This document discusses breast anatomy and various breast conditions. It describes the basic anatomy of the female breast including lobes, ducts, and other structures. It then covers many benign and malignant breast conditions such as fibroadenomas, cysts, hyperplasia, mastitis, fibrocystic disease, fat necrosis, and various types of breast cancer. It provides brief descriptions of each condition and their typical presentations. The document also discusses breast imaging tests and biopsies that are used in evaluation of breast abnormalities.

1. The Breast
Dr Y Phiri, MMed(Surg)
LAMU

3. Breast Anatomy
•The adult female breast is located within the superficial
fascia of the anterior chest wall.
•The base of the breast extends from the 2nd rib above to
the 6th or 7th rib below, and from the sternal border
medially to the midaxillary line laterally.
•Two-thirds of the base of the breast lies anterior to the
pectoralis major muscle; the remainder lies anterior to the
serratus anterior muscle. A small part may lie over the
aponeurosis of the external oblique muscle

6. • Women’s breasts are made of specialized tissue that produces
milk (glandular tissue - parenchyma) as well as fatty tissue
(stroma)
• Modified sweat gland found in the subcutaneous layer of the skin
• The milk-producing part of the breast is organized into 15 to 20
sections, called lobes.
• Within each lobe are smaller structures, called lobules, where milk
is produced.

7. Breast Anatomy
•The milk travels through a network of tiny tubes called
ducts. The ducts connect and come together into larger
ducts, which eventually exit the skin in the nipple. The
dark area of skin surrounding the nipple is called the
areola.
•Connective tissue and ligaments (stroma) provide
support to the breast and give it its shape.
•The breast also contains nerves, blood vessels, lymph
vessels, and lymph nodes.

10. Anatomy of the Breast

23. Breast Conditions
Simple breast cyst:
• A benign (noncancerous), fluid-filled sac that commonly
develops in women in their 30s or 40s.
• Breast cysts may cause tenderness and may be drained.

26. Breast Conditions - fibroadenoma
• A very common noncancerous solid tumor of the breast.
• Fibroadenomas develop from the lobules. The glandular tissue
and ducts grow over the lobule to form a solid lump.
• A typical fibroadenoma creates a painless, mobile lump in the
breast (breast mouse) and most commonly occurs in women in
their 20s or 30s.
• Fibroadenomas are partially hormone-related and frequently
regress after menopause.

28. Fibroadenoma

29. Breast Conditions – fibrocystic disease
• Fibrocystic breast disease, is a common condition also commonly called
fibrocystic breasts, is a benign (noncancerous) condition in which may
present with uncomfortable breast lumps which may change in size
throughout the menstrual cycle.
• Breast tissue changes in response to ovarian hormones. Fibrocystic breasts,
have more pronounced changes in response to these hormones.
• This can result in swelling and tender or painful breast lumps.
• Symptoms are most common just before or during menstrual period.
• The breast lumps are caused by cysts and swelling of the breast lobules, and
an excess growth of fibrous tissue.

32. Hyperplasia of the Breast
• Hyperplasia and atypical hyperplasia of the breast tissue are benign (not
cancer) breast conditions.
• They don’t cause any symptoms or pain and are usually found by chance.
• The increase in number of the epithelial cells of the lobules and ducts is
called hyperplasia.
• Hyperplasia can occur in the ducts (ductal hyperplasia) or the lobules
(lobular hyperplasia). It can be graded as mild, moderate or florid (more
extensive), according to how the cells look under the microscope.
• Hyperplasia usually develops naturally as the breast changes with age. It can
affect women of any age, but is more common in women over 35.

33. Atypical hyperplasia of the breast:
• Atypical hyperplasia is also benign.
• Abnormal-appearing cells (unusual pattern or shape)
multiplying either in the breast ducts (atypical ductal
hyperplasia) or lobules (atypical lobular hyperplasia),
• sometimes discovered by a breast biopsy.
• Having atypical ductal hyperplasia has been shown to
slightly increase the risk of developing breast cancer in
the future.

