CH. 28 The breast

Increased levels of ____________________ stimulate the development of the breast lobules and alveoli.

progesterone

after childbirth the anterior pituitary gland will secrete _________, which stimulates development of the secretory system of the breast.

prolactin,

The hypothalamus produces ___________________________, which prevents the release of prolactin until milk production becomes necessary after childbirth.

prolactin-inhibiting factor

The main function of the breast is the

secretion of milk

oxytocin

stimulates the breast's secretory system after childbirth.

The breast contains ______________________________, as well as the fat that separates the lobes.

subcutaneous fat and retromammary fat layers

the _______________________ of Cooper (Cooper's ligaments), which run between each two lobules from the deep muscle fascia to the skin surface.

suspensory ligament

Support of breast tissue is provided by the ___________________________________ , which run between each two lobules from the deep muscle fascia to the skin surface

suspensory ligaments of Cooper (Cooper's ligaments)

The mammary glands are modified __________________.

sweat glands

The size of the normal breast varies depending on

the age, functional state, and amount and arrangement of stromal and parenchymal elements of the individual.

Danazol:

A male hormone that may help to decrease pain and swelling of the breast. It suppresses activity of the anterior pituitary gland and is used to treat women with endometriosis. This hormone may be associated with side effects.

Fibrocystic breast:

A variant common in women of childbearing age. Various fibrotic components and cystic areas may be distributed throughout the entire breast.

Progesterone —

Elevated levels of this hormone during pregnancy stimulate development of breast lobules and alveoli to prepare the breast for lactation.

Prolactin-Inhibiting Factor —

Inhibiting factor released by hypothalamus that prevents release of prolactin until after milk production becomes necessary following childbirth.

Stromal Elements —

Connective tissue and fat components of the breast.

Pectoralis Major Muscle —

Large chest muscle located in the retromammary layer.

Parenchymal Elements —

Lobes, lobules, ducts, and acini components of the breast.

Anterior Pituitary Gland —

Located in the brain and influenced by the hypothalamus. Secretes prolactin, which stimulates development of the secretory system of the breast after childbirth to prepare for lactation.

Breast —

Mammary gland that produces milk after pregnancy for suckling.

Breast Parenchyma —

Mammary layer that contains glandular tissues and ducts.

Each lactiferous duct has an ampulla or expanded region called _____________________ near the nipple, where milk can be stored until released during suckling

Montgomery's glands

Subcutaneous Layer —

Most anterior of the 3 breast layers; contains skin and subcutaneous fat.

Retromammary Layer —

Most posterior of the 3 breast layers; contains retromammary fat, muscle, and deep connective tissues.

Fatty Breast —

Normal variant characterized by increased fatty components throughout the breast. Deposition of fat increases with age and parity.

Fibrocystic Breast —

Normal variant common in women of childbearing age.

• Venous drainage:

Occurs through a combination of superficial and deep venous systems. The veins course parallel to the arteries.

Arterial blood: .

Supplied through the internal thoracic or the internal mammary artery. The internal mammary artery originates off the subclavian artery and enters the breast through the second, third, and fourth intercostal spaces medially and through the lateral thoracic artery. That artery becomes the superficial mammary artery and supplies the more superficial breast structures.

Connective Tissues —

Supportive structures located in the mammary layer.

Cooper's Ligaments —

Suspensory ligaments that run between each 2 lobules from the deep muscle fascia to the skin surface.

oxytocin

causes contraction of the lactiferous ducts, and lactation begins.

the secretion of milk via the ____________________ ducts after childbirth. This function is called lactation.

lactiferous

The breast has 3 layers.

1. subcutaneous layer 2.mammary layer 3.retromammary layer

Each lobule consists of up to ___________ clustered around a collecting duct.

100 acini

The normal breast is composed of ________________________ separated by adipose tissue.

15 to 20 mammary lobes

Lactiferous ducts in Nonpregnant women:

2 mm

Insulin:

A hormone produced by the pancreas that is necessary for breast development during pregnancy.

Thyroxine:

A hormone produced by the thyroid gland that is necessary for breast development during pregnancy.

Lactiferous ducts in Nursing women:

8 mm

Cortisol:

A hormone produced by the adrenal cortex that is necessary for breast development during pregnancy

Vitamin E:

Affects the levels of fat and hormones in the blood and may help relieve pain and swelling of breast tissues.

Elastography —

Also known as strain imaging or elasticity, elastography helps determine the stiffness of a mass relative to its surrounding tissue. Another type of elastography referred to as shear wave elastography uses a focused ultrasound beam to create an acoustic radiation force impulse. This type of elastography allows for a quantitative measurement of tissue stiffness.

The ______________________________ strongly urges women to perform breast self-examinations every month.

American Medical Association

Montgomery's Glands —

Ampulla or expanded region for each lactiferous duct near the nipple, where milk can be stored until released by suckling.

Fatty breast:

Characterized by increased fatty components throughout the breast, with decreased echogenicity.

Lactiferous Ducts —

Ducts in the parenchyma of the breast that secrete milk after pregnancy.

Exocrine —

Glands with ducts; mammary glands secrete milk through lactiferous ducts after pregnancy.

Alveoli —

Glandular tissue elements within mammary lobules.

Oxytocin —

Hormone produced by the posterior pituitary gland, which stimulates contraction of the lactiferous ducts for milk secretion. Secretion is stimulated by infant suckling during breastfeeding.

Prolactin —

Hormone released from anterior pituitary gland that stimulates development of the secretory system of the breast after childbirth to prepare for lactation.

Estrogen —

Hormone that stimulates breast tissue development during puberty, childbearing years, and pregnancy.

Mammography —

Radiographic examination of the breast.

