MAMMOGRAPHY

Breast Anatomy and Mammographic

Correlation
Male Vs. Female Breast
• The female breast is more developed than the male breast.
• The primary function of female breast is to produce milk for nutrition
of the infant and baby.
• Male breasts have only an erotic function.
• Female hormones such as estrogen and progesterone are important in
promoting growth and changes that occur in the breast, especially
during pregnancy and the menstrual cycle.
• The male hormones which is testosterone if it is out of balance it also
affects the male breast.
• The structure of the male breast is nearly identical to that of the
female breast, except that the male breast tissue lacks the specialized
lobules, as there is no physiologic need for milk production by the
male breast. Abnormal enlargement of the male breast is medically
known as gynecomastia.
• It is important for women to understand the normal anatomy and
function of their breasts so that any abnormalities can be detected and
treated.
Breast
• specialized organs which are located at the anterior chest
wall (pectoral) muscles.
• are made of specialized tissue that produces milk
(*glandular tissue) for women and as well as fatty tissue.
*are a mixture of both endocrine (ductless,
hormones are secreted into the blood) and
exocrine (have ducts, hormones are secreted
onto surfaces) glands.
• The amount fat of the breast determines it size.
• The milk-producing part of the breast is organized into 15
to 20 sections, called lobes.
Within each lobe are smaller structures, called
lobules, where milk is produced. The milk travels
through a network of tiny tubes called ducts. The
ducts connect and come together into larger ducts,
which eventually exit the skin in the nipple.
Breast
- The dark area of skin surrounding the nipple is
called the areola.
- Connective tissue and ligaments provide support to
the breast and give it its shape.
- It also contains nerves that provide sensation to the
breast.
- It contains blood vessels, lymph vessels, and lymph
nodes.
Breast Components
The Breast Consist of:
 Milk glands (lobules) that produce and
supply milk
 Special ducts that transfer milk from the
lobules to the nipple

 Nipple
 Areola (pink/brown pigmented region
surrounding the nipple)
 Fat

 Connective (fibrous) tissue

Breast Structure
- a breast is usually slightly larger or smaller, higher or
lower or of different shape to the other side.
- It is composed of 15–20 lobes of branching glands when
its fully developed.
lobes are separated by bands of connective tissue,
which radiate out from the nipple like spokes from
the middle of a bicycle wheel.
- There is lots of fat tissue within the breast.
- The special glands in the breast are called tubuloalveolar
glands, which are modified sweat glands.
A gland whose secretory portions end in tubular
and alveolar configurations.
- Each of these glands end in a lactiferous duct (2–4 mm
in diameter) and opens up through a small hole onto
the nipple.
 Breast Structure
- Deep to the areola, each duct has a dilated part called
the lactiferous sinus, in which milk can accumulate and
remain in the nursing mother.
- Myoepithelial cells, cells which are important in
contraction movement, are present in the gland and
help secreting fluids.
- There are many smooth muscle fibers in tissues of the
breast, which are specially arranged to help the nipple to
become erect when stimulated.
During puberty, the pigment in the nipple and
areola increases and the nipple becomes more
prominent.
- Within the areola, there are sebaceous glands, sweat
glands and modified mammary glands (glands of
Montgomery).
Vasculature of the Breast
Arteries carry oxygen-rich blood from the heart
to the chest wall and the breasts, while veins
take de-oxygenated blood back to the heart.
The arterial supply of the breast is from:
 Internal thoracic artery
 Lateral thoracic and thoraco-acromial arteries
 Posterior intercostal arteries
- Venous drainage of the breast is mainly
through the axillary vein, and some
drainage occurs through the internal
thoracic veins.
- Lymph runs from the nipple, areola and
lobules into a special network, which then
drains to the axillary lymph noses,
parasternal and sub-clavicular nodes.
- The nerve supply of the breast is derived from
the intercostal nerves.
Normal Breast
Development
and
Changes
When does breast development
begin?

