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Endo > SM_195b: Breast Development, Pregnancy, Lactation, and Benign Breast > Flashcards

SM_195b: Breast Development, Pregnancy, Lactation, and Benign Breast Flashcards

1
Q

Describe 5th week of fetal breast development

A

Fetal breast development: 5th week

  • Bilateral ectodermal ridges originating from the axilla to the inguinal region develop into 15-20 buds
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2
Q

Describe 7th week of fetal breast development

A

Fetal breast development: 7th week

  • Buds undergo apoptosis except for a single pair at thr 4th-5th intercostal space called the primary mammary buds
  • Breast development as these buds penetrate into underlying mesoderm
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3
Q

Describe 12th week of fetal breast development

A

Fetal breast development: 12th week

  • Primary buds develop into secondary buds which will eventually form into mammary lobules
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4
Q

Describe 20th week of fetal breast development

A

Fetal breast development: 20th week

  • Mammary ridge penetrates the mesoderm sending radial ingrowths into the breast
  • Areola begins to develop
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5
Q

Describe fetal breast development during 2nd and 3rd trimesters

A

Fetal breast development: 2nd and 3rd trimesters

  • Sweat, sebaceous, and apocrine glands develop into Montgomery glands
  • Lumina develop within the mammary buds developing into the lactiferous ducts, a mammary pit, and eventually a nipple in infancy
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6
Q

Describe breast development after birth

A

Breast development after birth

  • Protrusion of the nipple and development of terminal ducts
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7
Q

Describe congenital abnormalities of the nipple

A

Congenital abnormalities of the nipple

  • Polythelia: accessory nipples
  • Athelia: absence of the nopples
  • Polymastia: supernumerary breast
  • Retracted or inverted nipple: due to failure of full development of the nipple
  • Amastia: absence of the breast, usually unilateral
  • Micromastia: excessively small breast
  • Poland syndrome: unilateral underdevelopment of pectoralis muscle and breast
  • Macromastia / virginal hypertrophy: diffuse hypertrophy of one or both breasts
  • Anisomastia: significant size difference
  • Symmastia: medial confluence of the breast
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8
Q

Polythelia is ____

A

Polythelia is accessry nipples

(Particularly common in Asian women)

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9
Q

Retracted or inverted nipples result from ___

A

Retracted or inverted nipples result from failure of full development of the nipple

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10
Q

Poland syndrome is ____

A

Poland syndrome is unilateral underdevelopment of pectoralis muscle and breast

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11
Q

Anisomastia is ____

A

Anisomastia is significant size difference between breasts

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12
Q

Describe normal breast development

A

Normal breast development

Puberty begins between ages 8-12 years

  1. Hypothalamus -> GnRH
  2. GnRH -> FSH and LH from pituitary
  3. FSH and LH -> maturation of ovarian follicles
  4. Production of estrogens
  5. Mammary duct epithelium and stroma proliferate under ovarian estrogen: terminal duct lobules, collecting ducts, and breast buds proliferate
  6. Vascular and connective tissue proliferate -> increased breast size
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13
Q

Describe what complete breast development requires

A

Complete breast development requires

  • Insulin, cortisol, thyroxine, prolactin, and GH
  • Normal menstrual cycles: adequate body fat (16-24%), adequate sleep (gonadotropins released during sleep cycles)
  • Exposure to sunlight: optimizes pituitary secretion of gonadotropins
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14
Q

Breast development stops ____

A

Breast development stops 2 years after onset of menarche

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15
Q

____ are used to categorize breast development

A

Tanner’s breast development stages are used to categorize breast development

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16
Q

Tanner Stage 1 (preadolescent) breast development is ____

A

Tanner Stage 1 (preadolescent) breast development is papilla elevation above the level of the chest wall

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17
Q

Tanner Stage II (breast budding) breast development is ____

A

Tanner Stage II (breast budding) breast development is breast and papilla elevation along with increased areola diameter

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18
Q

Tanner Stage III breast development is ____

A

Tanner Stage III breast development is ongoing enlargement of the breasts and areola

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19
Q

Tanner Stage IV breast development is ___

A

Tanner Stage IV breast development is elevation of the areola and papilla above the breast mound

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20
Q

Tanner Stage V (mature breast) breast development is ____

A

Tanner Stage V (mature breast) breast development is elevation of the papilla with regression of the areola

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21
Q

Breast ____ stops approximately 2 years after puberty

A

Breast development stops approximately 2 years after puberty

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22
Q

Breast ____ continues until approximately age 30 or during pregnancy to prepare for lactation

A

Breast maturity continues until approximately age 30 or during pregnancy to prepare for lactation

