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Breast

Christine Du

INTRODUCTION

Test Taking Tips

  • Know the contraindications for breast conservation. This is a commonly missed area. Most people are aware that breast conservation is the preferred treatment, so they tend to pick this as the answer.

  • Surgical management of breast cancer after neoadjuvant therapy is another frequently missed topic. If the patient doesn’t have contraindications to breast conservation, they may choose either breast conservation or mastectomy. This is based on the residual disease, not on the original tumor size.

  • Know the anatomic levels of the axilla. The pectoralis minor muscle divides the axilla into 3 levels.

ANATOMY/PHYSIOLOGY

The embryologic structure from which the breast forms:

  • Ectodermal thickenings, termed mammary ridges or milk lines

Name the function of the following hormones:

  • Estrogen: branching differentiation and duct development in the breast

  • Progesterone: lobular development of the breast

Name the muscle the artery supplies:

  • Lateral thoracic artery

    • Serratus anterior muscle

  • Thoracodorsal artery

    • Latissimus dorsi

Name the nerve that innervates the following muscles:

  • Serratus anterior muscle

    • Long thoracic nerve

    • Latissimus dorsi

    • Thoracodorsal nerve

  • Pectoralis minor

    • Medial pectoral nerve

  • Pectoralis major

    • Lateral and medial pectoral nerves

Name the complication if the following nerves were injured:

  • Long thoracic nerve: Winged scapula

  • Thoracodorsal nerve: Weak arm adduction/pull-ups

Name the arterial supply to the breast:

  • Branches derived from the intercostal arteries, internal thoracic artery, lateral thoracic artery, and thoracoacromial artery

The valveless venous plexus responsible for direct hematogenous spread of breast cancer to the spine:

  • Batson plexus

Suspensory ligaments that divide the breast into segments:

  • Cooper ligaments

Percentages of lymphatic drainage of the breast:

  • The axillary nodes: 97%

  • The internal mammary nodes: 1% to 2%

Anatomic description for levels I, II, and III nodes in the breast:

  • Level I: Lateral to the pectoralis minor muscle

  • Level II: Beneath the pectoralis minor muscle

  • Level III: Medial to the pectoralis minor muscle

What are Rotter nodes?

  • Nodes between the pectoralis minor and major muscles

What are the boundaries of the axilla?

  • Superior: Axillary vein

  • Posterior: Long thoracic nerve

  • Lateral: Latissimus dorsi muscle

  • Medial: Pectoralis minor

FIGURE 11-1

Axillary lymph node groups. Level I includes lymph nodes located lateral to the pectoralis minor (PM) muscle, level II includes lymph nodes located deep to the PM, and level III includes lymph nodes located medial to the PM. Arrows indicate the direction of lymph flow. The axillary vein with its major tributaries ...

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