Podcast
Questions and Answers
What role does oxytocin play during lactation?
What role does oxytocin play during lactation?
- Inhibits milk secretion
- Decreases prolactin levels
- Prevents involution of breast tissue
- Stimulates contraction of myoepithelial cells (correct)
How does breast tissue composition change after menopause?
How does breast tissue composition change after menopause?
- Increase in fibroglandular tissue
- Fat tissue decreases
- Reduction of glandular elements (correct)
- Increase in glandular tissue
What indicates higher mammographic density?
What indicates higher mammographic density?
- An increase in fibroglandular tissue (correct)
- Radiolucent appearance
- A decrease in fibroglandular tissue
- An increase in fat tissue
What is a common effect of aging on breast tissue composition?
What is a common effect of aging on breast tissue composition?
What triggers the secretion of prolactin during lactation?
What triggers the secretion of prolactin during lactation?
What is the role of the sebaceous glands in the nipple?
What is the role of the sebaceous glands in the nipple?
What stimulates the secretion of oxytocin during feeding?
What stimulates the secretion of oxytocin during feeding?
Which fascia splits into superficial and deep layers that envelop breast tissue?
Which fascia splits into superficial and deep layers that envelop breast tissue?
What forms the potential space between the pectoral fascia and the deep lamella?
What forms the potential space between the pectoral fascia and the deep lamella?
What is the visual indication of infected Montgomery glands?
What is the visual indication of infected Montgomery glands?
What occurs during the proliferation of mesoderm in the breast development process?
What occurs during the proliferation of mesoderm in the breast development process?
At birth, which of the following structures is predominantly present in the breast?
At birth, which of the following structures is predominantly present in the breast?
Which quadrant of the breast is most commonly associated with malignancies?
Which quadrant of the breast is most commonly associated with malignancies?
Which hormone primarily triggers parenchymal proliferation during the neonatal period?
Which hormone primarily triggers parenchymal proliferation during the neonatal period?
What might be required if fibrous tissue continues to keep the nipple inverted beyond puberty?
What might be required if fibrous tissue continues to keep the nipple inverted beyond puberty?
At what stage of prenatal development does the mammary line appear?
At what stage of prenatal development does the mammary line appear?
What happens to most of the mammary ridge by 9-10 weeks of intrauterine life?
What happens to most of the mammary ridge by 9-10 weeks of intrauterine life?
What is often referred to as 'Witch's milk' in neonates?
What is often referred to as 'Witch's milk' in neonates?
Which of the following statements about pre-pubertal breasts is correct?
Which of the following statements about pre-pubertal breasts is correct?
During which trimester does the surface ectodermal invagination form the mammary pit?
During which trimester does the surface ectodermal invagination form the mammary pit?
What is the main source of connective tissue and smooth muscles in the nipple's formation?
What is the main source of connective tissue and smooth muscles in the nipple's formation?
Which percentage range represents the likelihood of a neonate having an inverted nipple at birth?
Which percentage range represents the likelihood of a neonate having an inverted nipple at birth?
What happens to the nipple during puberty as mesoderm proliferates?
What happens to the nipple during puberty as mesoderm proliferates?
What develops from the ectodermal proliferation around the 4th intercostal space?
What develops from the ectodermal proliferation around the 4th intercostal space?
How many lactiferous ducts canalize during the late second trimester?
How many lactiferous ducts canalize during the late second trimester?
What typically happens to the primary and secondary mammary buds during development?
What typically happens to the primary and secondary mammary buds during development?
What is the primary drainage route of the axillary lymph nodes?
What is the primary drainage route of the axillary lymph nodes?
Which axillary node level is located below or lateral to the pectoralis minor?
Which axillary node level is located below or lateral to the pectoralis minor?
Rotter's node is situated between which two muscles?
Rotter's node is situated between which two muscles?
Which lymph node group is drained by level 1 nodes?
Which lymph node group is drained by level 1 nodes?
What defines level 2 nodes in the axillary lymphatic system?
What defines level 2 nodes in the axillary lymphatic system?
What is the most superior axillary node level?
What is the most superior axillary node level?
Which group of axillary nodes would be classified as lateral nodes?
Which group of axillary nodes would be classified as lateral nodes?
The apical nodes are positioned in relation to which structure?
The apical nodes are positioned in relation to which structure?
Which lymphatic duct receives drainage from the apical nodes?
Which lymphatic duct receives drainage from the apical nodes?
Which node serves as a critical point between the pectoralis major and minor?
Which node serves as a critical point between the pectoralis major and minor?
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Study Notes
Breast Anatomy and Development
- The breast is divided into four quadrants for systematic examination; the upper outer quadrant contains most glandular tissue, with malignancies commonly found here (up to 60% according to some studies).
- Prenatal development begins around 5-6 weeks intrauterine life (WIUL) with ectodermal thickening forming the mammary line, which extends from the axilla to the thigh region.
- Most of the mammary line disappears by 9-10 WIUL except near the 4th intercostal space (ICS), where primary and secondary mammary buds develop.
- By the late second trimester, 15-20 lactiferous ducts form through the canalization of secondary mammary buds, leading to the establishment of the mammary pit.
- The nipple develops from the mammary pit, with lactiferous ducts opening into it; at birth, only ductular structures are present without alveoli.
Postnatal Breast Changes
- During the neonatal period, some infants may have inverted nipples (5-10%); nipples typically become everted with hormonal stimulation during puberty.
- After birth, a decrease in estrogen/progesterone causes prolactin secretion, leading to breast enlargement and potential milk secretion known as "Witch’s milk," usually occurring within the first few days and resolving in about two weeks.
- Prepubertal breasts are characterized as ductular without alveoli; proliferation occurs during pregnancy and lactation.
Connective Tissue and Fasciae
- The breast has various connective tissue layers resembling the fascial layers of the abdomen; the subcutaneous fat layer corresponds to Camper’s fascia.
- The retro-mammary space is a potential area between the pectoral fascia and deep lamella, essential for surgical procedures.
Hormonal Regulation
- Suckling stimulates mechanoreceptors in the areola, leading to oxytocin release from the pituitary, causing myoepithelial contraction to expel milk during lactation.
- Breast composition changes with age; glandular tissue decreases and fat increases, especially noticeable during menopause.
Breast Tissue Composition
- The amount of fibroglandular tissue decreases with age, while fat tissue becomes more prevalent, affecting mammographic density (fibroglandular tissue is radiopaque while fat is radiolucent).
Axillary Lymph Nodes
- Axillary lymph nodes are organized into three surgical levels based on their position relative to the pectoralis minor:
- Level 1: Below/lateral to the pectoralis minor, includes anterior, posterior, and lateral groups.
- Level 2: At the level of the pectoralis minor, contains central and interpectoral (Rotter's) groups.
- Level 3: Above/medial to the pectoralis minor, consists of apical nodes.
- All level 1 nodes drain into the central group before moving to apical nodes, ultimately draining into the thoracic duct or the right lymphatic duct.
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