Breast Anatomy

• Surface breast anatomy

  A) Sternal Notch

  B) Sternum

  C) Inframammary fold

  D) Areola

  E) Nipple

  F) Axillary tail

  
• Breast anatomy

  A) Lobe

  B) Ductule

  C) Lactiferous sinus

  D) skin

  E) fat

  F) pectoralis minor

  G) lymph node

  
• Breast anatomy

  A) rib

  B) pectoralis major

  C) fascia

  D) suspensory ligaments

  E) Nipple

  F) Ampulla

  G) Lobule

  
• Blood supply

  • Internal thoracic artery
  • lateral thoracic and thoracoacromial branches
  • lateral mammary branches
  • mammary branches
• The veins of the breast correspond with the arteries, draining into the axillary and internal thoracic veins
• Internal thoracic artery (also known as internal mammary artery) - a branch of the subclavian artery. Medial perforators intercostal spaces 2-6.
• Lateral thoracic and thoracoacromial branches originate from the axillary artery
• Lateral mammary branches originate from the posterior intercostal arteries (derived from the aorta). they supply the lateral aspect of the breast in the 2nd, 3rd and 4th intercostal spaces
• Mammary branches originate from the anterior intercostal artery
• Nerve supply

  • nipple at 4th intercostal space in men. Variable in women. T4 nerve
  • Nerve supply T3 - 5th intercostal: sensory to skin, sympathetic to blood vessels in the breast and smooth muscle in skin and nipple
  • Supraclavicular nerves from cervical plexus to upper and lateral parts
• Embryology of the breast

  • modified sweat gland 4/40 iu from ectodermal ridge
  • axilla to medial thigh through groin - 'milk line'
  • shortly before birth the invagination everts to form a nipple
  • at puberty alveoli sprout from the ducts, fatty infiltration occurs
  • pregnancy makes alveoli enlarge and in lactation secrete milk
  • at menopause the gland atrophies
• Congenital problems

  • amastia (poland syndrome, polydactyly)
  • hypoplasia, tuberous breast
  • juvenile hypertrophy
  • accessory tissue/nipple (polythelia)
  • inverted nipples (not acute)
• Common acquired breast problems

  • breast cancer 1 in 8 (Ductal, Lobular)
  • angiosarcoma (RT induced)
  • FA/Phyliodes
  • Abscess/mastitis
  • Duct ectasia
  • Cysts
  • Hamartoma
  • PASH
  • Fat necrosis
  • B3 lesions
• Triple assessment

  • describe lump
  • size, quadrant, Skin, Nipple discharge
  • flat of hand, radial or circular, normal breast first
  • axilla - same arm 'shake hands', SCF/ICF
  • Imaging
  • ultrasound
  • MRI
  • Biopsy
  • histology - core or punch
  • cytology FNA or nipple smear
• Treatment of breast cancer

  • usually surgery first - try to preserve breast
  • mastectomy - consider reconstruction
  • chemotherapy
  • radiotherapy
  • immunotherapy
  • anti-her2 treatments
  • endocrine therapy
  • bisphosphonates