The breast is a modified sweat gland that appears in the 6th week of pregnancy. It has borders from the 2nd to 6th ribs and from the sternum to the mid-axillary line. Its main components are epithelium and supporting tissue. The breast structure includes acini, collecting ducts, lobules, terminal ducts, and lactiferous ducts that drain into the nipple. Tubercles of Montgomery are sebaceous glands that lubricate the breast during pregnancy and lactation. Fat is located subareolarly and subcutaneously around the nipple. The breast ductal histology changes from columnar to cuboidal to squamous moving from proximal to distal. The arterial supply

1. Breast anatomy questions:
1) What type of modified gland is the breast? Modified sweat gland
2) Which week of pregnancy do they appear? 6th
week
3) What are the borders of the breast? From 2nd
to 6th
ribs, and from the sternum to
the mid-axillary line.
4) What are the main components of the breast? Epithelium and supporting tissue.
5) What is the structure of the breast?
 Acini (100s)  collectingduct lobule (20-40) drainsintoa terminal duct  lobe
(15-20) (collection of lobule)  drains into lactiferous duct at nipple.
6) What are tubercles of montogomry? Sebaceous glands that lubricate the breast in
pregnancy and lactation.
7) Where is fat located around the nipple? Subareolar and subcutaneous fat.
8) What is the subareolar area made of? Smooth muscle fibers.
9) What is the breast ductal histology? From proximal to distal: columnar, cuboidal,
then squamous.
10) What is the arterial supply of the breast?
a. internal thoracic artery
b. axillary artery gives lateral thoracic artery and thoracoacromial arteries.
c. intercostals arteries: lateral branches of posterior intercostals
11) What is the venous drainage of the breast?
a. superficial veins that cross the midline
b. deepveinsintothe azygosand intercostals:communicate withthe vertebral veins
in the space of batson.
12) What is the nerve supply to the breast?
a. medial and lateral branches of the intercostals nerves.
13) What is the lymphatic drainage of the breast? (levels of berg)
a. level 1: lateral and lower pect. Minor: anterior, posterior and lateral
b. level 2: behind pect. Minor: central
c. level 3: above and medial to pect. Minor: apical (halsted)
14) What otherlymphnodesare there? Supraclavicular and internal mammary (2nd
and
3rd
intercostals spaces)
15) What is another name for the lateral LN? axillary vein
16) What is another name for the posterior LN? subscapular
17) What is another name for the apical LN? subclavicular

2. 18) What is the name of the interpectoral LN? rotter's LN
19) Which one crosses the diaphragm or the midline? LN cross the diaphragm (might
presentwithascites,orspine mets).veinscrossthe midline (dilatationof superficial
veins in breast CA)
20) Where do breast LN drain in? thoracic duct (lt) and jugulosubclavian (rt)
21) Involvement of which LN group causes lymphedema? Apical (the most aggressive)
22) What is the only part of the breast under the deep fascia? Tail of Spence.
23) What forms the suspensory ligament of the axilla? Deep fascia of pect. Major.
24) The internal thoracic artery is a branch of which artery? Subclavian artery.
25) Which nerves might be injured in breast surgery?
a. long thoracic: serratus anterior  winged scapula
b. thoracodorsal: lattismus dorsi  flap
c. anteriorthoracic:medial and lateral are reversed  supply the pectoralis major.
d. intercostobrachial mostcommonto be injured. Transverse sensation to axilla.
_________________________________________________________________________
Benign breast diseases:
They usually appear in the teenager period. But most patients are in their 30s-40s.
Malignant diseases occur more frequently after menopause.
1) What is the most common cause of ectopic breast tissue? Axilla.
2) Is there a cancer riskinectopicbreasttissue? Yes, but it's rare. Note that any breast
problem might occur in them.
3) What is the difference between perpural and non-perpural mastitis?
Perpural occursin lactatingwomen;highfever, staph,erosions,periductal,localized.
Non-perpural is caused by strep, no erosions, the lesion is intraductal, diffuse.
4) Why is non-perpural mastitis concerning? Because ddx inflammatory carcinoma.
5) Name 5 inflammatorybreastdisorders?Mastitis, abscess, fat necrosis, granulomas,
duct ectasia (periductal mastitis).
6) What are the causes of breast granulomas? Foreign body, vasculitis, TB, sarcoid.
7) What is the most common cause of foreign body granuloma? Silicon.
8) What is zuskas disease? Triad of recurrent abscesses, thick discharge, and fistula.
9) Note: whenever there's an abscess, think of a fistula!
10) What is the cause of zuskas disease? Smoking!!
11) What is the presentation of fat necrosis? Hard irregular mass with gritty sensation.

3. 12) What is the clinical presentation of duct ectasia?
Non cyclical Subareolar pain/mass + bilateral nipple discharge from many ducts.
HX of abscess, fistula, nipple retraction, smoking.
13) What isthe treatmentof ductectasia?Urban procedure.(total excision of the ducts
with nipple eversion).
14) Would you take a biopsy from a fat necrosis? Not if it's big or low CA suspicion.
_______________________________________________________________________
1) What are fibrocysticchanges: it’sanabberance of normal development rather than
a disease. Present in 90% of women on histology.
2) What is the presentation of fibrocystic diseases? NODULARITY/pain/mass.
3) How are fibrocysticchanges classified? Proliferative (with and without atypia), and
non-proliferative.
4) What are non-proliferativechanges? Cysts/ductectasia/fibroadenoma/calcification.
5) What are proliferative without atypia? Sclerosing adenosis/radial scar/papilloma
6) What are proliferative with atypia? Atypical lobular/ductal hyperplasia
7) Which fibrocystic changes have CA risk? proliferative with(out) atypia
8) What is the pathophysiology of cysts? Destruction of lobules and terminal ducts.
9) whatare the main twotypesof cysts that influence management?Simplecystneeds
drainage, and complex cyst needs surgical excision.