Human Anatomy Vol 1

Umbilicus

Possible position

ofaccessory nipples

Fig. 3.13: Milk line with possible positions of accessory nipples

Self-examination of breasts (Fig. 3.18):

a. Irspect: Symmetry of breasts and nipples.

b. Change in colour of skin.

c. Retraction of nipple is a sign of cancer.

d. Discharge from nipple on squeezing it.

e. Palpate all four quadrants with palm of hand.

Note any palpable lump.

f. Raise the arm to feel lymph nodes in axilla.

Mammogram may reveal cancerous mass

(Fig.3.1e).

Fine needle aspiration cytology is safe and quick

method of diagnosis of lesion of breast (Fig. 3.20).

Retracted nipple is a sign of tumour in the breast.

Srze of mammary gland can be increased by

putting an implant inside the gland.

Cancer of the mammary glands is the most

comnon cancer in females of all ages. It is more

frequently seen in postmenopausal females due

to lack of oestrogen hormones.

Self-examination of the mammary gland is the only

wayfor early diagnosis and appropriate treatment.

PECTORAL REGION

Skin ond Foscioe of the Bock

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The upper and outer quadrant ofbreast is a frequent

site of carcinoma (cancer). Several anatomical facts

are of importance in diagnosis and treatment of this

condition. Abscesses may also form in the breast and

may require drainage. The following facts are worthy

of note.

o Incisions of breast are usually made radially to

avoid cutting the lactiferous ducts (Fig. 3.9).

r Cancer cells may infiltrate the suspensory

ligaments. The breast then becomes fixed.

Contraction of the ligaments can cause retraction

or puckering (folding) of the skin (Fig. 3.1a).

r Infiltration of lactiferous ducts and their consequent

fibrosis can cause retraction of the nipple.

o Obstruction of superficial lymph vessels by cancer

cells may produce oedema of the skin giving rise

to an appearance like that of the skin of an orange

(peau d'orange appearance) (Fig. 3.15).

Because of communications of the superficial

lymphatics of

'the

breast across the midline, cancer

may spread from one breast to the other (Fig. 3.15).

Because of communications of the lymph vessels

with those in the abdomen, cancer of the breast

may spread to the liver, and cancer cells may

'drop' into the pelvis producing secondaries there

(Fig. 3.15).

Apart from the lymphatics, cancer may spread

through the segmental veins. In this connection,

it is important to know that the veins draining the

breast communicate with the vertebral venous

plexus of veins. Through these communications

cancer can spread to the vertebrae and to the brain

(Fi9.3.17).

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Fig. 3.15: Peau d'orange appearance