Handout

Question 1

External anatomy of breast

Answer 1

Skin
Nipple
Areola

Question 2

Skin is composed of [..]

Answer 2

Sudoriferous glands
Subcutaneous glands
Hair follicles

Question 3

Innervation of skin

Answer 3

Lateral cutaneous branches of 2nd to 6th ribs

Question 4

Arterial supply of the skin [medial breast surface]

Answer 4

Arises from anterior intercostal artery branches

Question 5

Artery supply [lateral breast surface]

Answer 5

Lateral thoracic artery and posterior intercostal artery

Question 6

Venous drainage [medial breast surface]

Answer 6

Intercostal artery branches

Question 7

Venous drainage [lateral breast surface]

Answer 7

Lateral thoracic artery branches
Posterior intercostal artery branches

Question 8

Lymphatic drainage (3) types

Answer 8

Breast tissue drainage
Periareolar lymphatic drainage
Cutaneous anatomical lymph channels

Question 9

Lymphatic drainage [breast tissue drainage]

Answer 9

Dermal lymphatics and periareolar lymphatic

Question 10

Lymphatic drainage [Periareolar lymphatic drainage]

Answer 10

Axillary and internal mammary lymphatics

Question 11

Lymphatic drainage [Cutaneous anatomical lymph channels]

Answer 11

Potential pathways for the spread of contralateral breast cancer

Question 12

Appears as a thin, continuous, radiopaque rim homogenous in density, approx 1 mm thin

Answer 12

Cutaneous anatomical lymph channels

Question 13

Nipple [location]

Answer 13

Project at the level of 4th intercostal space in the non-pendulous breast

Question 14

Conical shape with an average height of 10-12 mm

Answer 14

Nipple

Question 15

Orifices of nipple

Answer 15

8-12 major duct orifices at the bases of crevices

Question 16

Present to facilitate nipple function during nursing
Expedite nipple erection

Answer 16

Subdermal smooth muscle

Question 17

Can be up to 3-5 mm thick, central opacity, roughly cylindrical in shape and of variable size and density

Answer 17

Areola

Question 18

Contains smooth muscle in contiguity with nipple smooth muscle

Answer 18

Areolar dermis

Question 19

Areola [lymphatic drainage]

Answer 19

From subareolar (Sappey) plexus to axillary and internal mammary lymph nodes

Question 20

Highly pigmented; covered by stratified squamous epithelium
Increases pigmentation and size during puberty and further, during pregnacy

Answer 20

Nipple-Areolar Complex

Question 21

Functional unit of the breast, composed of acini

Answer 21

Terminal ducal lobular unit (TDLU)

Question 22

Three layers of acini and ducts

Answer 22

Basement Membrane
Myoepithelial Layer
Epithelial Lining

Question 23

[acini & duct layer] acts as a barrier to the spread of cancer; if breached carcinoma is termed as invasive

Answer 23

Basement membrane

Question 24

[acini & duct layer] help in forming basement membrane

Answer 24

Myoepithelial membrane

Question 25

[acini & duct layer] usually only one cell thick Further proliferation leads to hyperplasia

Answer 25

Epithelial lining

Question 26

Arterial supply

Answer 26

Blood supply Main arterial supply Superomedial perforator supply Additional arterial supply

Question 27

[arterial supply] blood supply

Answer 27

Subdermal complex

Question 28

[arterial supply] main arterial supply

Answer 28

Perforating branches of the internal mammary artery ( most noticeable the second to fifth perforators)

Question 29

[arterial supply] superomedial perforator supply

Answer 29

Internal mammary artery 60% of the total breast arterial blood supply

Question 30

[arterial supply] additional arterial supply

Answer 30

Thoracoacromial artery Lateral thoracic artery Intercostal arteries

Question 31

Venous drainage

Answer 31

Axillary vein Internal mammary and thoracic veins Superficial venous - internal thoracic vein Deep venous - perforating branches of the internal thoracic vein, lateral thoracic, axillary vein and upper intercostal vein

Question 32

Lymphatic drainage

Answer 32

Begins in PERILOBULAR PLEXUS (con. tissue in stroma) → LACTIFEROUS DUCTS → SUBAREOLAR PLEXUS (lymphatic fluid flows) Breast drains into AXILLARY, SUBSCAPULAR, CENTRAL, PECTORAL, APICAL and CLAVICULAR NODE groups LATERALLY PARASTERNAL (INTERNAL MAMMARY NODES MEDIALLY

Question 33

First node to which cancer cells are most likely to spread from a primary tumor; in breast carcinoma, this is most likely to lie low in the axilla

Answer 33

Sentinel lymph node

Question 34

Three Groups of Axillary Lymph Nodes

Answer 34

Level I Level II Level III

Question 35

[axillary lymph nodes group] lie lateral to the lateral border of the pectoralis major muscle and can extend into the axillary tail

Answer 35

Level I

Question 36

[axillary lymph nodes group] lie beneath the pectoralis minor muscle

Answer 36

Level II

Question 37

[axillary lymph nodes group] ie medially and superiority to the pectoralis minor muscle up to the clavicle

Answer 37

Level III