The breast

Question 1

Where do accessory breasts form?

Answer 1

Axilla to medial thigh, through groin

Question 2

How do breasts form?

Answer 2

Invagination of chest wall ectoderm forms ducts
Invagination everts to form niple
At puberty, alveoli sprout from ducts

Question 3

What happen to breast in menopause?

Answer 3

Gland atrophies

Question 4

Sign of malignant breast

Answer 4

Stiffened ligaments of Astley Cooper

Question 5

Blood supply to breast

Answer 5

Axillary artery, lateral thoracic and acromio-thoracic branches

Question 6

Veins to breast

Answer 6

Lateral thoracic and internal thoracic

Question 7

Where does level 1 axillary node go?

Answer 7

Pec minor

Question 8

Where does level 2 axillary node go?

Answer 8

Under pec minor

Question 9

Where does level 3 axillary nerve go?

Answer 9

Medial to pec minor

Question 10

5 main groups of lymph nodes

Answer 10

Anterior
Posterior
Lateral
Central
Apical

Question 11

Where is anterior lymph node

Answer 11

Deep to pec major

Question 12

Where is posterior lymph node?

Answer 12

Along sub scapular vessels

Question 13

Where is lateral lymph node?

Answer 13

Along axillary vein

Question 14

Where is central lymph node

Answer 14

Axillary fat

Question 15

Where is apical lymph node?

Answer 15

All others drain, apex of axilla

Question 16

Spinal nerves supplying breasts

Answer 16

T3-T5 intercostal

Question 17

Where are most breast tumours?

Answer 17

Superior lateral - by axillary

Question 18

Symptoms of breast cancer

Answer 18

Dimpling, nipple bleeding/retraction

Question 19

How to examine breasts

Answer 19

Feel with flat of hand - history and exam of breast and lymph nodes

Question 20

Sentinel node biopsy

Answer 20

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

Question 21

Breast conservation

Answer 21

Wide local excision, excise tumour with clear margins, mastectomy plane down to pectoral fascia. External beam or brachytherapy

Question 22

Simple mastectomy

Answer 22

Whole breast removal

Question 23

Extended mastectomy

Answer 23

Clearance of axillary fat and nodes

Question 24

Radical mastectomy

Answer 24

Axillary fat and nodes, pec major, pec minor, parts of chest wall

Question 25

How can you reconstruct breast?

Answer 25

Balloon or lat dorsi or stomach tissues

Question 26

Lymph drainage from breast

Answer 26

Apical - subclavian trunk - either subclavian vein or right jugular trunk - on left drains to thoracic duct

Question 27

Parasternal nodes

Answer 27

Internal thoracic/mammary nodes lie along internal thoracic walls, drain to mediastinal then thoracic duct