The Breasts and Vulva Flashcards
What are the two regions of the breasts?
Circular body
Axillary tail
What is the nipple composed of and what surrounds it? What does this contain?
Smooth muscle
Areolae - contains numerous sebaceous glands which enlarge during pregnancy to produce an oily substance which acts as a protective lubricant of the nipple
Structure of the mammary glands?
Series of ducts and 15-20 secretory lobules
Each lobule made of many alveoli drained by a single lactiferous duct which contains a dilated section - lactiferous sinus
Droplets of milk collect here
Ducts converge at the nipple
What is the connective tissue stroma of the breast?
Supporting structure which surrounds the mammary glands?
What are the components of the connective tissue stroma?
Fibrous - condenses to form suspensory ligaments which attach and secure breasts to dermis and underlying pectoral fascia. Also separates secretory secretory lobules of the breast
Fatty component
What is the pectoral fascia?
Flat sheet of connective tissue associated with the pec major which the breast lies on.
What is the layer of loose connective tissue between the pectoral fascia and and breast?
Retromammary space - a potential space often used in plastic surgery
Arterial supply to the breasts?
Medial aspect - internal thoracic, branch of the subclavian
Lateral aspect - lateral thoracic and thoracoacromial branches of axillary artery
Lateral mammary branches of posterior intercostal arteries supply lateral aspect of 2-4th intercostal spaces
Mammary branch from anterior intercostal artery
Venous drainage of mammary glands?
Correspond with arteries
Drain into axillary and internal thoracic veins
Lymphatic drainage of the breasts?
Axillary lymph nodes - 75%
Parasternal - 20%
Posterior intercostal lymph nodes - 5%
Skin drains into axillary, inferior deep cervical and infraclavicular nodes
Nipple and areolar - subareolar lymphatic plexus
Nerve supply of the breasts?
Anterior and lateral cutaneous branches of the 4th-6th IC nerves which contain sensory and autonomic nerve fibres (regulates smooth muscle and blood vessel tone)
What is secretion of milk regulated by?
Prolactin secreted by anterior pituitary
Most common cancer in the UK?
Breast cancer
What can happen when lymph drainage is blocked by breast cancer?
Lymph collects in subcutaneous tissue leading to nipple deviation and retraction, prominent skin between small dimpled pores
What are larger dimples in skin of the breast caused by? (breast cancer)
Invasions and fibrosis
Causes traction of the suspensory ligaments causing them to shorten
What do breast cancer metastases feel like?
Stony, hard and fixed
Where can breast cancer metastasise to?
Most commonly the axillary lymph nodes Ovaries Bone Lungs Liver
What is the triple assessment done in suspected breast cancer?
Clinical exam
Mammogram and ultrasound
Biopsy
How is breast cancer staged?
1-4 or TNM
What is the best treatment for breast cancer?
Chemo and surgery
Describe the location of the beats
Anterior thoracic wall
Extend horizontally to mid-axillary line
Extend between 2nd and 6th IC cartilages
What is the vulva?
Collective term for female external genital organs
Functions of the vulva?
Sensory tissue in sex
Assist in micturition by directing flow
Protect internal female repro tract from infection
What makes up the vulva?
Mons pubis Labia majora and minora Vestibule Bartholin's glands Clitoris
Clinical relevance of Bartholin’s glands?
Can get bartholinitis
Vascular supply of the vulva?
Paired pudendal arteries - internal branch contributes mostly
Pudendal veins and smaller labial veins as tributaries
What happens during sex to the veins draining the vulva?
Become engorged to increase the size of the clitoris
Lymphatic drainage of the vulva?
Superficial inguinal lymph nodes
Innervation of the vulva?
Sensory
- anterior supplied by ilioinguinal and genital branch of genitofemoral nerve
- posterior by pudendal and posterior cutaneous nerve of the thigh
Parasympathetic
- to clitoris and vestibule
- from cavernous nerves derived from uterovaginal plexus
