The breast

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Anatomy of breast

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  • 4. Vascular Supply to Breast (39)
  • 6. Lymph Vessels of Mammary Glands (41)
  • The breast

    1. 1. THE BREAST
    2. 2. I. Introduction/General Information A. Embryologically: belong to integument B. Functionally: part of reproductive system 1. Respond to sexual stimulation 2. Feed babies
    3. 3. Breast, continued … C. Modified apocrine sweat glands - apex of cell becomes part of secretion and breaks off D. Present in males and females
    4. 4. II. Anatomy A. Position and Attachment 1. 2. 3. 4. 5. Lateral aspect of pectoral region Located between ribs 3 and 6/7 Extend form sternum to axilla Surrounded by superficial fascia Rest on deep fascia
    5. 5. Breast Anatomy
    6. 6. Position & attachment, continued …. 6. Fixed to skin & underlying fascia by fibrous C.T. bands a. Cooper’s (Suspensory) Ligaments b. Ligaments may retract when breast tumors are present
    7. 7. Cooper’s Suspensory Ligaments
    8. 8. Position & attachment, continued … 6. Left breast is usually slightly larger 7. Base is circular, either flattened or concave 8. Separated from pectoralis major muscle by fascia, retromammary space
    9. 9. Retromammary Space Retromammary Space
    10. 10. Anatomy, continued … B. Structure 1. Outer surface convex, skin covered 2. Nipple: a. At fourth intercostal space b. Small conical/cylindrical prominence below center
    11. 11. Nipple location 4th intercostal space
    12. 12. Structure, continued … c. Surrounded by areola: pigmented ring of skin d. Thin skinned region lacking hair, sweat glands e. Contains areolar glands
    13. 13. Structure, continued … 3. Areola: contains dark pigment that intensifies with pregnancy a. Circular and radial smooth muscle fibers b. Cause nipple erection
    14. 14. Areola
    15. 15. Structure, continued … 4. Each breast consists of ~ 20 lobes of secretory tissue a. Each lobe has one lactiferous duct b. Lobes (and ducts) arranged radially c. Embedded in connective tissue & adipose of superficial fascia d. Lobes composed of lobules e. Lobules comprise alveoli
    16. 16. Lobes and Lobules
    17. 17. Structure, continued … 5. Excretory (lactiferous) ducts converge toward areola a. Form ampullae (collection sites of lactiferous sinuses) b. Ducts become contracted at base of nipple
    18. 18. Excretory (lactiferous) ducts
    19. 19. Structure, continued … 6. Secretory epithelium a. Changes with hormonal signals b. Onset of menstruation c. Pregnancy (glands begin to enlarge at 2nd month) d. After birth, 1st secretion is colostrom (contain antibodies)
    20. 20. Structure, continued … 7. “Tail of Spence” = axillary tail a. prolongation of upper, outer quadrant in axillary direction b. Passes under axillary fascia c. May be mistaken for axillary lymph nodes
    21. 21. “Tail of Spence” Axillary Tail
    22. 22. Structure, continued … 8. Fatty Tissue: surrounds surface, fills spaces between lobes a. Determines form & size of breast b. No fatty deposit under nipple & areola
    23. 23. Breast: Fatty Tissue
    24. 24. Structure, continued … C. Vessels & nerves 1. Arteries: derived from thoracic branches of three pairs of arteries a. Axillary arteries 1) continuous with subclavian a. 2) gives rise to external mammary ( = lateral thoracic) artery
    25. 25. Vessels & Nerves, continued … b. Internal mammary (thoracic) arteries 1) first descending branch of subclavian artery 2) supply intercostal spaces & breast 3) used for coronary bypass surgery c. Intercostal arteries: 1) numerous branches from internal & external mammary arteries 2) supply intercostal spaces & breast
    26. 26. Arterial Supply to the Breast Subclavian a. Axillary a. External mammary (thoracic) a. Internal mammary (thoracic) a.
    27. 27. Vessels & Nerves, continued … 2. Veins: a. form a ring around the base of the nipple (“circulus venosus”) b. Large veins pass from circulus venosus to circumference of mammary gland, then to c. External mammary v to axillary v or d. Internal mammary v to subclavian v
    28. 28. Veins draining the Breast Subclavian vein External mammary vein
    29. 29. Breast Anatomy, con’t… 3. Innervation: derived from: a. anterior & lateral cutaneous nerves of thorax b. spinal segments T3 – T6
    30. 30. Structure, continued … 4. Lymphatics: clinically significant!  a. Glandular lymphatics drain into anterior axillary (pectoral) nodes central axillary nodes  apical nodes  deep cervical nodes  subclavicular (subclavian) nodes b. Medial quadrants drain into parasternal nodes
    31. 31. Lymph Nodes of the Breast Subclavian nodes Axillary nodes Lateral pectoral nodes Parasternal nodes
    32. 32. Lymphatics, continued … c. Superficial regions of skin, areola, nipples: -form large channels & drain into pectoral nodes d. NOTE: axillary nodes also drain lymph from arm
    33. 33. Lymph Nodes and Lymph Drainage Axillary Nodes
