ANATOMYANATOMY

FETAL DEVELOPMENT Mammary Glands Mammary Line Buds Lobes Lobules Lactiferous Ducts Interlobar and Connective Tissue Fatty Tissue Nipple

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/glandu lar 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 - ducts B - lobes C - ampulla D - nipple E - fat F - pectoralis major muscle G - chest wall/rib cage Enlargement: A - normal duct cells B - basement membrane C - lumen (center of duct)

TDLU Intralobular terminal duct (dots) Extralobular terminal duct (dashes)

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 Date 2. Marker 3. Whole breast imaged 4. Skin Pores 5. Nipple in profile 6. Pectoralis muscle 7. IMF

ASSIGNMENT Log in to

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.