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23
Q

Radiation to the breast ___ can damage immature stem cells and increase risk of breast cancer

A

Radiation to the breast prior to age 30 can damage immature stem cells and increase risk of breast cancer

(minimal effect after age 30)

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24
Q

Describe breast anatomy

A

Breast anatomy

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25
Q

Tomosynthesis is ___

A

Tomosynthesis is an advanced form of mammography that can be used to screen for early signs of breast cancer in women with no symptoms

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26
Q

Describe breast anatomy

A

Breast anatomy

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27
Q

Describe tissue of breast

A

Breast tissue

  • Skin
  • Subcutaneous tissue
  • Breast tisusue: epithelial tissue (ducts, lobules), stroma (adipose, fibrous connective tissue)
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28
Q

Fatty breasts are ___

A

Fatty breasts are 0-25% breast tissue

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29
Q

Scattered fibroglandular densities are ____

A

Scattered fibroglandular densities are 25-50% breast tissue

30
Q

Heterogeneously dense breasts are ____

A

Heterogeneously dense breasts are 50-75% breast tissue

31
Q

Extremely dense breasts are ____

A

Extremely dense breasts are > 75% breast tissue

32
Q

Describe breast density

A

Breast density

  • Fatty breasts: 0-25% breast tissue
  • Scattered fibroglandular densities: 25-50% breast tissue
  • Heterogeneously dense breasts: 50-75% breast tissue
  • Extremely dense breasts: > 75% breast tissue
33
Q

Dense breasts ____

A

Dense breasts make it more difficult for the radiologist to identify abnormalities including cancer

  • Increases risk of patient developing breast cancer
  • Nothing the patient can do about their breast density
  • Supplemental screening may be beneficial in these patients
34
Q

Breast arterial blood supply is primarily ____ and ____

A

Breast arterial blood supply is primarily internal mammary artery (60%) and lateral thoracic artery (30%)

  • Minor contributions from thoracoacromial, intercosts, subcapsular, and thoracodorsal arteries
35
Q

Describe venous drainage of breast

A

Venous drainage of breast

  • Courses towards axilla along same path as arteries
  • Circulus venosus: an anastamotic circle of veins underlying the nipple-areolar complex
36
Q

These are the ____

A

These are the internal mammary arteries

37
Q

____ innervate the majority of the breast

A

3rd-6th intercostal nerves, lateral and anterior cutaneous branches, innervate the majority of the breast

38
Q

Lymphatic drainage involves ____ and ____

A

Lymphatic drainage involves axillary lymph nodes (75%) and internal mammary lymph nodes (25%)

39
Q

Describe breast physiology at menstrual cycle

A

Breast physiology at menstrual cycle

  • Estrogen peaks prior to mid-cycle: enlargement of breast ducts
  • Progesterone peaks around day 21 during luteal phase: causes growth of breast lobules
  • Increased fluid secretion, mitotic activity, and DNA production of both non-glandular and glandular tissue occurs and may cause breast tenderness
  • Volume of premenstrual breast increases by 25-30 mL due to increased blood flow and water retention
40
Q

Describe breast physiology at menses

A

Breast physiology at menses

  • Normalization of hormone levels causes breast size to return to normal and tenderness to resolve
41
Q

Describe breast tenderness during pregnancy

A

Breast tenderness during pregnancy

  • Prolactin levels increase through the course of pregnancy: 10-25 ng/mL to 200-400 ng/mL at term
  • Estrogen, progesterone, and prolactin cause new duct formation, ductal branching, and alveolar proliferation: this along with placental lactogen likely cause breast size increase in pregnancy, breast tenderness is also common and likely due to high levels of progsterone in pregnancy
42
Q

Describe role of prolactin during lactation

A

Prolactin during lactation

  • Produced by anterior pituitary
  • Stimulates milk production within alveolar cells of breast
43
Q

Describe role of oxytocin during lactation

A

Oxytocin during lactation

  • Produced by posterior pituitary
  • Stimulates myoepithelial cells surrounding the alveoli that lead to milk ejection into milk ducts
  • Milk ejection reflex
44
Q

Describe role of progesterone and estrogen during lactation

A

Progesterone and estrogen during lactation

  • Are both at high levels during pregnancy
  • Inhibit lactation by interfering with prolactin binding of the alveolar cells
  • Drops with delivery of baby
  • Placenta leads to lactation due to longer presence of prolactin in body
45
Q

