes to breasts
Puberty
Rising Oestrogen/ Progesterone cause changes that increase breast size
Areola increases in size and darkness
Asymmetrical development is common
Cyclical
Hormonal changes during cycle
Variation in size of epithelial cells.
Can affect mammogram procedure
Pregnancy
Rises in oestrogen, progesterone and prolactin.
Growth in the epithelium
Lobules engorge
Reduced sensitivity in mammography
Post Childbirth
Progesterone decreases and prolactin remains
Signals mammary gland to start lactating
Lobular system fills and empties milk each time breast feeding occurs
Cognitional abnormalities
Accessory Breast Tissue
Islands of lactogenic tissue can develop in more than one area – commonly in axillary region
Failure of breast development
Genetic disorders – Turner’s syndrome
Radio / Chemotherapy
Poland’s Syndrome – under development of pectoral muscle
What is Gynaecomastia?
The term for men growing breasts
Breast blood supply
Lateral thoracic
Internal thoracic (mammary)
Lateral mammary branches of
lateral cutaneous branches of
Posterior intercostal arteries.
Lateral mammary
Median mammary
Sternal branches
Its important to know for things like reconstruction
Lymphatic drainage
Infection/Dead or Damaged cells 🡪
Connective tissue
Subareola plexus – Sappey’s Plexus
Lymph Node Groups
Laterally:
Axillary
Subscapular
Central
Pectoral
Apical
Clavicular
Medially
Parasternal
Divided into 3 groups, I / II / III – Lvl I nodes often visible on mammo
Sentinal lymph node – 1st node for cancer to spread to