34. Breast Conditions
• Intraductal papilloma: A noncancerous, wart-like breast mass
that grows inside the breast ducts. Intraductal papillomas may be
felt as a lump or cause clear or bloody fluid to leak from the
nipple.
• Adenosis of the breast: A noncancerous enlargement of the breast
lobules. Adenosis can look like breast cancer on mammograms, so
a biopsy may be needed to rule out breast cancer.

35. Phyllodes tumour of the Breast
• A rare, usually large, rapidly growing breast tumor that looks like a
fibroadenoma on ultrasound.
• Phyllodes tumors may be benign or malignant and most commonly develop
in women in their 40s.
• Histologically, these tumors are biphasic lesions consisting of a stromal and
epithelial components
• The 2003 WHO tumor classification proposed the classification of phyllodes
tumors into three categories (benign, borderline and malignant) according to
the degree of cellular atypia, mitotic activity, characteristics of the tumor
margins and the presence of stromal growth

37. Breast Conditions – Fat Necrosis
• Fat necrosis is a condition that occurs when a person
experiences an injury to an area of fatty tissue.
• In response to an injury in the fatty part of the breast, a
lump of scar tissue may develop.
• This can result in the fat being replaced with the oily
contents of fat cells.
• This mass can seem like breast cancer on examination or
in mammograms.

40. Breast Conditions - Mastitis
• Inflammation of the breast, causing redness, pain,
warmth, and swelling.
• Breastfeeding mothers are at higher risk for mastitis,
which is usually the result of infection.

41. Breast Conditions
• Breast calcifications: Calcium deposits in the breast are a
common finding on mammograms. The pattern of
calcium might suggest cancer, leading to further tests or a
biopsy.

42. Gynecomastia
• Overdevelopment of male breasts.
• Gynecomastia can affect newborns, boys, and men.
• Caused by an imbalance of the hormones estrogen and
testosterone.
• Gynecomastia can affect one or both breasts, sometimes
unevenly.

43. Gynecomastia

44. Gynecomastia

45. Breast Tumour (Benign)
Classification:
• epithelial:
– intraduct papilloma
– adenoma i.e. an excess of ductules
• mesenchymal:
– lipoma
– fibroma
• mixed:
– fibroadenomas
– Phyllodes tumours
• Note fibroadenomas though included here are not true neoplasms. They originate from a whole group
of cells and are so common that they are best considered as abberations of normal development rather
than neoplastic in origin.

46. Breast Conditions
Breast cancer: - malignant cells multiplying abnormally in the
breast, eventually spreading to the rest of the body if untreated.
Breast cancer occurs almost exclusively in women, although men
can be affected.
• Ductal carcinoma in situ (DCIS): Breast cancer in the duct cells
that has not invaded deeper or spread through the body. Women
diagnosed with DCIS have a high likelihood of being cured.
• Lobular carcinoma in situ (LCIS): Although called a carcinoma
LCIS, which occurs in the milk-producing lobule cells, does not
invade or spread and is not a true cancer. However, women with
LCIS have an increased likelihood of developing invasive breast
cancer in the future.

47. Breast Conditions
• Invasive ductal carcinoma: Breast cancer that begins in the duct
cells but then invades deeper into the breast, carrying the
potential of spreading to the rest of the body (metastasizing).
Invasive ductal carcinoma is the most common type of invasive
breast cancer.
• Invasive lobular carcinoma: Breast cancer that begins in the milk-
producing lobule cells, but then invades deeper into the breast,
carrying the potential of spreading to the rest of the body
(metastasizing). Invasive lobular carcinoma is an uncommon form
of breast cancer.

