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