Describe breast physiology during lactation

A

Breast physiology during lactation

  • Milk secretion begins at 3-4 days postpartum: due to decrease in circulating steroid hormones
  • Suckling causes: increase in prolactin levels, increase in oxytocin levels
  • Thyroid hormone, insulin, cortisol necessary for optimal breast milk development
  • Initially colostrum is produced: high levels of WBCs and IgA which coat baby’s intestines and help prevent pathogens from invading and decrease food allergy
46
Q

Suckling causes ____ and ____

A

Suckling causes increase in prolactin levels and increase in oxytoxcin levels

  • Increase in prolactin levels: initiation and maintenance of milk production
  • Increase in oxytocin levels: due to stimulation of the paraventricular and supraoptic nucleus of hypothalamus (produce oxytocin and signal posterior pituitary gland)
47
Q

Breastfeeding has benefits for ___ and ___

A

Breastfeeding has benefits for infants and mothers

  • Recommended: exclusive breastfeeding for 6 months with continuation of breastfeeding for 1 year or longer
48
Q

Mastitis is ____

A

Mastitis is pain and inflammation of the breast

  • Risk factors: sore / cracked nipples, blocked milk ducts, yeast infection of the breast
49
Q

Unilateral breast pain and erythemia, fever, malaise, and body aches is ____

A

Unilateral breast pain and erythemia, fever, malaise, and body aches is mastitis

(clinical diagnosis)

50
Q

Firm area in the breast with fluctuance is ____

A

Firm area in the breast with fluctuance is breast abscess

  • Diagnose with ultrasound
51
Q

Mammogram yields a ___ score

A

Mammogram yields a BIRADS score

  • 0: negative
  • 1: additional evaluation required
  • 2: benign
  • 3: probably benign
  • 4A: low malignancy suspicion
  • 4B: intermediate malginancy suspicion
  • 4C: moderate malignancy suspicion
  • 5: highly suggestive of malignancy
52
Q

BIRADS 0 is ____

A

BIRADS 0 is negative

53
Q

BIRADS 1 is ____

A

BIRADS 1 is additional evaluation required

54
Q

BIRADS 2 is ____

A

BIRADS 2 is benign

55
Q

BIRADS 3 is ____

A

BIRADS 3 is probably benign

56
Q

BIRADS 4A is ____

A

BIRADS 4A is low malignancy suspicion

57
Q

BIRADS 4B is ____

A

BIRADS 4B is intermediate malignancy suspicion

58
Q

BIRADS 4C is ____

A

BIRADS 4C is moderate malignancy suspicion

59
Q

BIRADS 5 is ____

A

BIRADS 5 is highly suggestive of malignancy

60
Q
A
61
Q

____, ____, ____, ____, and ____ are abnormal breast symptoms

A

Pain, lump, nipple discharge, nipple retraction, and skin changes are abnormal breast symptoms

62
Q

Cyclic mastalgia is ____

A

Cyclic mastalgia is breast pain and tenderness that occurs with menstrual cycle

  • Treatments: reassurance, well-fitted bras, restrict caffeine / fat / salt, evening primrose oil, NSAIDs
63
Q

Extramammaroy sources of breast pain are ____ and ____

A

Extramammaroy sources of breast pain are costochondritis (Tietze syndrome) and Mondor disease

64
Q

Costochondritis (Tietze syndrome) is ____

A

Costochondritis (Tietze syndrome) is inflammation of cartilage that connects rib to the sternum

  • Treat with NSAIDs
65
Q

Mondor disease is ____

A

Mondor disease is superficial thrombophlebitis of the lateral thoracic vein

  • Underlying cause may be found in about 50% with chance of underlying breast cancer
  • Treat with NSAIDs
66
Q

____ is most commonly used for BIRADS 4

A

Core needle biopsy is most commonly used for BIRADS 4

(excisional biopsy if core needle biopsy not successful)

67
Q

Describe benign nipple discharge

A

Benign nipple discharge

  • Bilateral
  • Any color EXCEPT bloody or clear
  • Multiductal
68
Q

Describe nipple discharge that needs additional evaluation

A

Nipple discharge that needs additional evaluation

  • Unilateral
  • Uniductal
  • Spontaneous
  • Clear, serous, or bloody
69
Q

Describe management of suspicious nipple discharge

A

Management of suspicious nipple discharge

  • Imaging with diagnostic mammogram and ultrasound
  • Suspicious imaging features: retroareolar calcifications and intraductal mass
  • Biopsy lesions if identified
  • MRI indicated if no mammogram or US findings
  • Referral to breast surgeon
70
Q

___ and ___ are suspicious imaging features for nipple discharge

A

Retroareolar calcifications and intraductal mass are suspicious imaging features for nipple discharge

Endo (25 decks)

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