1. Breast anatomy

2. What area does the base of the breast cover? Extends from lateral border of sternum to midaxillary line From 2 nd to 6 th ribs Small part may extend towards the axilla – the axillary tail

3. What two muscles does the breast overly? Pectoralis major Serratus anterior

4. What separates the breast from the underlying muscle? Retromammary space A potential space filled with loose connective tissue

5. How is the breast attached to the skin that overlies it? Suspensory ligaments of Cooper Helps support the lobules of the breast

6. On what line does the nipple lie? Mammary ridge/milk line From the anterior axillary fold to the groin Supernumerary nipples can be occur along this line Also axillary breasts

7. How is the breast divided for descriptive purposes? Quadrants

8. What glands are found on the areola? Sebaceous (Montgomery) glands Secrete oily substance following pregnancy Oily substance protects the nipple from irritation

9. How many lobules are in the breast? How are they separated? 15-20 lobules of glandular tissue Separated by suspensory ligaments of Cooper

10. Describe the drainage of milk from a lobule? Each lobule drains into a lactiferous duct Each lactiferous duct opens on the nipple

11. What arteries supply the breast? Medial mammary – From internal thoracic (mammary)/anterior intercostal Lateral mammary – From lateral thoracic artery & posterior intercostals

12. What is the nerve supply to the breast? T4-6 intercostal nerves

13. What different areas do the lymphatics of the breast drain to? Auxiliary nodes Parasternal nodes Contralateral parasternal nodes Contralateral breast Subdiaphragmatic/hepatic nodes Inguinal lymph nodes (rare) Interpectoral (rotter’s) nodes

15. What changes does the breast go through during pregnancy? (6) Lengthening and branching of ducts Development of secretory alveoli Vascularity increases Nipples enlarge Areola becomes more prominent Lobular structure more prominent

16. What effect do progesterone and oestrogen have on breast tissue? Progesterone – lobular development (growth) Oestrogen – ductal growth Combined – suppress lactation

17. Benefits of breast feeding Bonding Infection Cheap Convenient Sterile

18. Who should not breast feed Alcohol misuse Certain drugs-methotrexate, cyclosporine, lithium Active TB HIV Breast Cancer Rx Infant with galactosemia

19. Difficulties with Breast feeding 2/3 of women have some problem Cracked nipple Mastitis S. Aureus Preemie Need advice and support