breast anatomy brogan spencer and laura smitherman tunstall & shah 2012 pocket tutor: surface...

Breast anatomyBROGAN SPENCER AND LAURA SMITHERMAN

Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy

You are in a breast clinic and the consultant asks you to do a breast examination.

Sits over ribs 2-6 ribs

Extends from lateral border of sternum to midaxillary line

Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy

Axillary tail/Tail of Spence

What area does the base of the breast cover?

Don’t forget: May extend superolateraly into the axilla (the axillary tail)

How is the breast divided for examination purposes?

Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy

Upper inner

Upper outer

Lowerouter

Lowerinner

What glands are found on the areola? Sebaceous (Montgomery) glands

◦ Secrete oily substance following pregnancy◦ Oily substance protects the nipple from irritation

What is this area of pigmented skin called?

The image below is an incidental finding on examination of a 23yr male patient.

What could this be?

Supernumerary Nipple

Where do these occur?

Mammary ridge/milk line

(From the anterior axillary fold to the groin)

What tissue is found in the breast (3)?

Connective

Glandular

Fatty

What supports the breast tissue?

Suspensory ligaments of Cooper

1.2.

4.3.

5.

Approximately how many lactiferous ducts does the nipple receive?

15-20

Label the diagram

During the breast examination you ask the patient to place their hands on their hips and contract their pectoralis muscle.

Would you expect the breast to move with contraction of the muscle?

No

Why?The retromammary space permits free movement of the breast independent of pectoralis major (there should be no attachment!)

The space is between the breast tissue and the pectoralis fascia

What arteries supply the breast?

Medial mammary – From internal thoracic (mammary)/anterior intercostal

Lateral mammary – From lateral thoracic artery & posterior intercostals

What is the nerve supply to the breast?

T4-6 intercostal nerves

Why is it important to understand the blood supply to the breast?

The blood supply helps you determine the route of lymph drainage

Where does most of the lymph from the breast drain (>75%) and where else might it go to?

Most to axillary lymph nodes (ant. & central)but also to:

Interpectoral (rotter) nodesParasternal (internal thoracic) nodesContralateral parasternal nodesContralateral breastSub diaphragmatic/Hepatic nodesInguinal lymph nodes

A patient presents to the breast clinic with the below finding

What procedure is the patient likely to have had?

Upper limb lymphodema on the left hand side

Left sided mastectomy with axillary lymph node clearance

What do you notice?

Is this a pitting or non-pitting oedema?Non-pitting oedema

What are some common clinical signs of breast disease?

A lump

Skin changes◦ Dimpling◦ Tethering (1d)◦ Peau d’orange (1b)

Nipple inversion (1a)

Nipple discharge

Pain (mastalgia)

What is the arrangement of the glandular tissue in a lactating breast?

Acinar

Normal/Quiescent Lactating

What changes does the breast go through during pregnancy? (6)

Lengthening and branching of ducts

Development of secretory alveoli

Vascularity increases

Nipples enlarge

Areola becomes more prominent

Lobular structure more prominent

Name 4 benefits of breast feeding for mother?

Skin to skin contact

Promotion of attachment

Uterine involution

Prevention of rheumatoid arthritis

Lower risk of breast and ovarian cancer

Lower risk of hip fractures and decreased bone density

Name 4 benefits of breast feeding for baby?

Lower risk of GI, respiratory infections, urinary and ear infections

Lower risk of allergic disease (eczema and wheezing)

Lower risk of SIDS

Lowered risk of childhood leukaemia

Breastfed babies may have better neurological development

How is it recommended that a baby is positioned to latch onto the breast?

“Nipple to nose” technique

Baby’s nose/upper lip needs to be opposite the nipple

Which women should not breast feed? Alcohol misuse

Certain drugs-methotrexate, cyclosporine, lithium

Active TB

HIV

Breast Cancer Rx

Infant with galactosemia

What effect do progesterone and oestrogen have on breast tissue?

Progesterone –

Oestrogen –

Combined –

ductal growth

lobular development (growth)

suppress lactation