51. Paget’s Disease of the Breast
•Paget's disease of the nipple is a rare form of breast
cancer in which cancer cells collect in or around the
nipple.
•The cancer usually affects the ducts of the nipple first
(small milk-carrying tubes), then spreads to the nipple
surface and the areola (the dark circle of skin around the
nipple

53. Breast Symptomatology
Signs of breast cancer include
•lump,
•bloody nipple discharge
•skin changes.

56. Breast Investigations
• Physical Exam: By examining the breast and nearby
underarm tissue for lumps, skin changes, nipple
discharge, or lymph nodes, a doctor can find any
abnormalities in the breast.
• Characteristics of breast lumps, such as size, shape,
texture, are usually noted.

69. Breast Investigations
• Mammogram: A mammography machine compresses each breast and
takes low-dose X-rays. Mammograms are the most commonly used test
for early detection, or screening, for breast cancer.
• Digital mammogram: A mammogram that stores the electronic images
of each breast in a digital, computer-readable format. This is different
than a standard film mammogram, where the images are created
directly on film.

70. Breast Investigations
• Breast ultrasound: A device placed on the skin bounces high-frequency
sound waves through breast tissue. The signals are converted into
pictures on a video screen, allowing structures inside the body to be
seen. Breast ultrasound can often determine whether a lump is made of
fluid (cyst) or solid material.
• Breast magnetic resonance imaging (MRI scan): An MRI scanner uses a
high-powered magnet and a computer to create detailed images of the
breast and surrounding structures. Breast MRIs can add additional
information to mammograms and are recommended only in specific
cases.

71. Breast Investigations
• Breast biopsy: A small sample of tissue is taken from an
abnormal-appearing area of the breast that is seen on physical
exam, mammogram, or other imaging study and examined for
cancer cells. A biopsy may be done with a needle or with minor
surgery.
• Fine needle aspiration (FNA) breast biopsy: a thin needle is
inserted into an abnormal-appearing area of the breast and draws
out (aspirates) fluid and breast tissue. This is the simplest type of
biopsy and is mostly used for lumps that can be easily felt in the
breast.

72. Breast Investigations
• Core needle breast biopsy: A larger, hollow needle is inserted into
a breast mass, and a tube-shaped piece of breast tissue (core) is
drawn out. A core biopsy provides more breast tissue for
evaluation than an FNA biopsy.
• Surgical biopsy: taking out part or all of a breast lump to check for
cancer.
• Sentinel node biopsy: A type of biopsy in which you locate and
remove the lymph node(s) that the primary tumor is most likely
to spread. This type of biopsy helps determine the likelihood that
a cancer has spread.

74. Breast Investigations
• Ductogram (galactogram): A thin plastic tube is inserted into a duct in the
nipple, and contrast dye is injected into the breast to help the health care
provider view the breast ducts. A ductogram can help identify the cause of
bloody nipple discharge.
• Nipple smear (nipple discharge exam): A sample of bloody or abnormal fluid
leaked from the nipple is examined under the microscope to see if any cancer
cells are present.
• Ductal lavage: Sterile water is injected into the nipple ducts, then collected
and examined for cancer cells. This experimental test is only used in women
known to be at high risk for breast cancer.

76. Breast Treatment Modalities
• Lumpectomy: Surgery to remove a breast lump (which may be
breast cancer) and some normal tissue surrounding it. Many early
breast cancers are surgically removed by lumpectomy rather than
mastectomy.
• Mastectomy: Surgery to remove the entire breast. In a radical
mastectomy, some of the chest wall muscle and surrounding
lymph nodes are also removed.
• Axillary lymph node dissection: Surgical removal of armpit
lymph nodes, which may be affected by breast cancer. These
lymph nodes are the gateway for cancer cells to spread to the rest
of the body.

77. Breast Treatment Modalities
• Breast reconstruction: When an entire breast or large amounts of
breast tissue are removed, such as after a mastectomy, the breast
can be reconstructed using either an implant or tissue from your
own body.
• Breast augmentation: Surgery to increase the size or improve the
shape of the breasts, using artificial implants.
• Breast reduction: Surgery to reduce the size of breasts. In women,
this is often done to relieve neck or back pain from exceptionally
large breasts. Men may also seek breast reduction for
gynecomastia.