SBO - Breast and Thoracic Pain

Question 1

Identify the Location, Structure and Function of the Breast.

Answer 1

Location:
Paired structures on the anterior thoracic wall.
Lie in the subcutaneous tissue.
Anterior to the pectoralis major mm (2/3), serratus anterior mm (1/3) and their fascia.
Structure:
Contains mammary glands (modified sweat glands).
Supported by connective and adipose tissue.
Function:
Well developed in women (accessory reproductive function for nursing offspring).
Rudimentary in men (functionless).

Question 2

Describe the nipple of the breast

Answer 2

Conical prominences
Circularly arranged smooth mm
Indented with openings of 15-20 lactiferous ducts
No fat, no hair, no sweat glands.

Question 3

Describe the areola of the breast

Answer 3

Circular pigmented skin surrounding the nipple
Contains 18-20 sebaceous glands
Secretes an oily substance to protect and lubricate the nipple.

Question 4

What are the boundaries of the breast

Answer 4

Lateral border of the sternum to mid-axillary line.

Vertically from 2nd to 6th ribs

Question 5

Describe the tail / axillary process of the breast

Answer 5

Extends along pectoralis major toward the armpit.

Can become enlarged during menstruation

Question 6

Describe the retromammary space

Answer 6

Between the breast and the deep pectoral fascia
Contain a small amount of fat
Allows some movement of the breast

Question 7

What is the function of the suspensory ligaments of the breast and where do they attach?

Answer 7

Support the breast tissue

Attach between the mammary gland and the dermis

Question 8

Describe the components of the lactiferous ducts

Answer 8

Function
Carry milk to the nipple
Open independently on the nipple

Structure
Each duct has 15-20 lobules of glandular tissue draining into it.
Milk-secreting alveoli are arranged in grape-like clusters
Alveoli are drained by ducts that converge toward the nipple.
Become Lactiferous sinuses just before reaching the nipple.

Location
Located within the breast tissue between the lobules and the nipple.

Question 9

Identify the arterial supply of the breast

Answer 9

Anterior intercostal arteries
Lateral thoracic and thoracoacromial arteries
Posterior intercostal arteries (2nd, 3rd, and 4th)

Question 10

What is the venous drainage of the breast

Answer 10

Axillary vein and internal thoracic vein

Question 11

Describe the lymphatic drainage of the breast

Answer 11

Begins at the subareola lymphatic plexus
75% drains to the pectoral nodes (anterior axillary) some to other axillary nodes.
Remaining lymph (from medial aspect of breast) drains to the inferior phrenic and parasternal lymph nodes
Skin over the breast: drains to many different nodes around the sternum and clavicle.

Question 12

What is the nerve supply to the breast

Answer 12

Anterior and lateral cutaneous branches of 4th-6th intercostal nerves

Question 13

What are the two gonaditrophin hormones released by the pituitary gland. And what do they do

Answer 13

Follicle stimulating hormone (FSH)
Lutenising hormone (LH)
Stimulate the release of oestregen and progestorone

Question 14

What does oestregen and progestorone do to the breast.

Answer 14

Stimulates growth and function

Question 15

Where is Prolactin produced and what does it do?

Answer 15

Produced in the anterior portion pituitary gland.

Responsible for milk production.

Question 16

Where is Oxitocin produced and what does it do?

Answer 16

Produced in the posterior portion of the pituitary gland

Responsible for milk ejection.

Question 17

What is the definition and aetiology of acute mastitis

Answer 17

Definition:
Acute inflammation of the breast
Aetiology:
Often associated with staphlacoccus aureus and and streptococcal infections.
Usually occurs during lactation i.e. following cracked nipples.
Or from other nipple injuries.
Commensal or hospitial-sourced bacteria gain entry to the duct.
Proliferation occurs in stagnant milk

Question 18

What are the clinical features of acute mastitis

Answer 18

Hard, painful and inflammed breasts
Axillary lymphadenpathy
+/- pyrexia, tachycardia

If not treated effectively
Breast abscess -> extensive scarring

Question 19

What is the management process for acute mastitis

Answer 19

Culture the breast milk
Provide appropriate antibiotics
Treat the breast engorgement (analgesia, local heat)
Cessetation of breast feeding?
Abscess - inscision and drainage.