CVR 3 Flashcards
Is the breast always subcutaneous
no the axillary tail goes deeper
What runs in the deltopectoral groove
the cephalic vein
What are the suspensory ligaments of cooper
network of connective tissue. Disease process can distort the breast
Describe lymph drainage of the breast?
Mainly axilla.
Can also mestastates to the parasternal lymph.
Posterior chest wall
Clavicular
Describe lymph drainage of the breast?
Mainly axilla.
Can also mestastates to the parasternal lymph.
Posterior chest wall
Clavicular
Where is the highest incident of breast cancer
Upper outer
Where does mid axillary fold peirce
deep fascia
What is peau d orange
block of lymph giving orange appearance
Causes and treatments of gynaecomastia
puberty, weight, cannabis (continue)
Causes and treatments of gynaecomastia
puberty, weight, cannabis (continue)
Describe the breast (basics)
Paired structures, both genders, anterior chest wall, contains exocrine glands, modified sweat glands
Describe clavicle (most important)
Inferior surface rough underneath, sternal round end is medial, medial is convex, lateral is concave, impressions for pectoralis major, deltoid tubercle, impression for costoclavicular ligament, subclavian groove, conoid tubercle, arcromial facet, trapezoid line
Scapula basics
Spine at T3, Inferior angle at T7, superior angle border, medial border, coracoid process, suprascapular notch, infra supra spinous,
Humerus basics
arrow head anterior, deltoid tuberosity, attach for lateral head of triceps, attach for cocachobrachialis, radial groove, greater tubercle
What does pec minor do?
protraction
What does subclavius do?
nerve to subclavius and stabilises clavicle
What peirces the clavipectoral fascia?
lateral pectoral nerve
thoracoacromial artery
cephalic vein
lymphatics
Basics of serratus anterior
upper 8 rib to anteromedial scapula
long thoracic nerve of bell risk during axilarry operations
protract scapula and assist in lateral rotation of scapula winging
Describe the breast?
12-20 lobes divided into lobules
Contains acini - clusters of epithelial cells which produce milk
Lobules lead to lactiferous ducts which lead to lactiferous sinuses converging onto nipple where secretions are expelled.
The nipple has circular and longitudinal muscle.
Raised points on areola are Montgomerys tubercles which have sebaceous glands and secrete sebum making it waterproof.
Surface anatomy of breast
base of breast goes from 2nd to 6th costal cartilage mid clavicular line to lateral sternum.
Base is 2/3 over pec major and 1/3 over serratus anterior.
Conical shaped.
Nipple is at the 4th intercostal in a young male.
How is the breast suspended?
Suspensory ligaments of Cooper. Network of connective tissue for parenchyma. Attach on clavicle, dermis, deep fascia.
How does the breast develope?
Mammary buds begin in week 6 as a thickening on the chest called Mammary ridge or milk line. Buds come from ectoderm and supporting tissue from mesenchyme. Lactiferous ducts are present. Additional nipples can occur. polythelia (xtra nips) polymastia (breasts)
What happens at puberty?
Mammary glands develope influenced by oestrogen and progesterone increasing fat and connective tissue
What happens at pregancy in breasts?
Increase in first 8/40 weeks. areola darkens, montgomery tubercles increase. Intralobular ducts develope forming acini cells which produce milk.
What happens to breasts post menopause?
involution of ducts, glands, relacement of fat, atrophy. Can begin at 35 and post partum.
What is the blood supply to the breast plus veins?
Internal thoracic from first part of subclavian.
Lateral thoracic artery giving to intercostals.
Thoracoacromial artery.
Nerves of breast?
anterior and lateral branches of intercostals T2-6
Lymph drainage of breast?
Two lymphatic plexuses of the breast. Subareolar Submammary Axillary - 75% Parasternal 25% along internal mammary Central Anterior = CANCER Posterior Lateral
How do you find the Sentinel Lymph node?
Identifies the first draining lymph node of the breast. Outrules metastatic breast cancer.
Where is the highest incidence of cancer?
upper outer quadrant
Name benign and malignant breast cancer
benign - cysts, fibrocystic, adenoma
Malignant - tumours, ductal carcinoma, lobular medullary - 1% of tumours
Can occur in men
Signs and symptoms of breast cancer?
Lump - hard ireegular fixed
Pain - rare
Asymmetry
Skin - tethering peau d orange ulceration
Nipple - discahrge inversion pagets
Signs of metastatese - lymphatic local haematological
What does Peau d’orange signify?
blockage of lymph
What to look out for in breast check?
lump palpated unusual nipple discharge skin tethering lump in axilla new nipple inversion peau d orange
Name some treatments of breast cancer?
Surgery, radiotherapy, systemic treatment (hormonal chemo)
Where are implants placed?
submammary and subglandular
Some causes of gynaecomastia?
puberty, excess weight, cannabis, meds, liver disease
What is amastia?
congenital absense of breast rare
What is the diep flap?
operative surgical removal and displacement
The breast can be considered to composed of two regions
circular largetst and most prominent and axillary smaller running along ht e lateral edge of pec major towards axillary fossa
