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
