Female reproductive system Compiled by Ukwuma, Chijioke m.

(08036017362)

GUIDED DISCOVERY CLUB

Breasts (L. mammae)

Definition: The mammary glands are modified sweat glands in the superficial fascia anterior to the pectoral muscles and the anterior thoracic wall. The breasts are the most prominent superficial structures in the anterior thoracic wall, especially in women. The mammary glands are in the subcutaneous tissue overlying the pectoralis major and minor muscles.

Both men and women have breasts; normally they are well developed only in women. The mammary glands in the breasts are accessory to reproduction in women but are rudimentary and functionless in men, as the glandular system does not normally develop. The amount of fat surrounding the glandular tissue determines the size of non-lactating breasts, although in most women, the breasts enlarge slightly during the menstrual period from increased release of the gonadotropic hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) on the glandular tissue. At the greatest prominence of the breast is the nipple, surrounded by a circular pigmented area of skin, the areola (L. small area).

Location and extent:

Female reproductive system Compiled by Ukwuma, Chijioke m. (08036017362)

GUIDED DISCOVERY CLUB

Each breast is positioned over ribs 2 through 6 and overlies the pectoralis major muscle, the pectoralis minor muscle, and portions of the serratus anterior and external abdominal oblique muscles. The medial boundary of the breast overlies the lateral margin of the sternum, and the lateral margin of the breast follows the anterior border of the axilla. The axillary process of the breast extends upward and laterally toward the axilla, where it comes into close relationship with the axillary vessels. Between the breast and the pectoral fascia is a loose connective tissue plane or potential space the retromammary space (bursa). This plane, containing a small amount of fat, allows the breast some degree of movement on the pectoral fascia. A small part of the mammary gland may extend along the inferolateral edge of the pectoralis major toward the axillary fossa (armpit), forming an axillary process or tail (of Spence). The mammary gland is firmly attached to the dermis of the overlying skin by the suspensory ligaments (of Cooper). These fibrous connective tissues help to support the mammary gland lobules.

Morphology: During puberty, the breasts normally enlarge, owing in part to glandular development but primarily from increased fat deposition. The areolae and nipples also enlarge. Breast size and shape are determined by genetic, ethnic, and dietary factors. The lactiferous ducts give rise to buds that form 15-20 lobules of glandular tissue, which constitute the parenchyma of the mammary gland. Each lobule is drained by a lactiferous duct, which usually opens independently on the nipple. Deep to the areola, each duct has a dilated portion, the lactiferous sinus, in which a small droplet of milk accumulates or remains in the nursing mother. As the infant begins to suckle, compression of the areola (and the lactiferous sinus beneath it) expresses/secretes the accumulated droplets and encourages the infant to continue nursing as the hormonally mediated let-down reflex
2

Female reproductive system Compiled by Ukwuma, Chijioke m. (08036017362)

GUIDED DISCOVERY CLUB

ensues and the mother's milk is secreted into not sucked from the gland by the baby's mouth.

The areolae contain numerous sebaceous glands, which enlarge during pregnancy and secrete an oily substance that provides a protective lubricant for the areola and nipple, which are particularly subject to chaffing and irritation as mother and baby begin the nursing experience. The nipples are conical or cylindrical prominences in the centers of the areolae. The nipples have no fat, hair, or sweat glands. The nipples in the male are located at the fourth intercostal spaces (the area between the fourth and fifth ribs), about 10 cm (4 in.) from the midline. In sexually mature women, their position varies according to age and the size and pendulousness of the breasts. The tips of the nipples are fissured with the lactiferous ducts opening into them. The nipples are composed mostly of circularly arranged smooth muscle fibers that compress the lactiferous ducts during lactation and erect the nipples in response to stimulation, as when a baby begins to suckle.

