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Flashcards in Breast Deck (14):
0

Lies in superficial fascia of anterior chest wall

Overlies the PECTORALIS MAJOR & SERRATUS ANTERIOR MUSCLES

Axillary tail - high percentage of tumors

Extends from rib 2-6 vertically, from sternum to MAL laterally

Breast

1

Between breast & pectoral (deep) fascia
- allows free movement of the breast
- cancer invasion --> pectoralis major contraction --> whole breast move superiorly

Retromammary space

2

For support

Extends from dermis to pectoral (deep) fascia

Cancer invasion --> skin dimpling or nipple inversion

Suspensory (cooper) ligament

3

For contour & size

Adipose tissue

4

Modified sweat glands consisting of acini

Acini --> 15-20 lactiferous ducts --> lactiferous sinus (milk reservoir) --> nipple

Glandular tissue (mammary gland)

5

Arterial supply

Internal thoracic artery

Lateral thoracic artery

Intercostal artery

6

Venous drainage

Chief: Axillary vein

Others: internal thoracic vein, lateral thoracic vein, intercostal vein

7

Lymphatic drainage

Chief: Axillary nodes

Cancer invasion --> block lymph flow --> thick, leathery skin (peau d orange)

8

Sensory innervation

Intercostals nerves 2-6

9

Nipple secretion

Contents:
- exfoliates duct cells
- a-lactoalbumin
- immunoglobulins
- lactose
- cholesterol
- steroids
- fatty acids
- caffeine, ethanol, nicotine, barbiturates, pesticides & technetium

10

Nipple discharge

Benign cause:
- green, milky, yellow or brown
- bilateral
- not spontaneous
- affects multiple ducts

PITUITARY ADENOMA (prolactinoma)
- Galactorrhea + headache + loss of peripheral vision

Malignant cause:
- bloody or clear (serous)
- unilateral
- spontaneous
- affects a single duct

11

Benign, glands are compressed into cords of epithelium

Sharply circumscribed, spherical nodule, movable

Fibroadenoma

12

Most common breast cancer

Malignant, arranged in cell nests, cords,, anastomosing masses

Jagged-edged, fixed mass

If (+) estrogen/progesterone receptor --> good prognosis

If (+) c-erb B2 oncoprotein --> poor prognosis

Mutation of BRCA 1 (a tumor suppressor gene) --> very high lifetime risk of breast & ovarian cancer

Infiltrating ductal carcinoma

13

Surgical procedures for breast cancer

Lumpectomy
- primary lesion with clear margins

Axillary lymphadenectomy
- Level 1 LN (lateral to Pectoralis minor)
- Level II LN (behind Pectoralis minor)
- Level III LN (medial to Pectoralis minor) usually are NOT removed

Simple mastectomy
- all breast tissue, nipple-areolar complex
- preserve the long thoracic nerve --> motor to serratus anterior muscle (if damaged --> winged scapula)

Modified radical mastectomy
- skin, entire breast, Pectoralis minor & Axillary contents

Halsted radical mastectomy
- skin, entire breast, Pectoralis minor, PECTORALIS major & Axillary contents

Decks in Anatomy (TOPNOTCH SUPPLEMENT) Class (71):