Chapter 58 The Breast

The breast in adult females overlies the pectoral region, extending from the second rib above to the sixth rib or inframammary crease below. The axillary tail of the breast is palpable in some women and can be seen in the premenstrual period or during lactation. A well-developed axillary tail is sometimes mistaken for a mass of enlarged lymph nodes, a breast mass or a lipoma. The breast parenchyma consists of ductolobular and supportive tissue. The areola and nipple contain involuntary muscle arranged in concentric rings as well as radially in the subcutaneous tissue. Patients presenting with a breast lump, nipple discharge or other symptoms are assessed by a combination of clinical examination, radiological imaging and tissue sampling taken for either cytological or histological analysis. Mammography in two planes and ultrasonography are the first-line investigations for imaging the breast.

Multiple Choice Questions
Weblinks

We have tried to provide the best description of the anatomy of the breast as well as benign and malignant diseases of the breast, supported by images, illustrations, tables and videos in this chapter. Below are some additional weblinks to further support your understanding in this area.

Journal articles

https://www.sciencedirect.com/science/article/pii/S0960977607000707/ (paid)

The commonest benign breast disease is mastalgia, the treatment of which is challenging. This meta-analysis of various trials of mastalgia will help you to understand it further.

https://www.thebreastonline.com/article/S0960-9776(10)00046-9/pdf/ (free)

Triple assessment is essential for breast examination and the recording of results. Breast changes in the form of nodularity have been discussed in this chapter. To find out more about this nodularity and the scores for recording, refer to this link.

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(17)30777-5/fulltext (paid)

Breast surgery has evolved from radical surgery to more focused and individualised care. This article provides more understanding on this subject.

https://academic.oup.com/jnci/article/98/9/599/2522073/ (free)

The management of the axilla forms an important part of breast cancer surgery. This article reports on the landmark ALMANAC trial regarding sentinel lymph node versus complete axillary lymph node treatment in operable breast cancer.

https://www.sciencedirect.com/science/article/abs/pii/S1879850016301849?via%3Dihub/ (paid)

After surgery, further management with adjuvant and neoadjuvant treatment is essential.

https://www.nejm.org/doi/full/10.1056/NEJMoa020989/ (free)

Is there a need to remove the whole breast or not? This randomised study will help further understanding of this concept.

Book

https://www.sciencedirect.com/book/9780702027741/hughes-mansel-and-websters-benign-disorders-and-diseases-of-the-breast/

Benign breast disease itself is an extensive topic, we therefore recommend this publication.

Guidelines

https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf/

The details of breast cancer are summarised well in the chapter, but these guidelines provide more detail.

Videos

58.2 Triple assessment

Videos

58.3 Fibroadenoma and phyllodes

Videos

58.4 Nipple discharge

Videos

58.5 Lactational breast abscess

Videos

58.6 Animation showing the formation of a milk duct fistula

Videos

58.7 Early breast cancer

Videos

58.8 Axillary assessment

Videos

58.9 Locally advanced breast cancer

Videos

58.1 Breast anatomy and ANDI

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