Breast: Dr. Sylvia N. Saing

BREAST
Dr. Sylvia N. Saing

SURFACE ANATOMY OF BREAST
• The breasts are modified skin
glands
• Located on the anterior and
also partly the lateral aspects
of the thorax.
• Each breast extends superiorly
to the second rib, inferiorly to
the sixth costal cartilage,
medially to the sternum, and
laterally to the mid-axillary
line.
• Langer lines, extend outwards
circumferentially from the
nipple–areola complex.
Jatoi I., Kaufmann M., Petit JY. Atlas of Breast Surgery. Springer. German. 2006
BREAST STRUCTURE
• Breast contains 15-20 lobes
• Fat covers the lobes and shapes the
breast
• Lobules fill each lobe
• Sacs at the end of
lobules produce milk
• Ducts deliver milk to the
nipple
Drake RL., et al. Gray's Basic Anatomy, Second Edition. Elsevier. 2018.
THE FOUR BREAST QUADRANTS
• The “tail” is an extension of
the upper outer quadrant.
• The resulting four quadrants
are the upper outer, upper
inner, lower outer, and lower
inner.
Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

LOCATION OF PRIMARY BREAST
CANCER
Jatoi I., Kaufmann M., Petit JY. Atlas of Breast Surgery. Springer. German. 2006
BREAST CLOCK AND QUADRANTS
Clock Position, Quadrants, and ICD codes of the breast
BLOOD SUPPLY OF THE BREAST
• The blood supply of the breast

is derived primarily from the
internal mammary artery
(internal thoracic artery), and
the lateral thoracic artery.
• Both these arteries originate
from the axillary artery and
then enter the breast from the
superomedial and
superolateral aspects,
respectively.
Jatoi I., Kaufmann M., Peti “ JY. Atlas of Breast Surgery. Springer. German. 2006
BLOOD SUPPLY TO THE BREAST: CROSS-
SECTIONAL VIEW.
Jatoi I., Kaufmann M., Peti “ JY. Atlas of Breast Surgery. Springer. German. 2006
VENOUS SUPPLY
• Veins are
corresponding to
the arteries.
• Circular venous
plexus are found
at the base of
nipple.
• Finally, veins of
this plexus drain
into axillary &
internal thoracic
veins.
REGIONAL LYMPH NODES FOR BREAST
• Axillary lymph nodes (B) (C) (D)
– Located in the underarm to the
collarbone
– Include interpectoral or Rotter
nodes
• Internal mammary (parasternal)
lymph nodes (F)
– Tucked under the sternum
• Infraclavicular (subclavicular) lymph
nodes
– In the deltopectoral groove
• Supraclavicular lymph nodes (E)
– Above the collarbone
LYMPH NODES AND LYMPH DRAINAGE
NERVE SUPPLY TO THE BREAST
• The sensory innervation is from
the following:
– Supraclavicular nerves
from 3rd and 4 th branches
of the cervical plexus
– Anterior cutaneous
branches from intercostal
nerves 2 to 6
– T4 is believed to be the
primary innervation to the
nipple
Weinzweig J. Plastic Surgery Secrets, Second Edition. Elsevier. 2010.

MAMMARY RIDGE (MILK LINE)
• Mammary ridge
extends from the axilla
to the inguinal region.
• In human, the ridge
disappears EXCEPT for a
small part in the
pectoral region.
• In animals, several
mammary glands are
formed along this ridge.
PHYSICAL
EXAMINATION
PHYSICAL EXAMINATION
• No special equipment is necessary for the examination of the breast. The
examination of the breast consists of the following:
– Inspection
– Axillary examination
– Palpation
• The examination of the breast is in two parts:

– The first is performed with the patient SITTING UP. Inspection of the
breasts and palpation of the lymph nodes are done in this position.
– The second is performed with the patient LYING DOWN. The
examiner systematically palpates the entire breast by using firm,
gentle pressure exerted by the pulp of his or her finger rather than
the fingertips.
INSPECT THE BREASTS
• Any changes in the skin, contour,
or symmetry
• Inspected for size, shape,
symmetry, contour, color, and
edema.
• The nipples are inspected as to
size, shape, inversion, eversion,
or discharge. The nipples should
be symmetric.
• The skin of the breast is observed
for edema. Edema of the skin of
the breast that overlies a
malignancy may manifest as
peau d'orange.

• Dimpling of the breast and • Paget's disease of the
bloody nipple discharge. breast.
• Erythema of the breast.

INSPECT THE BREASTS IN VARIOUS
POSTURES
• This maneuver tenses the
pectoralis muscles, which may
bring out dimpling caused by
fixation of the breast to the
underlying muscles.
• If a malignancy is present, the
abnormal attachment of the
tumor to the fascia and pectoralis
muscle pulls on the skin and may
produce skin dimpling.

• Another maneuver, which is
useful for a woman with
pendulous breasts, involves
her bending at the waist and
allowing her breasts to hang
free from the chest wall.
• A carcinoma causing fibrosis
in one breast produces a
change in the contour of that
breast.

AXILLARY EXAMINATION
• The axillary examination is performed with the patient seated

facing the examiner.
• Examination of the axilla is best accomplished by relaxing the
pectoral muscles.
• The supraclavicular, subclavian, and axillary regions are
palpated.

TECHNIQUE FOR AXILLARY
EXAMINATION
• Low axilla ( right side ) • High axilla ( left side )

PALPATION
• The woman is asked to lie METHOD OF BREAST
down and is told that the
breast will next be palpated. PALPATION
• The examiner stands at the
right side of the patient's
bed.
• Although the examiner can
usually palpate each breast
from the patient's right side,
it is often better with large- Concentric circles
breasted women to examine
the left breast from the left
side. Spokes of a wheel

• The “spokes of a wheel”
method starts at the
nipple.
• The concentric circles

approach also starts at the
nipple, but the examiner
moves from the nipple in a
continuous circular
manner around the
breast.

IF A MASS IS PALPATED, THE FOLLOWING
CHARACTERISTICS SHOULD BE DESCRIBED:
Should be described:
1. The size of the mass in centimeters and its position
2. The shape of the mass
3. The delimitation , referring to the borders of the mass: Is it well
delimited, as with a cyst? Are the edges diffuse, as with a
carcinoma?
4. The consistency , describing the “hardness” of the mass: a
carcinoma is often stony hard. A cyst has some elastic qualities.
5. The mobility of the lesion: Is the lesion movable in the tissue that
surrounds it? Benign tumors and cysts are freely mobile.
Carcinomas are usually fixed to the skin, underlying muscle, or
chest wall.

• Examination of the Examination for discharge
nipple concludes the
examination of the
breast.
• Inspect for nipple
retraction, fissures,
and scaling.
• To examine for
discharge, place each Examination for masses below the nipple
hand on either side of
the nipple and gently
compress the nipple,
noting the character
of any discharge.

THANK YOU

Breast: Dr. Sylvia N. Saing

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BREAST

Dr. Sylvia N. Saing

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

• The blood supply of the breast

Weinzweig J. Plastic Surgery Secrets, Second Edition. Elsevier. 2010.

• The examination of the breast is in two parts:

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

• Erythema of the breast.

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

• The axillary examination is performed with the patient seated

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

• The concentric circles

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

Swartz et al. Textbook of Physical Diagnosis, Seventh Edition. Elsevier. 2014.

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