Congenital Anomalies in Breast Development

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Questions and Answers

What is the location of the breast tissue in relation to the rib cage?

From the 5th to the 9th rib

From the 4th to the 8th rib

From the 1st to the 5th rib

From the 2nd or 3rd rib to the 6th or 7th rib (correct)

What is the axillary tail?

A type of breast cancer

A prolongation of the parenchyma that passes deeply through an opening in the deep fascia (correct)

A vein that drains the breast tissue

A ligament that connects the breast to the rib cage

What is the primary source of arterial supply to the breast?

Internal mammary artery (correct)

Thoracoacromial artery

Axillary artery

Posterior intercostal arteries

What is the primary mode of venous return from the breast?

Through the axillary and internal mammary veins Signup and view all the answers

What is the significance of the perforating branches of the internal mammary artery during mastectomy?

They should be ligated or clamped before division to prevent bleeding Signup and view all the answers

What is the extent of the breast tissue in the transverse plane?

From the lateral border of the sternum to the anterior axillary line Signup and view all the answers

What is the significance of the deep fascia in relation to the breast tissue?

It provides a route for the axillary tail to pass through Signup and view all the answers

What is the relationship between the breast tissue and the surrounding muscles?

The breast tissue rests on the fascia of the pectoralis major, serratus anterior, and external oblique abdominal muscles Signup and view all the answers

What is the term for aberrations of normal development and involution?

ANDI Syndrome Signup and view all the answers

What is the most frequent disorder of the breast?

Fibrocystic Disease Signup and view all the answers

What is the term for the formation of multiple accessory breasts?

Polymastia Signup and view all the answers

What is the term for the inflammation of the mammary ducts?

Mammary duct ectasia Signup and view all the answers

What is the term for the absence of breast tissue?

Amastia Signup and view all the answers

What is the term for the inflammation of the breast tissue during lactation?

Acute lactational mastitis Signup and view all the answers

What is the term for the abnormal growth of breast tissue in males?

Gynecomastia Signup and view all the answers

What is the stage of life where the breast tissue undergoes involution?

Involution (age 35-55y) Signup and view all the answers

What is the primary goal of treatment for ANDI?

Exclusion of malignancy and reassurance of the patient Signup and view all the answers

What is the purpose of performing a biopsy on a recurring cyst in ANDI?

To rule out other possible causes of the cyst Signup and view all the answers

What is the recommended treatment for mild cases of cyclic mastalgia in ANDI?

Reassurance and wearing a supportive brassiere Signup and view all the answers

What is the dose of Danazol used to control cyclic pain in ANDI?

100-200 mg twice daily orally Signup and view all the answers

What is the significance of the intercostal veins in relation to breast cancer?

They communicate with the vertebral venous plexus, facilitating the spread of cancer to the axial skeleton and central nervous system Signup and view all the answers

What is the recommended follow-up for cases with atypical epithelial hyperplasia discovered by biopsy in ANDI?

Monthly breast self-examination and regular medical follow-up Signup and view all the answers

What is the purpose of giving up caffeine consumption in the treatment of ANDI?

To control cyclic mastalgia Signup and view all the answers

How do lymph vessels typically follow the course of blood vessels in the body?

They parallel the blood vessels, but remain separate Signup and view all the answers

What is the purpose of dividing the axillary lymph nodes into three levels?

To determine the prognosis after radical or modified radical mastectomy Signup and view all the answers

Which of the following hormonal stimuli is NOT involved in breast development and function?

Testosterone Signup and view all the answers

At which level are the axillary lymph nodes located medial or above the pectoralis minor muscle?

Level III Signup and view all the answers

What is the primary physiological change that occurs in the breast during pregnancy?

Hormonal stimuli-induced growth and development Signup and view all the answers

What is the primary location where carcinoma of the breast arises from?

Ducts Signup and view all the answers

What is the term for the occurrence of a second breast cancer outside the breast quadrant of the primary cancer?

Multicentricity Signup and view all the answers

What is the term for the carcinoma that remains within the epithelium?

Non-infiltrating duct carcinoma Signup and view all the answers

What percentage of cases have bilateral lesions in lobular carcinoma?

25% Signup and view all the answers

What is the term for the occurrence of a second cancer within the same breast quadrant as the primary cancer?

Multifocality Signup and view all the answers

What is the type of carcinoma that begins in the epithelium and is essentially an intraductal carcinoma?

Paget's disease of the nipple Signup and view all the answers

What is the name of the type of carcinoma that arises from the ducts?

Carcinoma of the ducts Signup and view all the answers

What is the percentage of infiltrating ductal carcinoma among all breast carcinomas?

75% Signup and view all the answers

Study Notes

Functional Anatomy of the Breast

The mature female breast overlies the area from the 2nd or 3rd rib to the inframammary fold at the 6th or 7th rib.
It extends transversely from the lateral border of the sternum to the anterior axillary line.
The deep or posterior surface of the breast rests on the fascia of the pectoralis major, serratus anterior, and external oblique abdominal muscles, and the upper extent of the rectus sheath.
The axillary tail (of Spence) is a prolongation of the parenchyma which passes deeply through an opening in the deep fascia to blend with the axillary fat.

Blood Supply

Arterial supply comes from the following arteries in order of their contribution:
- Perforating branches of the Internal mammary artery
- Lateral branches of the posterior intercostal arteries
- Branches from the axillary artery, including the highest thoracic, lateral thoracic, and pectoral branches of the thoracoacromial artery

Veins

The venous return is primarily through the axillary and internal mammary veins.
The intercostal veins are clinically important as they drain into the azygos system and communicate with the valveless vertebral venous plexus (Batson's).

Lymphatic Drainage

Lymph vessels follow the course of blood vessels.
The six axillary lymph node groups are:
- Axillary nodes (lateral)
- Anteromedial (pectoral) or external mammary
- Posterior (subscapular) group
- Central group
- Apical group (subclavicular)
- Interpectoral (Rotter)
The axillary lymph nodes are divided by the pectoralis minor muscle into three levels:
- Level I nodes: located low in the axilla, lateral or below the lower border of the pectoralis muscle
- Level II nodes: located superficial or deep to the pectoralis minor muscle
- Level III nodes: located medial or above the muscle in the apex of the axilla

Physiology of the Breast

Hormonal control: estrogen, progesterone, and prolactin modulate breast development and function.
Physiological changes occur at puberty, during menstruation, pregnancy, lactation, and after menopause.