- Breasts begin to form while the unborn baby

is still growing in the mother’s uterus. This
starts with a thickening in the chest area
called the mammary ridge or milk line.
- The first thing to develop are lobes, or small
subdivisions of breast tissue. Mammary
glands develop next and consist of 15 to 24
lobes.
- Shrinkage (involution) of the milk ducts is the
final major change that happens in the breast
tissue.
 What breast changes happen at
puberty? Female Breast Description
Development Stage
- When the ovaries start to produce and release Stage 1 Preteen, only the tip of the nipple is
(secrete) estrogen, fat in the connective tissue raised
starts to collect.
Stage 2 Buds appear, and breast and
- Breast causes to enlarged nipple are raised. The dark area of
- Duct system starts to grow. skin around the nipple (the areola)
gets larger

- Once ovulation and menstruation begin, Stage 3 Breast are slightly larger, with
the maturing of the breasts begins with the glandular breast tissue present.
formation of secretory glands at the end of Stage 4 The areola and nipple become
the milk ducts. raised and form a second mound
above the rest of the breast
Stage 5 Mature adult breast. The breast
becomes rounded and only the
nipple is raised.
What cyclical changes happen to the
breasts during the menstrual cycle?

- The hormone estrogen is produced by the

ovaries in the first half of the menstrual cycle.
- It stimulates the growth of milk ducts in
the breasts.
- The hormone progesterone takes over in the
second half of the cycle.
- It stimulates the formation of the milk
glands.
What happens to the breasts during
pregnancy and milk production?
Breast changes are one of the earliest signs of
pregnancy. In addition, the dark areas of skin
around the nipples (the areolas) begin to swell. This
is followed by the rapid swelling of the breasts
themselves.

Most pregnant women feel soreness down the sides

of the breasts, and nipple tingling or soreness. This
is because of the growth of the milk duct system
and the formation of many more lobules.

By the fifth or sixth month of pregnancy, the

breasts are fully capable of producing milk. As in
puberty, estrogen controls the growth of the ducts,
and progesterone controls the growth of the
glandular buds.
What happens to the breasts at
menopause?

- The levels of estrogen and

progesterone begin to change.
Estrogen levels dramatically
decrease.
- The breast tissue, which was
prepared to make milk, shrinks
and loses shape.
DIVISION
OF
BREAST
QUADRANTS
- The breasts are divided by an invisible line
running up and down and right to left through
the nipple.
- The mammary gland is divided into 4 regions
called a quadrant.
Upper outer (superolateral) quadrant
Upper inner (superomedial) quadrant
Lower outer (inferolateral) quadrant
Lower inner (inferomedial) quadrant
- Most breast cancers develop in the upper outer
quadrant of the breast, closest to the armpit.
UPPER OUTER OR SUPEROLATERAL
QUADRANT
- Where majority of cancers develop.
- Large amount of the glandular tissue is here.
- Therefore many breast conditions (among
them is breast cancer) occur more
frequently in this region.
- Axillary tail of Spence is a prolongation of upper,
outer quadrant in axillary direction passes under
axillary fascia.
- It is surgically importance.
- In some normal subjects it is palpable and, in
a few, it can be seen premenstrual or during
lactation.
- A well-developed axillary tail is sometimes
mistaken for a mass of enlarged lymph nodes
or a lymphoma
OTHER QUADRANT OF THE BREAST

