Anatomy Lecture Breast- MT.pdf

Anatomy Lecture: Breast MAT T TOMMASINO, PA -C ACADEMIC COORDINATOR, NUMC Breast Made up of Adipose and Glandular tissue, extending from 2nd – 6th rib, clavicle to sternum/axilla. Size varies and change throughout life. Suspensory ligaments (Coopers Ligament), help maintain the shape and support...

Anatomy Lecture: Breast MAT T TOMMASINO, PA -C ACADEMIC COORDINATOR, NUMC Breast Made up of Adipose and Glandular tissue, extending from 2nd – 6th rib, clavicle to sternum/axilla. Size varies and change throughout life. Suspensory ligaments (Coopers Ligament), help maintain the shape and support the breast. Arise from the dermis and insert on pectoralis muscle. Pectoral fat pad (adipose), provide the mass of the breast and protect the mammary glands Mammary Glands: Lobes (14-18), Lactiferous ducts (ducts), Lactiferous sinus Nipple and Areola Mammary Glands  Produces milk (lactation) which is the primary nourishment for infants  Lie in each of the fat pads of subcutaneous tissue over the pectoral muscle in each breast Several Lobes in each breast, connected to the Lactiferous Ducts (Mammary ducts) which travel from the lobes of the mammary glands to an opening known as the nipple.  The ducts expand into a chamber at the distal end to create the Lactiferous Sinus which opens into the Nipple (15-20) Nipple and Areola: Area surrounding the nipple is known as the Areola, usually a darker pigmentation than skin modified sweat glands known as Montgomery's glands These glands secrete oily fluid that lubricate and protect the nipple during breastfeeding Arterial Supply: Coming off the subclavian artery is the internal thoracic and axillary arteries Internal thoracic will supply blood to the anterior chest wall, skin, muscles and mammaries medially via internal mammary arteries and posterior intercostal arteries. Axillary will supply blood to the lateral anterior chest, axilla and mammaries laterally via the lateral thoracic and lateral mammary arteries Additionally: The thoracoacromial artery (axillary) The lateral thoracic artery (axillary): gives branches to the serratus anterior muscle, both pectoralis muscles, and the subscapularis muscle. The lateral mammary arteries also come from here and the posterior intercostals. Arteries of the Breast 11/15/2018 8 Venous Supply The veins of the breast correspond with the arteries, draining into the axillary and internal thoracic veins. Medial mammary to the internal thoracic Lateral mammary to the Lateral thoracic to the axillary vein Veins of the Breast 11/15/2018 11 Lymph Nodes:  The majority of the breast is drained by the axillary lymph nodes. (includes chest, subscapular, humerus regions)  Remainder is drained via parasternal nodes A small amount of remaining lymph travels to the other breast and to the abdominal lymph nodes. Lymph System of the Breast Nerves: Majority of the breast is sensory in nature Most of the innervation comes from the anterolateral and anteromedial portions of the 2nd-6th intercostal nerves. Additionally from the supraclavicular branch Breast Cancer Prevalence: breast cancer is the leading type of adenocarcinoma in women, accounting for 25% of all cases. In 2012 it resulted in 1.68 million new cases and 522,000 deaths. It is more common in developed countries and is more than 100 times more common in women than in men. Most Common/RF’s: female, obesity, lack of physical exercise, drinking alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, having children late or not at all, older age, and family history Screening: breast exam, BRCA 1 & 2, Mammography (controversial), Sonogram Site: Ductal vs Lobular Mets: Common sites of metastasis include bone, liver, lung and brain Stage: Stage 0 pre-cancerous or marker condition, either ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS). Stages 1–3 are within the breast or regional lymph nodes. Stage 4 is 'metastatic' cancer that has a less favorable prognosis since it has spread beyond the breast and regional lymph nodes Signs: lump(s), asymmetry, dimpling, nipple discharge, red scaly patches Diagnosis: Biopsy, Mammography, Sonogram Treatment: Tamoxifen, lumpectomy, Mastectomy, Radiation, Chemotherapy, etc. Adenocarinoma This type of cancer begins in the glandular tissue of the body. In the breast the cancer originates in either the lobules or the ducts forming either Ductal carcinoma or Lobule carcinoma of the breast. Ductal Carcinoma of the Breast: Ductal Carcinoma In Situ (DCIS)- This is found in the milk ducts and has not spread to the walls and is almost 100% curable if detected early by mammo. If left can become IDC Invasive Ductal carcinoma(IDC)- 80% of the breast cancers fall into this category. This can metasasize if left undiagnosed through the lymphatics. Lobular Carcinoma of the Breast: Lobular carcinoma In Situ (LCIS). This is considered a neoplasm found in the lobules of the breast. This is more of a pre-cancer but if diagnosed with LICS you have a greater risk of having ILC lobular breast cancer can present in both breasts Invasive Lobular Carcinoma (ILC) 10-15% of the breast cancers. This originates in the glands of the breast and have spread into the fatty tissue with the potential to metasasize .