Normal anatomy of the breast Flashcards by Becca M

How do the breasts develop?

Mammary crests or ridges appear during 4th week
These crests extend from axillary region to inguinal region
The crests usually disappear except in the pectoral region
Primary mammary buds – Secondary buds – lactiferous ducts and their branches

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Describe the breasts?

Secondary sexual feature of females
Source of nutrition for the neonates
Present in a rudimentary form in males
Site of malignant change in as many as 1 in 10 women

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What are the general features of the breast?

•Modified and highly specialized sweat glands

No special capsule or sheath

Both Males & females have breasts
Well developed in females
Breast size and shape result from genetic,racial, and dietary factors

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What is the extent of the breast?

Vertical: 2nd or 3rd rib – 6th rib

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What is the transverse location of the breast?

Sternal edge to midaxillary line

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Where does the breast lie?

On the deep pectoral fascia

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Where is the axillary tail?

A small part of breasts may extend towards axillary fossa

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What does the retromarry space do?

Help some degree of movement

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Where does the parts of the breast rest?

2/3rd of the breast rests on the pectoral fascia covering pectoralis major
1/3rd of the breast rests on the fascia covering serratus anterior

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Where does the breast firmly attach?

To the dermis by suspensory ligament of cooper – help support the lobules of the gland

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What is the nipple?

Prominence of the breast

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What is the areola?

Pigmented area around the nipple

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How many lobules of the breast?

•Each breast contains 15-20 lobules of glandular tissue (parenchyma)

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What is each lobule of breast drained by?

Lactiferous duct – opens independently on the nipple

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What is a lactiferous sinus?

Dilated portion of breast

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What is important about a nipple?

No fat or hair
Contains collagenous dense connective tissue, elastic fibres and bands of smooth muscle
The tips of the nipples are fissured with lactiferous ducts opening into them

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What is the position of the nipple?

variable or 4th intercostal space

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What is important about the areola?

Skin covering the nipple and areola contains numerous sweat & sebaceous glands
Enlarge during pregnancy
Oily material secreted by the sebaceous gland provides a protective lubricant for nipple and areola

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What are the breast quadrants?

•For anatomical location and description of pathology (cysts and tumours) the breast is divided into 4 quadrants.

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What is the axillary tail an extension of?

Breast tissue in the supero-lateral quadrant

Explain the male breast?

Rudimentary throughout life
Formed by small ducts without lobules or alveoli
Little supporting fibroadipose tissue
Temporary enlargement in newborn & during puberty

What is gynaecomastia?

Postnatal development of rudimentary lactiferous ducts in males
During midpuberty about 2/3rd of boys develop varying degrees of hyperplasia of the breasts

What is polymastia?

Extra breast

What is polythelia?

An extra nipple

What is athelia or amastia?

Absence of nipple or breast

What is the breast supplied by?

Branches of axillary artery, internal thoracic, and some intercostal arteries * Thoraco acromial artery * Lateral thoracic artery * Internal mammary (thoracic) artery

What are the nerves of the breast?

* Anterior and lateral cutaneous branches of 4-6th intercostal nerves * They convey sensory fibers to the skin of the breast * They also carry sympathetic fibres to the blood vessels and to the smooth muscle around the nipple

What is the lymphagtic drainage of the breast?

* Great clinical significance because metastatic dissemination occurs primarily by the lymphatic routes * Breast lymphatics branch extensively and do not contain valves * Most lymph (more than 75%) from lateral quadrants – axillary lymph nodes * Some lymph may drain directly to supraclavicular or inferior cervical nodes * Lymph from medial quadrants – parasternal or to opposite breast

What is the role of sentineal lymph node biopsy?

•Lymphatic mapping & staging of patients • •A radiolabelled colloid is used to locate the sentinel node • •At the time of surgery, a vital blue dye is injected • •Combination of rodioisotope and dye provides most accurate means of localizing the node

What is breast soft tissue made up of?

Of lobes which contains a network of glandular tissue consisting of branching ducts and secretory lobules in a connective tissue stroma.

What is the termianl duct lobular unit of breast?

•lobular unit is the functional milk secretory component of the breast

connective tissue stroma that surrounds the lobules of breast is what?

dense and fibrocollagenous, whereas intralobular tissue has a loose texture

What is the normal breast like?

Extensive branching duct system Surrounded by dense fibrous interlobular tissue (F) & adipose tissue (A) Ducts & acini are lined by two layers of cells – Luminal epithelial cells (E) & myoepithelial cells (M)

What are the prepuberty age related changes of breasts?

* Neonatal breast contain lactiferous ducts but no alveoli * Until puberty, little branching of the ducts occurs * Slight breast enlargement reflects the growth of fibrous stroma and fat

What are the puberty related changes of breasts?

•Branching of lactiferous ducts • •Solid, spheroidal masses of granular polyhedral cells (alveoli) • •Accumulation of lipids in the adipocytes

What are the post menopausal age related changes of breasts?

* Progressive atrophy of lobules and ducts * Fatty replacement of glandular tissue

What kind of breasts are these and answer the labels

Breast during pregnancy

What happens to the breasts during pregnancy?

* Enlarged lobules * Acini are dilated * Epithelium vary from cuboidal to low columnar

What is colostrum?

Protein rich fluid, available few days after birth – rich in maternal antibodies

What kind of breasts are these?

Lactating breast

What are important parts of the lactating breast?

* Acini distended with milk * Thin septa (S) between the lobules * At higher magnification (b) – Acini with eosinophilic material containing clear vacuoles * Milk production – Suckling -Neurohormonal reflex –Prolactin & Oxytocin

What are the diagnostic methods for breaast conditions?

* Imaging –Mammography and Ultrasound * Fine needle aspiration cytology * Core biopsy

What is shown in this mammogram?

Mammogram of a fatty breast with an obvious cancer

What is the commonest cause of death in women age 35-55?

Breast cancer

What is the risk of breast cancer in UK women?

1 in 9 chance of developing breast cancer

What are some signs of breast cancer?

Skin dimpling Abnormal contours Edema of skin Nipple retraction and deviation

What are some examples of benign breast tumours?

* Fibroadenomas * Duct papillomas * Adenomas * Connective tissue tumours