Upper inner (superomedial) quadrant

Lower outer (inferolateral) quadrant
Lower inner (inferomedial) quadrant

Clinically this quadrants are important

to describe the lump of the human breast. It
used to easily location of the masses and
other pathologies that being examined at the
human breast.
CLOCKFACE REFERRENCE OF THE
BREAST
- Positions of findings in the breast are described in
breast quadrants, with the upper outer quadrant
representing the breast quadrant nearest the
axilla.
- Another way to describe a breast location is by
using the “clock face” method, in which the
location of breast findings is described as though
a clock were superimposed on each breast as the
woman faces the examiner
- Clock face description of breast lesion locations.
- The clock face location of breast findings is
described by imaging a clock on both the left and
the right breast as the woman faces the examiner.
- Note that the outer portion of the breast on the
right is at the 9-o’clock position and the outer
portion on the left is at the 3-o’clock position.
EXTERNAL ANATOMY OF THE BREAST
Nipple
- protrudes outward from the center of the
areola. There are several small openings in the
nipple that allow breast milk to flow out of the
breast and into the baby’s mouth.
Areola
- It is the circular or oval area at the center
of the breast that is a darker color than the
surrounding skin. It is believed that the areola
is darker in color so that the newborn can
more easily locate it to latch on and begin
breastfeeding.
Montgomery Glands
- On the outside of the nipple and areola are small raised,
bumpy glands. These glands produce a secretion that
cleans, moisturizes, and protects the nipple and areola
during breastfeeding.
- It is believed that it can produce a scent that helps the
newborn to find the nipple and latch on.
Morgagni's tubercles
- located near the periphery of the areola, are elevations
formed by the openings of the ducts of Montgomery's
glands.
- also known as areolar glands or glands of Montgomery.
These are the pimple-like pores on the surface the areola.
They are a type of sebaceous gland found all over the
body that produces oils to moisturize and protect the
skin.
- It can range from as few as one to as many as 30.
Skin
- The breasts are covered by skin. The skin
surrounding the breast contains the areola, the
nipple, and the Montgomery glands.
1. Sebaceous Glands
is a microscopic exocrine gland in
the skin that opens into a hair follicle to secrete an
oily or waxy matter, called sebum, which lubricates
the hair and skin of mammals.
2. Hair Follicle
Like other surfaces on the skin, the breast and
the area around the areola contains hair follicles
which are influenced by changes in both female and
male hormone levels.
Hormonal fluctuations are, in fact, frequently
responsible for the density and thickness of the
hair growing on the breast and around the areola.
Axillary tail
- The tail of Spence (Spence's tail, axillary
process, axillary tail) is an extension of the
tissue of the breast that extends into
the axilla.
- It is an extension of the upper lateral
quadrant of the breast. It passes into the axilla
through an opening in the deep fascia called
foramen of Langer.
Inframammary Fold
- is a zone of adherence of the superficial fascial
system to the underlying chest wall.
- It is anatomically defined as the area where the
skin of the lower pole of glandular breast tissue
meets the chest wall forming a groove known as
the inframammary crease.
INTERNAL ANATOMY OF THE BREAST
Retromammary Space
- is located between the membranous layer of superficial
fascia and the deep fascia covering the muscles of
the thorax.
- The mobility of the female breast on the body wall is
largely due to this space; in self-examination for breast
cancer, mobility can be decreased.
- It is often the site of the breast implantation due to its
location away from the key nerves and structures that
support the breast
- It contains the areolar tissue.
Cooper’s Ligaments
- are bands of tough, fibrous, flexible connective
tissue that shape and support your breasts.
Named for Astley Cooper, the British
surgeon who described them in 1840.
- It also known as the suspensory ligaments of
Cooper and the fibro collagenous septa.
