Normal Anatomy of the Breast

Question 1

The breast is present in what form in males?

Answer 1

Rudimentary form

Question 2

The breast is a site of malignant change in how many women?

Answer 2

1 in 10

Question 3

What are the functions of the breast?

Answer 3

Secondary sexual feature in females

Source of nutrition for the neonate

Question 4

What kind of glands are breasts developed from?

Answer 4

Modified and highly specialised sweat glands

Question 5

What is the breasts special capsule or sheath?

Answer 5

It doesnt have one

Question 6

Breast size and shape depends on?

Answer 6

Genetic, racial, and dietary factors

Question 7

The breast extends vertically between which ribs?

Answer 7

2nd or 3rd rib to 6th rib

Question 8

The breast extends transverselly from where to where?

Answer 8

Sternal edge to midaxillary line

Question 9

What is the location of the axillary tail (of spence) or process?

Answer 9

A small part of the breast that extends towards the axillary fossa

Question 10

What fascia does the breast lie on?

Answer 10

Deep pectoral fascia

2/3rd of the breast rests on the pectoral fascia covering pectoralis major

1/3rd of the breast rests on the fascia covering serratus anterior

Question 11

What bursa (space) helps the breast with some degree of movement?

Answer 11

Retromammary space (bursa)

Question 12

The breast is firmly attached to the dermis by what?

What does this help do?

Answer 12

Suspensory ligament of cooper

Help support the lobules of the gland

Question 13

What is the nipple and areola?

Answer 13

Nipple - prominence of the breast

Areola - Pigmented area around the nipple

Question 14

Each breast contains how many lobules of glandular tissue (parenchyma)?

Answer 14

15-20

Question 15

Each lobule is drained by what?

Answer 15

Lactiferous duct

opens independently on the nipple

Question 16

WHat is the dilated portion of each duct called?

Answer 16

Lactiferous sinus

Question 17

Describe the nipple:

Whats its surface like? What is it made of? Whats its position?

Answer 17

No fat or hair

Conatins collagenous dense connective tissue, elastic fibres and bands of smooth muscle

Position: variable or 4th intercostal space

Question 18

THe tips of nipples are fissured with what?

Answer 18

Lactiferous ducts opening into them

Question 19

What is the structure and function of the areola?

Answer 19

Skin covering the nipple and areola contains numerous sweat and sebaceous glands

Oily material secreted by the sebaceous glands provides a protective lubricant for nipple and areola

Question 20

What happens to the areola during pregnancy?

Answer 20

Enlarge

Question 21

For anatomical location and description of pathology (cysts and tumours) the breast is divided into 4 quadrants

Name the 4 quadrants of the breast.

Answer 21

Superolateral quadrant

Superomedial quadrant

Inferolateral quadrant

Inferomedial quadrant

Question 22

Which quadrant is the axillary tail a part of?

Answer 22

Extension of breast tissue in the superolateral quadrant

Question 23

Describe the male breast

Answer 23

Rudimentary throughout life

formed by small ducts without lobules or alveoli

Little supporting fibroadipose tissue

Temporary enlargement in newborn and during puberty

Question 24

During development of the breast mammary crests or ridges appear when?

Answer 24

During 4th week

Question 25

The mammary crests or ridges extend from where to where during development?

Answer 25

Extend from axillary region to inguinal region

Question 26

During breast development the crests usually disappear except in which region?

Answer 26

Pectoral region

Question 27

How do the lactiferous ducts and their branches develop?

Answer 27

Primary mammary buds -> secondary buds -> lactiferous ducts and their branches

Question 28

What is gynecomastia?

Answer 28

Postnatal development of rudimentary lactiferous ducts in males During mid puberty about 2/3rd of boys develop varying degrees of hyperplasia of the breasts

Question 29

What is polymastia?

Answer 29

An extra breast

Question 30

What is polythelia?

Answer 30

An extra nipple

Question 31

What athelia or amastia?

Answer 31

Absence of nipple or breast

Question 32

What is the blood supply of the breast?

Answer 32

Supplied by branches of: - Axillary artery - Internal Thoracic artery - Some intercostal arteries Thoraco acromial artery Lateral thoracic artery Internal mammary (thoracic) artery

Question 33

What nerves supply the breast and what do these convey?

Answer 33

Anterior and lateral cutaneous branches of 4-6th intercostal nerves They convey sensory fibres to the skin of the breast They also carry sympathetic fibres to the blood vessels and to the smooth muscle around the nipple

Question 34

What is the clinical significance of the lymphatic drainage of the breast?

Answer 34

Metastatic dissemination occurs primarily by the lymphatic routes Breast lymphatics branch extensively and do not contain valves

Question 35

Most lymph (more than 75%) from the lateral quadrants drains where?

Answer 35

Axillary lymph nodes

Question 36

Lymph from the medial quadrants of the breast drains where?

Answer 36

Parasternal or to opposite breast

Question 37

Some lymph from the breast drains where?

Answer 37

Directly to supraclavicular or inferior cervical nodes

Question 38

What is used to locate the sentinal node in breast cancer?

Answer 38

A radiolabelled colloid At the time of surgery, a vital blue dye is injected A combination of radioisotope and dye provides most accurate means of localising the node

Question 39

The breast soft tissue is made of lobes which contain what?

Answer 39

Network of glandular tissue consisting of branching ducts and secretory lobules in a connective tissue stroma

Question 40

What is the functional milk secretory component of the breast?

Answer 40

The terminal duct lobular unit

Question 41

What is the difference between the connective tissue stroma that surrounds the lobules and the intralobular tissue?

Answer 41

The connective tissue stroma that surrounds the lobules is dense and fibrocollagenous, whereas intralobular tissue has a loose texture

Question 42

Describe the histology of the normal breast

Answer 42

Extensive branching duct system Surrounded by dense fibrous interlobular tissue and adipose tissue Ducts and acini are lined by two layers of cells - Luminal epithelial cells - Myoepithelial cells

Question 43

Describe the prepuberty breast

Answer 43

Neonatal breast contain lactiferous ducts but no alveoli Until puberty, little branching of the ducts occurs Slight breast enlargement reflects the growth of fibrous stroma and fat

Question 44

Describe the puberty breast

Answer 44

Branching of lactiferous ducts Solid, spheroidal masses of granular polyhedral cells (alveoli) Accumulation of lipids in the adipocytes

Question 45

Describe the post menopausal breast

Answer 45

Progressive atrophy of lobules and ducts Fatty replacement of glandular tissue

Question 46

Describe the histology of the breast during pregnancy

Answer 46

Enlarged lobules Acini are dilated Epithelium vary from cuboidal to low columnar

Question 47

What is colostrum?

Answer 47

Protein rich fluid, available few days after birth Rich in maternal antibodies

Question 48

Describe the histology of the lactating breast

Answer 48

Acini distended with milk Thin septa between the lobules At high magnification -Acini with eosinophilic material containing clear vacuoles Milk production - Suckling - Neurohormonal reflex - Prolactin and oxytocin

Question 49

What are the daignostic methods for the breast?

Answer 49

Imaging: - Mammography - Ultrasound Fine needle spiration cytology Core biopsy

Question 50

What is the epidaemiology of breast cancer?

Answer 50

20% of all cancer in women Commonest cause of death in women in 35-55 age group In UK, any woman has a 1 in 9 chance of developing breast cancer

Question 51

Name the 4 types of benign breast tumours

Answer 51

Fibroadenomas Duct papillomas Adenomas Connective tissue tumours

Question 52

What is Paget's disease of the nipple?

Answer 52

Erosion of the nipple resembling eczema Association with ductal or invasive carcinoma