-1VIII.

Anatomy

and Physiology

The breast is the upper ventral region of the torso of a primate, in left and right sides, containing the mammary gland which in a female can secrete milk used to feed infants. Both men and women develop breasts from the same embryological tissues. However, at puberty, female sex hormones, mainly estrogen, promote breast development, which does not occur in men, due to the higher amount of testosterone. As a result, women's breasts become far more prominent than those of men. During pregnancy, the breast is responsive to a complex interplay of hormones that cause tissue development and enlargement in order to produce milk. Three such hormones are estrogen, progesterone and prolactin, which cause glandular tissue in the breast and the uterus to change during the menstrual cycle. Each breast contains 1520 lobes. The subcutaneous adipose tissue covering the lobes gives the breast its size and shape. Each lobe is composed of many lobules, at the end of which are sacs where milk is produced in response to hormonal signals. Morphology The human breast has two aspects: the functional aspect and the anatomic aspect. The functional breast The breast is an apocrine gland that produces milk to feed an infant child; for which the nipple of the breast is centred in (surrounded by) an areola (nipple-areola complex, NAC), the skin color of which varies from pink to dark brown, and has many sebaceous glands. The basic units of the breast are the terminal duct lobular units (TDLUs), which produce the fatty breast milk. They give the breast its offspring-feeding functions as a mammary gland. They are distributed throughout the body of the breast; approximately two-thirds of the lactiferous tissue is within 30 mm of the base of the nipple. The terminal lactiferous ducts drain the milk from TDLUs into 418 lactiferous

ducts, which drain to the nipple; the milk-glands-to-fat ratio is 2:1 in a lactating woman, and 1:1 in a non-lactating woman. In addition to the milk glands, the breast also is composed of connective tissues (collagen, elastin), white fat, and the suspensory Cooper's ligaments. Sensation in the breast is provided by the peripheral nervous system innervation, by means of the front (anterior) and side (lateral) cutaneous branches of the fourth-, the fifth-, and the sixth intercostal nerves, while the T-4 nerve (Thoracic spinal nerve 4), which innervates the dermatomic area, supplies sensation to the nipple-areola complex. The anatomic breast In women, the breasts overlay the pectoralis major muscles and usually extend from the level of the second rib to the level of the sixth rib in the front of the human rib cage; thus, the breasts cover much of the chest area and the chest walls. At the front of the chest, the breast tissue can extend from the clavicle (collarbone) to the middle of the sternum (breastbone). At the sides of the chest, the breast tissue can extend into the axilla (armpit), and can reach as far to the back as the latissimus dorsi muscle, extending from the lower back to the humerus bone (the longest bone of the upper arm). As a mammary gland, the breast is an inhomogeneous anatomic structure composed of layers of different types of tissue, among which predominate two types, adipose tissue and glandular tissue, which effects the lactation functions of the breasts. Morphologically, the breast is a cone with the base at the chest wall, and the apex at the nipple, the center of the NAC (nipple-areola complex). The supercial tissue layer (superficial fascia) is separated from the skin by 0.52.5 cm of subcutaneous fat (adipose tissue). The suspensory Coopers ligaments are fibrous-tissue prolongations that radiate from the superficial fascia to the skin envelope. The adult breast contains 1418 irregular lactiferous lobes that converge to the nipple, to ducts 2.04.5 mm in diameter; the milk ducts (lactiferous ducts) are immediately surrounded with dense connective tissue that functions as a support framework. The glandular tissue of the breast is biochemically supported with estrogen; thus, when a woman reaches menopause (cessation of menstruation) and her body estrogen levels decrease, the milk gland tissue then atrophies,

withers, and disappears, resulting in a breast composed of adipose tissue, supercial fascia, suspensory ligaments, and the skin envelope. The dimensions and the weight of the breast vary among women, ranging approximately 5001,000 grams (1.12.2 pounds) each; thus, a small-to-medium-sized breast weighs 500 grams (1.1 pounds) or less; and a large breast weighs approximately 7501,000 grams (1.72.2 pounds.) The tissue composition ratios of the breast likewise vary among women; some breasts have greater proportions of glandular tissue than of adipose or connective tissues, and vice versa; therefore the fat-to-connective-tissue ratio determines the density (firmness) of the breast. In the course of a womans life, her breasts will change size, shape, and weight, because of the hormonal bodily changes occurred in thelarche (pubertal breast development), menstruation (fertility), pregnancy (reproduction), the breast-feeding of an infant child, and the climacterium (the end of fertility).

Structure Structurally, the breast consist of fat, fibrous connective tissue, and glandular

tissue. The superficial fibrous connective tissue is attached to the skin, a fact that is important in the visual observation of skin movement over the breast during breast selfexamination. The breast mass is supported by the fascia of the pectoralis major and minor muscle by the fibrous connective tissue of the breast. Fibrous tissue ligaments, called Coopers ligaments, extend from the outer boundaries of the breast to the nipple area in radial manner. These ligaments support the breast and form septa that divide the breast into 15 to 25 lobe consist of grape like clusters, alveoli or glands, which are interconnected by ducts. The alveoli are lined with secretory cells capable of producing milk or fluid. The route of descent of milk and other breast secretions is from alveoli to duct to intra lobar duct to lactiferous duct and reservoir to nipple. The nipple is made up of epithelial, glandular, erectile, and nervous tissue. Areolar tissue surrounds the nipple and is recognized as the darker, smooth skin between the nipple and the breast. The small bumps or projections on the areolar surface known as Montgomerys tubercules are sebaceous glands that keep the nipple area soft and elastic. At puberty and during pregnancy, increased levels of estrogen and progesterone cause the areola and nipple to become darker and more prominent and at the same time cause the Montgomerys gland to become more active. The erectile tissue of the nipple is responsive to psychological and tactile stimuli, which contributes to the sexual function of the breast. There are many individual variations in breast size and shape. The shape and texture vary with hormonal, genetic, nutritional, and endocrine factors and with muscle tone, age, and pregnancy. A well-developed set of pectoralis muscle supports the breast mass higher on the chest wall. Poor posture, significant weight loss, and lack of support may cause breast to droop.

Lymphatic System

Lymphatic drainage Approximately 75% of the lymph from the breast travels to the ipsilateral (sameside) axillary lymph nodes, whilst 25% of the lymph travels to the parasternal nodes (beside the sternum bone), to the other breast, and to the abdominal lymph nodes. The axillary lymph nodes include the pectoral (chest), subscapular (under the scapula), and humeral (humerus-bone area) lymph-node groups, which drain to the central axillary lymph nodes and to the apical axillary lymph nodes. The lymphatic drainage of the breasts is especially relevant to oncology, because breast cancer is a cancer common to the mammary gland, and cancer cells can metastasize (break away) from a tumour and be dispersed to other parts of the womans body by means of the lymphatic system.