- are found under the skin of the breast, through
and around the breast tissue.
- It maintain the shape and structure of your
breasts and help to prevent sagging.
- It also help the early detection of breast cancer.
BREAST PARENCHYMAL COMPONENTS
1. Fibrous Tissues
- or supportive or connective, tissue is the
same tissue that ligaments and scar tissue
are made of.
- It holds the breast tissue in place.
2. Glandular tissue
- is the part of the breast that makes milk,
called the lobes, and the tubes that carry
milk to the nipple, called ducts.
Together, fibrous and glandular tissue are
called fibro glandular tissue.
2.1 Glandular Lobes
- the adult female breast contains
15 to 20 lobes of glandular tissue that
radiate around the nipple.
The lobes are separated by connective
tissue and adipose tissue. The connective
tissue helps support the breast.
Some bands of connective tissue, called
suspensory (Cooper's) ligaments, extend
through the breast from the skin to the
underlying muscles which is pectoral
muscles.
The amount and distribution of the adipose
tissue determines the size and shape of the
breast.
Each lobe consists of lobules that contain the
glandular units.
A lactiferous duct collects the milk from the
lobules within each lobe and carries it to the
nipple.
Just before the nipple, the lactiferous duct
enlarges to form a lactiferous sinus (ampulla),
which serves as a reservoir for milk.
After the sinus, the duct again narrows, and
each duct opens independently on the surface
of the nipple.
The normal growth and function of
mammary epithelial cells depend on
interactions with the supportive stroma.
The human mammary gland contains two
distinctive types of fibroblasts within the
stroma.
The epithelial cells are surrounded by loosely
connected intralobular fibroblasts, which are
subsequently surrounded by the more
compacted interlobular fibroblasts.
The different proximity of these fibroblasts to
the epithelial cells suggests distinctive
functions for these two subtypes.
Lymphatic drainage
Lymphatic drainage of breast originates
from breast lobules and flows
through intramammary nodes and
channels into a subareolar plexus,
called Sappey’s Plexus.
From this plexus, lymphatic drainage
takes place through three main routes
that parallel venous tributaries.
Lymphatics from the left breast
ultimately terminate in the thoracic duct
and the left subclavian vein, and from
the right breast in the right subclavian
vein.
•axillary or lateral pathway
• dominant pathway (receives >75%
of lymph from breasts).
• drains lateral quadrants of breast
either directly or via Sappey's plexus
to axillary nodes.
• either runs around inferior border of
pectoralis major to reach the
pectoral group of lymph nodes or
pass directly to the subscapular
group.
• few channels from superior breast to
the apical group sometimes
interrupted by the infraclavicular
group of lymph nodes.
•internal mammary pathway
• originates from both the medial and lateral
quadrants of the breast
• passes through the intercostal spaces and
pectoralis major into parasternal/internal
mammary lymph nodes
• connections may lead across the median plane
and hence to the contralateral breast
•retromammary pathway
• comes from the deeper portion of the breast
• drains to the subclavicular plexus
Other pathways occur when usual channels are blocked
in disease. Lymph may pass to the contralateral breast,
cervical nodes, peritoneal cavity and liver through
the diaphragm or through the rectus sheath.
Breast blood supply comes
from three sources:
•Branches of the axillary artery supply the lateral
part of the breast. These are:
1. Superior thoracic
2. thoraco acromial
3. lateral thoracic
4. subscapular arteries.
•Branchesof the internal thoracic artery, supply
the medial part of the breast as the medial
mammary arteries.
•Perforating branches of second, third and
fourth intercostal arteries contribute to the
supply of the entire breast.
BREAST
PATHOLOGY
BREAST CANCER
Carcinoma is a term used to describe a
cancer that starts in the lining layer
(epithelial cells) of organs like the breast.
Nearly all breast cancers are carcinomas.
Most are the type of carcinoma that starts in
glandular tissue called adenocarcinoma.
Benign Breast Conditions
Benign (non-cancer) breast changes can include:

