Flashcards in Breast_BTED Part 5 Deck (84):
When does puberty happen?
8 - 15 years of age
What happens during pubertal development?
Glandular development and increased fat deposition
What factors are pubertal developments affected by?
How many stages are there to the tanner stages?
What happens during stage 1 of the Tanner Stages?
Preadolescent juvenile breast with elevated papilla and small flat areola
What happens during stage 2 of the Tanner Stages?
The breast bud forms under the influence of hormonal stimulation.
The papilla and areola elevate a a small mound, and the areolar diameter increases.
What happens during stage 3 of the Tanner Stages?
Continued enlargement of the breast bud further elevates the papilla.
The areola continues to enlarge, no separation of breast contours is noted.
What happens during stage 4 of the Tanner Stages?
The areola and papilla separate from the contour of the breast to form a secondary mound.
What happens during stage 5 of the Tanner Stages?
Mature areolar mound recedes into the general contour of the breast, papilla continues to project.
When does the thickened epidermis at the mammary ridge develop?
What is the position of the breast?
At the anterior chest wall
Ribs 2 - 6
What does the breast look like?
Circular base with an axillary process or tail (of Spence)
What muscles are located around the breast?
What are the boundaries of the breast?
Where is the superior border of the breast located?
It is the inferior border of the clavicle
Where is the lateral border of the breast located?
It is the anterior border of the Latissimus dorsi muscle
Where is the medial border of the breast located?
It is the lateral Sternal border
Where is the inferior border of the breast located?
It is at the inframammary fold
Why is the nipple not a useful landmark?
What is the retromammary space consisted of?
Loose areolar tissue
Contains lymphatics and small vessels
What does the retromammary space do?
Allows movement of the breast on the chest wall
Where does the retromammary space lie?
Lies between the superficial and deep (pectoral) fascia
What is the fascia related to the breast?
What is the superior fascia?
Fatty layer surrounds the breast
Which fascia is the superior fascia continuous with?
Camper's and Scarpa's fascia of the abdominal wall
Where is the Superior fascia continuous with the Camper's and Scarpa's fascia?
At the inframammary fold
What does the Camper's fascia look like?
Thick and fatty
What does the Scarpa's fascia look like?
Thin and membranous
In the thoracic wall, there are two fascia, what are they?
- Pectoral (deep) fascia
- Clavipectoral fascia
What does the pectoral (deep) fascia look like
What does the pectoral fascia cover?
Cover the Pectoralis major
What is the pectoral fascia attached to?
Sternum and Clavicle
Deep to retromammary space
What is the pectoral fascia continuous with?
Deep fascia of the abdomen
Where is the clavipectoral fascia?
Deep to the pectoralis major
What does the clavipectoral fascia envelopes?
Where is the clavicpectoral fascia suspended from?
What does the clavipectoral fascia do?
Envelops axillary vessel
What is the four breast quadrants?
What are the basic tissues of the breast?
1) Glandular tissue
2) Ductal tissue
3) Connective tissue
4) Adipose tissue
What does the glandular tissue consist of?
What does the ductal tissue consist of?
What does the connective tissue of the breast consist of?
What does the adipose tissue of the breast consist of?
What does the nipple look like?
Circularly arranged smooth muscle
What are the properties of the nipple?
1) Opening of 15 - 20 lactiferous ducts, each arising from a lobule
2) Central raised bud - Mammary papilla (nipple)
What does the areola contain?
Contains montgomery's tubercles
What does the areola look like?
Circula pigmented area but pigmentation varies
What is the montgomery's tubercle?
Areolar glands which are sebaceous glands
How many montgomery's tubercle are there?
4 - 28 per nipple
What does the montgomery's tubercles do?
1) Produce protective lipid based fluid, this is for protection and lubrication
2) Olfactory appetite stimulus for the newborn
What happens when the olfactory appetite is stimulated?
The montgomery's tubercle becomes firm
What is the innervation of the breast?
Anterior and lateral cutaneous branches of the 4th to 6th intercostal nerves.
Where does the anterior and lateral cutaneous branches pass through?
Through the deep pectoral fascia to the skin
Where does the anterior and lateral cutaneous branches get to?
Sensory fibres to the skin
Sympathetic fibres to blood vessels of breasts and the overlying skin and nipple
What is the arterial supply for the breast?
1) Lateral Thoracic artery
2) Lateral Mammary branches
3) Lateral mammary branches of lateral cutaneous branches of posterior intercostal artery
4) Internal Thoracic (mammary) artery
5) Medial (internal) mammary branches
What category is the internal thoracic artery?
What is under the Axillary artery category?
Lateral Thoracic artery
What category is the intercostal artery?
Where is the thoracoacromial artery located?
Branch of part 1
Where is the thoracoacromial artery and the lateral thoracic artery lead to?
To the lateral breast
Where is the lateral thoracic artery located?
Branch of part 2
What is with the thoracoacromial artery and the lateral thoracic artery?
What are two veins that corresponds with the arteries in the breast?
Internal Thoracic Vein
What are the veins responsible for?
What do the axillary lymph nodes of the breast consist of?
- Apical Lymph Nodes
- Humeral (Lateral) Lymph Nodes
- Central Lymph Nodes
- Pectoral (Anterior) Lymph Nodes
- Subscapular (Posterior) Lymph Nodes
Which part of the lymphatic drainage system leads to the left breast from the right breast?
Subareolar lymphatic plexus
What do lymphatic drainage systems do?
Play a role in metastases
What is the pathway of lymphatic drainage at the breast?
Gland -> Nipple -> Areola -> Subareolar lymphatic plexus
75% (mainly supero-lateral quadrant) drain to which category of axillary lymph nodes?
Pectoral - anterior
Where does the remainder drain to (which category of the) axillary lymph nodes?
Inferior Deep Cervical Nodes
Where is the medial part of the lymphatic drainage?
Parasternal or opposite beast
Where is the inferior part of the lymphatic drainage?
Inferior phrenic (abdominal)
What is used as the landmark of the lymph nodes location of the breast?
What happens during Sentinel Node Biospy
- Flow of lymph is directional.
1) Inject a radioactive substance or dye to locate near the tutor to locate the position of the sentinel lymph node
2) Use a probe to detect radioactivity to find the sentinel node
3) Once the sentinel node is located, surgeon removes it
4) Sentinel node is then checked to see if it is cancerous
5) if there is, the surgeon may then remove additional lymph nodes
What is a cause for concern for women in regards to their breast?
- Lump (may not be seen, but might be felt)
- Skin texture (e.g. dimpling or puckering)
- Appearance or direction of nipple
- Nipple discharge
- Rash or crusting
What does nipple discharge mean?
Most commonly benign
What is a red flag for nipple discharge?
If purulent, yellow/straw coloured, pink or bloody
What may be the cause of skin changes that can happen to the breast?
- Inflammatory cancer of the breast
- Pagets disease of the nipple (which is cancerous)
- Cutaneous Lymphoedema
What causes secondary lymphoedema?
Impaired lymph flow from upper limb to axilla
What are the signs of lymphoedema?
What is the treatment for lymphoedema?
What is the Sentinel Node biopsy for?
If the cancer has spread to the sentinel lymph node (very first draining lymph node), then it may have spread to other parts of the body. If it hasn't, then it's probably localised.
How many percentage of each breast quadrant contains carcinomas?
Superior lateral: 60%
Superior medial: 15%
Inferior lateral: 10%
Inferior medial: 5%