Breast

Question 1

How many new breast cancers occur in the UK annually?

What is the risk?

Answer 1

56K - incidence expected to rise by 2%

Risk = 1 in 9

Question 2

What type of gland is in the breast tissue?

Answer 2

Modified apocrine (sweat) gland

Question 3

What is an additional nipple called?

Answer 3

Accessory nipple

Question 4

What is an absence of nipple & areola called?

Answer 4

Athelia

Question 5

What is an absence of breast tissue, but presence of nipple & areola complex called?

Answer 5

Amastia

Question 6

What type of breast shape do pre-pubertal girls get as part of development - which can be pathological if it doesn’t progress?

Answer 6

Tubular breast

Question 7

Upon what do the breasts lie?

Answer 7

Pectoralis major - from 2nd to 6th rib

Question 8

Which muscle is laterally related to the breast?

Answer 8

Serattus anterior

Question 9

Which muscles lie inferiorly to the breast?

Answer 9

Rectus abdominus and inferolaterally - external oblique

Question 10

Where is the nipple found anatomically?

Answer 10

Mid-clavicular line, 4th intercostal space

Question 11

What lies in the retromammary space?

Answer 11

Fat

Question 12

How does the breast attach to the pectoral fascia?

Answer 12

By suspensory ligaments extending from dermis of breast to pectoral fascia

Question 13

What divides the breast tissue into segments?

Answer 13

Suspensory ligaments - called Cooper’s ligaments

Question 14

What are the sebaceous glands of the areola called?

Answer 14

Montgomery glands

Question 15

Answer 15

Question 16

What does the nipple and areola contain?

Answer 16

Sweat glands
Sebaceous (Montgomery) glands

Question 17

Where does the upper and outer breast extend into? What is this called?

Answer 17

Extends into the axilla

Called axillary tail

Question 18

What type of cells are the ducts and lobules of the breast tissue lined with?

Answer 18

Columnar epithelium - with myoepithelial cells in the basement membrane

Question 19

What happens to the breast tissues during the menstrual cycle?

Answer 19

The structure can fluctuate - causing breast tissue to get bigger - causing breast pain. Can get firm lumpy areas due to hormonal changes.

Question 20

How many lobules are found in each breast?

Answer 20

15-20

Question 21

What are the ducts of the breast called?

Answer 21

Lactiferous ducts

Question 22

What do lactiferous ducts converge to become and where?

Answer 22

Converge to become lactiferous sinus - found at the nipple

Question 23

When do you get hormonal changes in breasts?

Answer 23

Puberty
Menstruation
Lactation
Menopause

Question 24

What happens to breast tissue in menopause?

Answer 24

The reduction of oestrogen causes much of the glandular tissue to be replaced with fatty tissue (involution).

Question 25

What happens to the breast during lactation?

Answer 25

The secretory lobules and ducts become enlarged.

Question 26

Which artery supplies the breast? What are the 3 main arterial branches of this?

Answer 26

Axillary artery - Thoracodorsal - Thoraco-acromial - Lateral thoracic

Question 27

What provides 60% of blood supply to the breast?

Answer 27

Internal mammary perforators - these are vessels which arise from the mammillary artery and perforate through the chest wall.

Question 28

What provides superficial venous drainage of the breast?

Answer 28

Nipple and areola complex venous plexus - drains into intercostal veins

Question 29

Where does venous drainage of the deep breast tissue go?

Answer 29

Into the axillary, internal thoracic vein and perforating intercostal veins

Question 30

What are the two types of lymph vessels in the breast?

Answer 30

Superficial and deep - relate to vascular structures - drain into local lymph nodes.

Question 31

What types of lymph nodes are in the breast?

Answer 31

Local Regional Central

Question 32

What is the path of lymph flow in the breast?

Answer 32

Local --> Regional --> Central --> Venous Circulation (thoracic duct -> left subclavian vein)

Question 33

Name two locations of superficial lymph nodes in the breast. Which direction do they drain in?

Answer 33

Areola Subareola Drain sideways and upwards

Question 34

Where does the axillary artery arise from?

Answer 34

The subclavian artery

Question 35

Where do internal mammary lymph nodes (intra mammary lymph) drain?

Answer 35

To lateral aspect and into axillary nodes - again sideways and upwards.

Question 36

What can happen in inflammatory breast cancer?

Answer 36

The lymphatics can be occluded causing oedema within the breast tissue.

Question 37

What is peau d'orange appearance associated with?

Answer 37

Breast cancer

Question 38

Where do lymph nodes of the breast and upper limb drain into?

Answer 38

The axilla

Question 39

What are the different levels of axillary drainage within the breast?

Answer 39

Lower Middle Superior

Question 40

What is the first lymph node in the chain of lymphatic drainage called?

Answer 40

Sentinel lymph node

Question 41

How are sentinel lymph nodes used in breast cancer?

Answer 41

Rather than removing all lymphatics - try to identify the sentinel nodes which are involved using blue / radioactive dye injected S/C - can detect which sentinel node has taken up the dye - these can then be removed.

Question 42

Where does main sensory supply to the breast originate from?

Answer 42

The lower cervical plexus (superior) Long thoracic nerve (laterally) Intercostal nerves (2nd-6th)

Question 43

Where does autonomic supply of the breast originate from?

Answer 43

2nd - 6th intercostal nerves

Question 44

What supplies sensation to the nipple?

Answer 44

Lateral cutaneous branch of T4

Question 45

What is the dermatome of the nipple?

Answer 45

T4