Blood suppy to the Breast: The arterial supply to the breast include:

Female reproductive system Compiled by Ukwuma, Chijioke m. (08036017362)

y

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Medial mammary branches of perforating branches and anterior intercostal branches of the internal thoracic artery, originating from the subclavian artery.

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Lateral thoracic and thoracoacromial arteries, branches of the axillary artery. Posterior intercostal arteries, branches of the thoracic aorta in the 2nd, 3rd, and 4th intercostal spaces.

The venous drainage of the breast is mainly to the axillary vein, but there is some drainage to the internal thoracic vein. The lymphatic drainage of the breast is important because of its role in the metastasis of cancer cells. Lymph passes from the nipple, areola, and lobules of the gland to the subareolar lymphatic plexus. From this plexus: most lymph (> 75%), especially from the lateral breast quadrants, drains to the axillary lymph nodes.

Nerves of the Breast The nerves of the breast derive from anterior and lateral cutaneous branches of the 46th intercostal nerves

CLINICAL CORRELATIONS: A milky discharge through the nipples which occurs periodically over a period of time in a woman who is not pregnant is a condition referred to as galactorrhea: which is the medical term for a whitish or greenish discharge from one or both breasts. This is linked to a hormonal dysfunction that might result from abenign growth on the pituitary gland.

LUMPS, CANCER AND BREASTS SELF EXAMINATION:

Female reproductive system Compiled by Ukwuma, Chijioke m. (08036017362)

GUIDED DISCOVERY CLUB

Breast cancer is one of the most common malignancies in women. In the early stages, curative treatment may include surgery, radiotherapy, and chemotherapy. Some manifestations and detections of cancer is shown below:

One diagnostic procedure that should be routinely performed by a woman is a breast self-examination (BSE). The importance of a BSE is not to prevent diseases of the breast but to detect any problems before they become life-threatening. Early detection of breast cancer and follow-up medical treatment minimizes the necessary surgical treatment and improves the patients prognosis. Breast cancer is curable if it is caught early. A woman should examine her breasts monthly. If she has not yet reached menopause, the ideal time for a BSE is 1 week after her period ends because the breasts are less likely to be swollen and tender at that time. A woman no longer menstruating should just pick any day of the month and do a BSE on that same day on a monthly basis. Visual inspection and palpation are equally important in doing a BSE. The steps involved in this procedure are the following:

Female reproductive system Compiled by Ukwuma, Chijioke m. (08036017362)

GUIDED DISCOVERY CLUB

1. Observation in front of a mirror. Inspect the breasts with the arms at the sides. Next, raise the arms high overhead. Look for any changes in the contour of each breasta swelling, dimpling of skin or changes in the nipple. The left and right breast will not match exactlyfew womens breasts do. Finally, squeeze the nipple of each breast gently between the thumb and index finger to check for discharge. Any discharge from the nipple should be reported to a physician.

2. Palpation during bathing. Examine the breasts during a bath or shower when the hands will glide easily over wet skin. With the fingers flat, move gently over every part of each breast. Use the right hand to examine the left breast, and the left hand for the right breast. Palpate for any lump, hard knot, or thickening. If the breasts are normally fibrous or lumpy (fibrocystic tissue), the locations of these lumps should be noted and checked each month for changes in size and location.

Female reproductive system Compiled by Ukwuma, Chijioke m. (08036017362)

GUIDED DISCOVERY CLUB

3. Palpation while lying down. To examine the right breast, put a pillow or folded towel under the right shoulder. Place the right hand behind the headthis distributes the breast tissue more evenly on the rib cage. With the fingers of the left hand held flat, press gently in small circular motions around an imaginary clock face. Begin at outermost top of the right breast for 12 oclock, then move to 1 oclock, and so on around the circle back to 12 oclock. A ridge of firm tissue in the lower curve of each breast is normal. Then move in an inch, toward the nipple, and keep circling to examine every part of the breast, including the nipple. Also examine the armpit carefully for enlarged lymph nodes. Repeat the procedure on the left breast.