• Adenosis - is a benign (non-cancerous) breast

condition in which the lobules (milk-producing
glands) are enlarged, and there are more glands than
usual. It is often found in biopsies of women who
have fibrosis or cysts in their breasts.

• Sclerosing adenosis - is a special type of adenosis in

which the enlarged lobules are distorted by scar-like
tissue. This type may cause breast pain.
• Apocrine metaplasia - it is the transformation
of breast epithelial cells into an apocrine or
sweat‐gland type of cells, often occurs in the
peripheral parenchyma, particularly among
premenopausal women and it is usually
associated with gross cysts in fibrocystic breast
disease, the most common non‐cancerous disease
of the breast.
• Breast Cysts - are a benign (not cancer)
condition. They’re one of the most common
causes of a breast lump and can develop in either
one or both breasts. It’s thought they develop
naturally as the breast changes with age due to
normal changes in hormone levels.
• Columnar cell change and Columnar cell hyperplasia
- are two common, closely related, non-cancerous
conditions that often develop together in the breast.
• Collagenous spherulosis - nonneoplastic alteration
characterized by spherules of basement membrane material
surrounded by myoepithelial cells
• Duct Ectasia - also known as mammary duct ectasia, is a
benign (non-cancerous) breast condition that occurs when a
milk duct in the breast widens and its walls thicken.
• Columnar alteration with prominent apical snouts and
secretions (CAPSS) - is a pathological entity encountered
when breast biopsies are done for investigation
of punctate or amorphous calcifications. CAPSS involves
the terminal ductal and lobular units (TDLU’s).
• Intraductal Papilloma's of the Breast - are benign (non-
cancerous), wart-like tumors that grow within the milk ducts
of the breast. They are made up of gland tissue along with
fibrous tissue and blood vessels (called fibrovascular tissue
I.BREAST ANOMALIES
1.Breast Asymmetry – it occurs when one breast
has a different size, volume, position,
or form from the other.
- A common abnormality seen
on mammogram results is breast
asymmetry.
- Juvenile hypertrophy is one of the
condition that cause breast asymmetry
2. Inverted Nipples - is a condition in which the
nipple is pulled inward into the breast
instead of pointing outward.
- alsobe called nipple inversion, nipple
retraction, or invaginated nipple, although
some observers distinguish these two
variations.
 I. BREAST ANOMALIES
3. Accessory breast tissue - tissue is a relatively
common congenital condition in which
abnormal accessory breast tissue is seen in
addition to the presence of normal breast
tissue.
- can be found anywhere along the
thoracoabdominal region of the milk line
(the embryologic mammary streak) but are
most frequently found in the axilla and may
occur bilaterally.
II. CLINICAL BREAST CHANGES
1.Lumps – it come in different shapes and sizes.
Normal breast tissue can sometimes feel lumpy.
2. Thickening
3. Swelling
4. Dimpling - can be a sign of a serious form of cancer known
as inflammatory breast cancer.
- Also known as peau d’orange, dimpling of the breast
causes the skin to look like the pitting and uneven
skin of an orange. Sometimes, the skin can also be
red and inflamed.
5. Skin Irritation
6. Breast pain (mastalgia) can be described as tenderness,
throbbing, sharp, stabbing, burning pain or tightness in the
breast tissue.
III. Breast discharge
IV. Nipple Retraction and areola changes
V. Lymphoedema - is swelling caused by a
build-up of fluid in the body’s
tissues.
- is a long-term condition,
which means that once it has
developed it can be controlled
but is unlikely to ever go away
completely.
VI. Erythema
VII. Implants
2 types: saline and silicone gel
VIII. Breast Reduction
XI. Post-Surgical Excision
X. Radiation Changes
Breast Changes During Your Lifetime That
Are Not Cancer

1. Before or during your menstrual periods

2. During pregnancy
3. As you approach menopause
4. If you are taking hormones
5. After menopause
MAMMOGRAPHIC APPEARANCE OF
PATHOLOGY
Fact Necrosis
DUCT ECTASIA
Fibrocystic Breast
DIAGNOSIS OF BREAST CARCINOMA
1. Mammography
- Diagnostic Mammogram
- Screening Mammogram
2. Ultrasound
3. MRI
4. Biopsy
- Fine Needle Aspiration
- Core- Needle Biopsy
- Surgical Biopsy
- Image Guided Biopsy
-Sentinel lymph node biopsy
5. Laboratory Test
- Hormone receptor test
- HER2/neu Test
- Tumor features.
- ER and PR
- Grade