ANATOMYANATOMYANATOMYANATOMY

FETAL DEVELOPMENT• Mammary Glands• Mammary Line• Buds• Lobes• Lobules• Lactiferous Ducts

• Interlobar and Connective Tissue

• Fatty Tissue• Nipple

http://sprojects.mmi.mcgill.ca/dir/mammography.html

PUBERTY DEVELOPMENT

• Estrogen production begins growth of mammary ducts.

• Fat increases and fibrous tissue elastic• Adolescent period 9-13 years.• Complete development after ovulation

with the effect of progesterone. (Age 17)• Mammographic appearance: dense and

homogeneous

MENSTRUAL CYCLE• Changes in size and firmness due

to hormone balance.• Breasts enlarge • Certain areas more tender• BSE 7-10 days after menstruation

begins

PREGNANCY• PROLIFERATION• Acini grow • Estrogen• Progesterone• Prolactin• Oxytocin

MENOPAUSE• INVOLUTION• Loss of lobules• Breast replaced largely with fat• Takes 3-5 years

DISTRIBUTION OF GLANDULAR TISSUE

• Majority of glandular tissue lies centrally and laterally.

• Atrophy of glandular tissue begins medially and posteriorly working toward nipple.

Estrogen Replacement Therapy

• Benefits:– Decrease in symptoms– Decrease risk of heart problems– Decrease risk of osteoporosis

• Contraindications:– Increased risk of breast CA– Can influence growth of CA

Estrogen Replacement Therapy

• Hysterectomy: estrogen only• Menopause with uterus:

estrogen/progesterone to prevent proliferation of uterine lining

• Pills, skin patches, vaginal creams• Side effects: breast enlargement,

cysts, fibrocystic changes

DEVELOPMENTAL ABNORMALITIES

CONGENITAL• Supernumerary

Nipples (Polymastia)

• Accessory Breast Tissue (2-6%)

• Amastia/Amazia

ACQUIRED• Trauma• Radiotherapy• Breast Biopsy

Supernummerary nipples, when present, follow a predictable line

down the thorax

• A supernumerary nipple is the aborted beginning of an additional nipple along the mid-clavicular line of the thorax.

Supernumerary on Adolescent boy

Supernumerary on Shoulder

Case 2: A 22-year-old white woman presented three days following spontaneous vaginal delivery with painless swelling of her right axilla. She had an unremarkable

medical history, and her prenatal course was unremarkable. She denied any fever or signs of systemic

infection. On physical examination, a 3 x 3 cm mobile, painless swelling was noted in the right axilla. A small

amount of cloudy fluid was expressed through a central punctum within the swelling.

AMASTIA

EXTERNAL ANATOMY• Breast• Nipple• Areola• Areolar Muscle• Montgomery Glands• Inframammary Fold• Axillary Tail of Spence

INTERNAL ANATOMY• Fascia• Retromammary/

glandular Fat Space• Connective Tissue• Blood Supply• Veins (Circulus

Venosus)• Lobes• Lactiferous Ducts• Ampulla

• Lobules• TDLU• Extralobular

Terminal Duct• Intralobular Terminal

Duct• Ductules (Acini)• Lymphatics

Breast profile:A - ductsB - lobesC - ampullaD - nippleE - fatF - pectoralis major

muscleG - chest wall/rib

cage

Enlargement:A - normal duct

cellsB - basement

membraneC - lumen (center of

duct)

TDLU• Intralobular

terminal duct (dots)

• Extralobular terminal duct (dashes)

http://sprojects.mmi.mcgill.ca/dir/mammography.html

Lymph node areas adjacent to breast area.

A - pectoralis major muscle

B - axillary lymph nodes: levels I

C - axillary lymph nodes: levels II

D - axillary lymph nodes: levels III

E - supraclavicular lymph nodes

F - internal mammary lymph nodes

MALE BREAST• Similar to female breast until

puberty• Male breasts stay in rudimentary

state• Gynecomastia

BREAST CLASSIFICATIONS

 

• Dense/GLANDULAR • Average/FIBRO-FATTY or

FIBRO-GLANDULAR  • Adipose/FATTY

WOLFE BREAST CLASSIFICATIONS

• N1• P1• P2• DY

DEFINITIONS• Nulliparity• Proliferation• Involution• Epithelial Cells• Myoepithelial Cells

MAMMOGRAPHIC ANATOMY

• Convex Pectoralis Muscle• Cooper’s Ligaments• Blood Vessels• Ducts• IMF• Skin Pores• Nipple in profile

MAMMOGRAPHIC CHANGES

• Pregnancy/lactation• Menstruation• Menopausal• Estrogen Replacement Therapy

(ERT)

Viewing A Mammogram• Right and Left opposite each other

for CC and MLO• Place comparison films either to the

sides or above or below current films• Hang anatomically• Axillary region always up• Marker always in Axillary region

1. ID and Date2. Marker3. Whole breast

imaged4. Skin Pores5. Nipple in

profile6. Pectoralis

muscle7. IMF

http://sprojects.mmi.mcgill.ca/dir/mammography.html

ASSIGNMENT• Log in to www.thehungersite.com• www.thebreastcancersite.com

Friday Assignment• Post a summary of an article related

to some sort of breast specialty exam in the Discussions section of WebCT. You must then respond to two other postings to show you have read their summaries. Your summary is due Friday night at midnight. Responses are due Monday night.