The breast Flashcards
Where do accessory breasts form?
Axilla to medial thigh, through groin
How do breasts form?
Invagination of chest wall ectoderm forms ducts
Invagination everts to form niple
At puberty, alveoli sprout from ducts
What happen to breast in menopause?
Gland atrophies
Sign of malignant breast
Stiffened ligaments of Astley Cooper
Blood supply to breast
Axillary artery, lateral thoracic and acromio-thoracic branches
Veins to breast
Lateral thoracic and internal thoracic
Where does level 1 axillary node go?
Pec minor
Where does level 2 axillary node go?
Under pec minor
Where does level 3 axillary nerve go?
Medial to pec minor
5 main groups of lymph nodes
Anterior Posterior Lateral Central Apical
Where is anterior lymph node
Deep to pec major
Where is posterior lymph node?
Along sub scapular vessels
Where is lateral lymph node?
Along axillary vein
Where is central lymph node
Axillary fat
Where is apical lymph node?
All others drain, apex of axilla
Spinal nerves supplying breasts
T3-T5 intercostal
Where are most breast tumours?
Superior lateral - by axillary
Symptoms of breast cancer
Dimpling, nipple bleeding/retraction
How to examine breasts
Feel with flat of hand - history and exam of breast and lymph nodes
Sentinel node biopsy
Dual technique, everything goes blue, small risk of allergy, highly targeted sample. Liquid injected into breast, reaches sentinel lymph node first, no signs of cancer in this node means it is unlikely there is any cancer beyond this site. The patient is injected with an isotope - it travels to lymph node and this shows up on scan. Blue dye is injected to site and travels to node so it glows blue in theatre
Breast conservation
Wide local excision, excise tumour with clear margins, mastectomy plane down to pectoral fascia. External beam or brachytherapy
Simple mastectomy
Whole breast removal
Extended mastectomy
Clearance of axillary fat and nodes
Radical mastectomy
Axillary fat and nodes, pec major, pec minor, parts of chest wall
How can you reconstruct breast?
Balloon or lat dorsi or stomach tissues
Lymph drainage from breast
Apical - subclavian trunk - either subclavian vein or right jugular trunk - on left drains to thoracic duct
Parasternal nodes
Internal thoracic/mammary nodes lie along internal thoracic walls, drain to mediastinal then thoracic duct
