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

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Breast anatomy

Breast anatomyBrogan Spencer and Laura Smitherman

Tunstall & Shah 2012 Pocket Tutor: Surface AnatomyYou are in a breast clinic and the consultant asks you to do a breast examination. Sits over ribs 2-6 ribsExtends from lateral border of sternum to midaxillary line

Tunstall & Shah 2012 Pocket Tutor: Surface AnatomyAxillary tail/Tail of SpenceWhat area does the base of the breast cover?Dont forget: May extend superolateraly into the axilla (the axillary tail)How is the breast divided for examination purposes?

Tunstall & Shah 2012 Pocket Tutor: Surface AnatomyUpper innerUpper outerLowerouterLowerinnerWhat glands are found on the areola?Sebaceous (Montgomery) glandsSecrete oily substance following pregnancyOily 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 NippleWhere do these occur?Mammary ridge/milk line

(From the anterior axillary fold to the groin)What tissue is found in the breast (3)?Connective GlandularFatty

What supports the breast tissue? Suspensory ligaments of Cooper

Approximately how many lactiferous ducts does the nipple receive? 15-20Label the diagramDuring 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?NoWhy?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 intercostalLateral 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 drainageWhere 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 sideLeft sided mastectomy with axillary lymph node clearanceWhat do you notice?Is this a pitting or non-pitting oedema?Non-pitting oedemaWhat are some common clinical signs of breast disease?A lump

Skin changesDimplingTethering (1d)Peau dorange (1b)

Nipple inversion (1a)

Nipple discharge

Pain (mastalgia)

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

Normal/QuiescentLactatingWhat changes does the breast go through during pregnancy? (6)Lengthening and branching of ductsDevelopment of secretory alveoliVascularity increasesNipples enlargeAreola becomes more prominentLobular 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 densityName 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 developmentHow is it recommended that a baby is positioned to latch onto the breast?Nipple to nose technique

Babys nose/upper lip needs to be opposite the nipple

Which women should not breast feed?Alcohol misuseCertain drugs-methotrexate, cyclosporine, lithiumActive TBHIVBreast Cancer RxInfant with galactosemiaWhat effect do progesterone and oestrogen have on breast tissue?Progesterone

Oestrogen Combined ductal growthlobular development (growth)suppress lactation