Breasts Flashcards
Embryological origin of breasts
Ectodermal
Factors deciding of size and shape of breasts
Age
race,
genetic
hereditary characteristics,
physiological states like pregnancy and lactation,
unilateral or bilateral disease
Normal borders of the breast
Superior - clavicle
Inferior - upper border of recrus sheath
Medial - midline
Lateral - posterior axillary line
Posterior - 2nd to 6th ribs, pectoral is major , serrâtus anterior , upper part of recrus sheath
Structural units of breast
Glandular tissue called acinus
Histology of acini
Cuboidal epithelium with myoepithelial cell for milk ejection
Type of cells at the bulk of the areola and the nipple
Contractile, smooth, muscle fibers, inserted directly to the skin
What are Montgomery glands?
Large sebaceous glands in the areola, which become prominent in pregnancy
What are the tissue layers of the breasts?
Breast is enveloped between two layers of superficial fascia
Cooper’s ligaments between fascia which separate the lobules
Retromamnary space between the deep layer of superficial fascia and facia covering pectoralis major
why is the retromammary space important
Contain important plexus of lymphatics
Influence mobility of the breasts on the chest wall by preservation of loose areolar tissue in the space
blood supply to the breast
Main one - Four perforating branches of the internal mammary artery
Axillary artery - pectoral branch of the thoraco-acromial artery, lateral thoracic artery, subscapular artery
Venous drainage of the breasts?
Medially- perforating branches of the internal mammary vein
Laterally - axillary vein,
posteriorly - intercostal vein
What is the lymphatic drainage of the breast?
Internal mammary chain in the intercostal spaces
axillary group of lymph nodes ( pectoral, central, apical, subscapularis ,lateral)
opposite breasts and axilla
liver via rectus abdominis muscle
Percentage of mammary lymph nodes that drains into the axillary nodes
90%
Function of the breast
Infant feeding
Presentation of breast change un premenstrual
Enlargement of breast due to increased vascularity
Tingling sensation
Feeling of fullness of breast
Mastodynia
Presentation of breast change in pregnancy
Increase in size and number of mammary lobules
Increase in areola area and bipolar
Erectile nipple
Prominent sebaceous gkands
Most important factor in maintenance of lactational cycle
Infant suckling
What are some true anomalies of the breast?
Complete absence - amazia
Multiple breast - polymazia
Accessory nipple - polythelia
What are some common inflammatory breast disease?
Bacterial infection leading to Lactational mastitis
What causes bacterial infection in lactational mastitis
Cracks on the nipple due to trauma of infant sucking followed by staphylococcus aureus infection
Complication of lactational mastitis is
Suppuration , which can lead to breast abscess and chronicity
Rare infection of the breasts
Tuberculosis,
parasitic, cyst,
subareolar abscess,
actinomycosis
Treatments of bacterial, mastitis
Antibiotics -cloxacillin or flucoxacillin
Abscess drainage
What is female pseudo hermaphroditism or congenital adrenal hyperplasia?
Cortisol deficient states of female with excessive ACTH output leading to failure of breast development
What are some hypogonadal states which cause failure of breast development?
Ovarian dysgenesis with hypoplastic ovaries devoid of germinal follicles
Presentation of ovarian dysgenesis
No menstruations
no developments of secondary sexual characteristics
can be of normal stature or short
somatic abnormalities like webbed neck, cubitus valgus, hypoplastic nails, coarctation of the aorta ( turner syndrome )
What is massive hypertrophy of the breast in pregnancy?
Massive breast development during pregnancy which regress to normal after parturition
there is commonly ulceration and a pre-existing dysplastic breast disease
Why is surgery and option in massive hypertrophy of the breast in pregnancy
Cosmetic
Establish diagnosis
arrest hemorrhage and control sepsis in ulceration
Types of tumors of the breast
Epithelial tumors
myoepithelial lesions
mesenchymal tumors
fibroepithelial tumors
tumors of the nipple
malignant lymphoma
metastatic tumor’s
tumors of the male breasts
what is aberration of normal development and involution
Benign breast dx classified into disorders
Types of disorders of aberration of normal development and involution
Disorders of development (fibroadenoma)
Disorders due to cyclical hormonal changes ( benign mammary dysplasia)
Disorders of involution ( lobular like cyst formation or sclerosing adenosis/ ductal like duct ectasia)
Age of incidence of benign mammary dysplasia
20-45yo
Pathology of benign mammary dysplasia
Hypersensitivity of breast epithelium to circulating hormones mostly estrogen
Gross morphology of benign mammary dysplasia
Localized tissue masses with cysts of variable size with bluish green or clear fluid
Microscopy morphology of benign mammary dysplasia
High stromal proliferation
Ductal epithelial hyperplasia
Cyst formation
Clinical features of benign mammary dysplasia
Pain or dull ache in one or both breast worse in lutéal phase , relieved in menstrual phase
Lumps
Serous or greenish nipple discharge
Differential diagnosis of benign mammary dysplasia
Carcinoma
Fibroadenoma
Duct ectasia
Causes of pain originating from breast
Fibroadenosis ( benign mammary dysplasia)
Breast cyst
Acute mastitis
Abscesses acute or chronic
Breast engorgement during lactation
Galactocele
Duct ectasia
Mondors disease
Pregnancy
Previous breast surgery
Trauma to breast
Heavy pendulous breast
Peri menopause
Extra mammary causes of breast pain
Tietzes disease
Bornholm dx
Spondylosis of spine
Pleuritic chest pain
Lung infection
Angina
Oesophagitis
Herpes zoster
Medications - chlorpromazine, diuretics , hormonal treatment , antidepressant, sertraline
Treatment of breast pain
Reassurance
Well fitting brassiere
OCP and hormonal treatment stopped
Xanthine containing substances like coffee , tea, chocolate , cola to relieve pain
Smoking stopped
Topical NSAIDs
Evening primrose oil
Danazol
Tamoxifen
Bromocriptine
Excision therapy
Types of nipple discharge
Clear
Purulent
Creamy
Green
Yellow
Brown
Black
Frankly bloodstains
Main causes of blood stained or persistent serous discharge
Introduction papilloma
Ductal carcinoma
Duct ectasia
Benign mammary dysplasia
Inflammation
Atypical Ductal hyperplasia
Main cause of clear creamy green brown or black discharge
Benign mammary dysplasia
Duct ectasia
Main cause of milky nipple discharge
Lactation
Galactorhea
Duct ectasia
Main cause of purulent nipple discharge
Breast abscess
Duct ectasia
Good differential for nipple discharge with Induration or lump in aerola
Duct ectasia
Presentation of sclerosing adenosis
Small mobile mass
Area of Breast pain
Trigger point pain when pressing affected part
Treatment of sclérosing adenosis
Excision of lesion
What is Tietze syndrome
Inflammation of costochondral junction and costal cartilage which can be mistaken for breast pain
Tietze syndrome presentation
Localized tenderness on palpation
No other clinical , radio, pathological abnormality in breast
Treatment of Tietze syndrome
Reassurance
NSAIDs
What is duct ectasia
Dilatation of lactiferous ducts
Clinical features of duct ectasia
Recurrent pain especially in subaerolar region
Nipple discharge - turbid, yellow, green, brown, black
Nipple retraction
Swelling under areola
Traumatic fat necrosis clinical features
Hard irregular mass
May be attached to the skin
Irregular surface
Edges indefinite
Traumatic fat necrosis treatment
Excision therapy
Cysts clinical features
Painless lump of short duration during menstrual cycle