    34. 34. Routes of Metastasis From medial lymphatics to parasternal nodes Then to mediastinal nodes Across the sternum in lymphatics to opposite side via cross-mammary pathways Then to contralateral breast From subdiaphragmatic lymphatics to nodes in abdomen Then to liver, ovaries, peritoneum
    35. 35. Major Routes of Metastasis Channels to Contralateral Breast Axillary Lymph Channels Subdiaphragmatic Lymph Channels
    36. 36. Structure, continued … D. Anomalies 1. Inverted nipple: congenital or due to cancer 2. Ectopic nipple: a. “polythelia” or “hyperthelia” b. additional nipples along milk line 3. Amastia 4. Micromastia
    37. 37. Anomalies, continued … 5. Macromastia 6. Gynecomastia a. breast development of male in areolar region b. noted in males who smoke marijuana at puberty
    38. 38. III. Diseases of the Breast A. Most are readily detectable B. Etiology unknown, influencing factors 1. Sex 2. Heredity
    39. 39. Diseases of the breast, continued … 3. Endocrine influence a. Menstruation – tenderness from fluid engorgement b. Post-menopause 1) decrease of fibro-cystic disease 2) increase in cancer c. Pregnancy
    40. 40. Diseases of the Breast, continued … C. General symptoms & signs 1. Nipple discharge a. always significant if not pregnant. b. May be due to benign pituitary tumor. 2. Local pain, tenderness 3. Duration of lesion 4. Size, rate of growth
    41. 41. Symptoms & Signs, continued … 5. Retraction sign: “dimpling” involving skin, nipple or areola 6. Mobility of mass a. Benign = movable 1) not attached 2) not invasive b. Malignant = attached 1)May grow into bone
    42. 42. Symptoms & Signs, continued … 7. Consistency of mass a. Cysts = fluctuant; compressible b. Fibroadenoma = rubbery c. Carcinoma = firm, hard (like gravel) 8. Axillary area lymph node enlargement
    43. 43. D. Benign breast conditions 1. Infection = usually during or after lactation a. Recurrent, subareolar abscess b. TB of the breast 2. Trauma = contusion 3. Hypertrophy = seen in either sex at adolescence a. Gynecomastia = in males
    44. 44. Hypertrophy, continued … b. Other causes 1) testicular or pituitary tumor 2) cirrhosis 3) hypogonadism = not enough testosterone 4) estrogen administration for prostate cancer
    45. 45. Benign Conditions, continued 4. Tumors & cysts a. Fibroadenoma = most common benign breast tumor
    46. 46. Tumors and Cysts, con’t… b. Breast Cyst 1. Benign 2. May be aspirated if large
    47. 47. Benign conditions, continued … c. Fibrocystic breast changes 1) 20%+ of premenopausal women 2) discomfort, cysts 3) treatment rarely required 4) More likely to not detect a developing cancer
    48. 48. Tumors & cysts, continued …. d. Intraductal papilloma - may produce “chocolate” or bloody discharge from nipple e. Lipoma: common - fatty tumors
    49. 49. E. Carcinoma of the breast 1. Most common malignant tumor among women 2. 1/8 of women will develop breast cancer a. 1/6 in Orange County b. 1/5 in San Francisco 3. Generally no discomfort
    50. 50. Breast cancer originates in breast tissue and Breast cancer originates in breast tissue and arises from the ductal tissue of the breast and, arises from the ductal tissue of the breast and, less commonly, the lobulartissue. There are less commonly, the lobulartissue. There are several forms of breast cancer based, in part, several forms of breast cancer based, in part, on cellular and genetic characteristics, on cellular and genetic characteristics,
    51. 51. Types of Breast Cancer Types of Breast Cancer
    52. 52. hat is HER2-positive breast cancer? All cells have HER2 receptors, including healthy cells and cancer cells. In HER2positive breast cancer, tumor cells have more HER2 receptors than normal. Too much HER2 makes these cancer cells grow and divide too rapidly. NONCANCEROUS CELL
    53. 53. What is HER2-positive breast cancer? All cells have HER2 receptors, including healthy cells and cancer cells. In HER2-positive breast cancer, tumor cells have more HER2 receptors than normal. Too much HER2 makes these cancer cells grow and divide too rapidly. HER2-POSITIVE CANCER CELL Cancer treatments called HER2-targeted therapies have been developed to target the HER2 receptor. PERJETA is one of those HER2-targeted therapies.
    54. 54. Progression to Breast Cancer
    55. 55. Carcinoma of breast, continued … 4. Physical signs: a. b. c. d. Slowly growing, painless mass May demonstrate retracted nipple May be bleeding from nipple May be distorted areola, or breast contour e. Skin dimpling in more advanced stages with retraction of Cooper’s ligaments
    56. 56. Physical signs, continued … f. Attachment of mass g. Edema of skin 1)with “orange skin” appearance (peau d’orange) 2) due to blocked lymphatics h. Enlarged axillary or deep cervical lymph nodes
    57. 57. Breast Cancer, con’t… 5. Common sites for metastasis a. Lungs & pleura b. Skeleton system (skull, vertebral column, pelvis) c. Liver 6. Atypical carcinomas a. Inflammatory carcinoma (hormonal, chemotherapy) b. Paget’s disease of the breast

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