Caffeine:

Reduced caffeine intake may lessen breast lumps, swelling, and soreness, especially in women with fibrocystic breast changes. Such a reduction will not affect risk factors for breast cancer.

Hypothalamus —

Region in the brain that controls hormones and the anterior pituitary gland. Produces prolactin-inhibiting factor, which prevents release of prolactin until milk production becomes necessary following childbirth.

Mammary Layer —

Second of the 3 breast layers; contains glandular tissues, ducts, and connective tissues.

Lactation —

Secretion of milk from mammary glands (breasts).

Acini —

Small, grape-shaped secretory portions of a gland (singular, acinus).

3-D/4-D —

Sonography that provides multiplanar imaging.

• Lymph drainage:

The breast's lymphatic system originates in lymph capillaries within breast connective tissues. Lymph drainage from the breast originates in the connective tissues of the breast and follows 3 main pathways: 75% of lymph drainage occurs through the axillary lymph nodes, which are in close proximity to the axillary tail of the breast, which extends superolaterally to border the axilla; 20% of lymph drainage occurs medially through the thoracic nodes; and 5% occurs subcutaneously through the intercostal nodes.

The glandular tissues of the breast become _________ as a result of __________________ during pregnancy.

active hormonal stimulation

Breasts often appear more fatty _______________________ because the fat components become more prominent as the mammary ducts begin to atrophy.

after menopause

sonographic appearance of the breast depends on several factors, primarily the

age of the woman and the functional state of the breast.

Prolactin

allows the production of milk

The function of the ___________ is to secrete milk into the secondary tubules.

alveoli

Breast ducts and ductules appear as _______________ tubular structures

anechoic

Secretory ducts appear as _____________ tubular structures on ultrasound.

anechoic

The ____________________________ secretes prolactin, which stimulates the development of the secretory system of the breast.

anterior pituitary gland

The hypothalamus produces many hormones and influences the ________________________________.

anterior pituitary gland.

Secretions from the _______________ keep the nipple area pliant

areolar glands

Fatty breasts may demonstrate areas of _____________________due to the connective tissues surrounding the mammary ducts.

bright echogenicity

The fibrous components, such as Cooper's ligaments, demonstrate increased echogenicity and are seen as _________________________.

bright, linear echoes.

the mammary layer

contains the glandular tissues, ducts, and connective tissues

the retromammary layer

contains the retromammary fat, muscle, and deep connective tissues.

The subcutaneous layer

contains the skin and all of the subcutaneous fat

All secondary tubules from each lobule ____________ to form a lactiferous duct.

converge

Breast development is stimulated by

estrogen

There is an increase in development of breast tissue owing to stimulation by ________________ during puberty and, later, during childbearing years and pregnancy. With the decrease in hormonal stimulation after menopause, the normal breast will atrophy to some degree.

estrogen

The breast( mammary glands) are ____________ organs.

exocrine

The stromal elements include _________________________, which helps provide support and structure.

fat and all of the connective tissue

With age, the breast parenchyma becomes replaced by _________________.

fatty tissues

Lobules contain _____________________ elements.

glandular tissue

After the placenta has been expelled and estrogen levels _____________________, the prolactin levels will begin to increase to a level that allows the production of milk.

have decreased

When the sonographic appearance is __________________ throughout the breast, it allows for differentiation of pathology

heterogeneous

The glandular or parenchymal tissues tend to appear

homogeneous in texture, with medium-level to low-level echogenicity

Breast fat appears ________________ to the surrounding breast parenchyma or glandular tissue

hypoechoic

The fat components appear _____________ to surrounding parenchymal breast tissue.

hypoechoic

the pectoralis major muscle, which appears distinctly ___________ in comparison with adjacent structures

hypoechoic

the production of milk and its absence are controlled by hormones produced within the ________________________________________, located deep within the brain.

hypothalamus and anterior pituitary gland

Cooper's ligaments demonstrate as ______________________ and are seen as bright linear echoes.

increased echogenicity

Elastography

is a technique that improves sonographic visualization of tissues in fibrous breasts

Elastography:

is most helpful in assessing the fibrous breast because it eliminates some of the posterior shadowing resulting from the increase in dense connective tissues.

The lobes are further divided into __________, each of which contains glandular tissue elements (alveoli).

lobules

The lobes in each breast are divided into ____________, each of which contains glandular tissue elements.

lobules

Montgomery's glands and areolar glands are similar in that both are

located near the nipple area

Glandular, or mammary, tissue demonstrates a

low to medium level echo pattern.

Many lobules make up a ______________, from which secondary tubules form __________________, which lead to ____________________ that exit at the nipple

mammary lobe mammary ducts lactiferous ducts

Dense parenchyma is difficult to visualize with ____________________; therefore, younger patients presenting with a possible breast mass often are first evaluated with ultrasound

mammography

The glandular layer of the breast atrophies after

menopause

3D/4D sonography provides ______________ imaging.

multiplanar

The younger breast has a higher percentage of __________________ than fat.

parenchyma

the breast is composed of ______________________________ elements.

parenchymal and stromal

The breast is anterior to the

pectoralis major, serratus, and external oblique muscles and the sixth rib.

The infant's suckling stimulates the secretion of oxytocin from the ___________________________.

posterior pituitary gland.

The infant's suckling stimulates the secretion of oxytocin from the _____________________________.

posterior pituitary gland.

When scanning directly anterior to the nipple, _______________________________.

posterior shadowing is visualized

Progesterone

prepares the breast during pregnancy for nursing

The parenchymal elements include

the lobes, lobules, ducts, and acini, which are small, grape-like secretory structures.

The function of the alveoli is__________________________. All secondary tubules from each lobe converge to form a lactiferous duct.

to secrete milk into the secondary tubules