Comprehensive Report on Breast Anatomy, Cancer, and Treatment Options

This report provides a comprehensive overview of breast anatomy, detailing the structure and function of the breast in both premenopausal and postmenopausal women. It explores differential diagnoses for palpable lumps, including cysts, fibrocystic changes, cancer, and fat necrosis, along with the main risk factors associated with breast cancer such as gender, age, family history, and genetics. The clinical presentation of breast cancer, including physical examination findings and the significance of family history, is discussed. The report also covers the grading of lesions, the distinction between DCIS and infiltrating ductal carcinoma, and the importance of estrogen and progesterone receptors in treatment decisions. Finally, it examines the complications of both surgery and radiotherapy, including changes in breast sensation, lymphedema, and potential side effects such as skin irritation and chronic lung, heart, and nerve problems, as well as the role of wide re-excision lumpectomy post-treatment.

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BREAST ANATOMY
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Breast Anatomy
Part 1: Breast Anatomy
The breast is an organ that is used in the production of milk during lactation in adult
women. The components of the tissue are made up of lobules that are responsible for the
production of milk. According to Pandya and Moore (2011), the lobules are connected to ducts
that proceed to nipples p. 92. The main mass of the breast is made up of adipose and fibrous
tissues where the lobules and ducts are spread out. The male and female breasts are almost
similar in structure apart from the absence of specialized lobules in male breasts due to the lack
of physiologic need of milk production in men (Hassiotou and Geddes, 2013, p. 35).
The breast of an adult is located above the pectoralis muscle that is located above the
ribcage. The breast tissues spread horizontally from the sternum’s edge towards the midaxillary
line. The tail of the breast tissues also referred to as the axillary tail of Spence extends into the
axilla (Gabriel and Long, 2016). It is worth noting that a mass of breast cancer can develop in the
axillary tail. The breast tissues are surrounded by fascia which is a thin layer of fibrous tissues.
Fascia’s deep layer is situated atop the pectoralis major whereas the superficial layer is located
just beneath the skin.
The lymphatic drainage of the breasts flows from the lobules into the sub-areolar plexus
that is known as Sappey’s plexus. The lymphatic drainage occurs in three routes from Sappey’s
plexus. These routes include the axillary or lateral pathway, internal mammary pathway, and
retro-mammary pathway (Pandya and Moore, 2011, p. 93). The axillary pathway is supplied by
the ducts satellite lymphatic and the Sappey’s plexus. It runs around pectoralis major’s inferior
edge to the axillary nodes. Conversely, the internal mammary pathway comes from the medial

Breast Anatomy 3
and lateral halves of the breasts and goes to the contralateral breast via the pectoralis muscle.
Finally, the retro-mammary pathway flows from the posterior section of the breast. It is
important to note that more than 75% of lymph drained by the breast is received by the axillary
lymph node.
Premenopausal and Postmenopausal Breast Anatomy
In premenopausal women, there are around 15-20 lobes in each breast with every lobe
having between 20 and 40 lobules. Each breast has around 10 duct systems with every system
having an opening to the nipples. The breasts are normally mature after puberty but only become
active after pregnancy (Ellis and Mahadevan, 2013, p. 13). In premenopausal women, the breasts
have higher breast density implying that the breast has more tissue than fats. Postmenopausal,
however, is when the breast has more fats than tissue thus a lower breast density. It is also
important to note that the lobules begin to reduce after menopause (Johnson and Cutler, 2016, p.
9). The breast, as a result, remains comprised mainly of ducts, fibrous tissues, and adipose
tissues.
In premenopausal breasts, the glandular tissues are kept firm for milk production.
However, after menopause, these tissues shrink, and are replaced by fatty tissues (Johnson and
Cutler, 2016, p. 11). It is also important that the breasts sag after menopause due to the loss of
strength by the fibrous tissues. These changes in the anatomy of the breast after menopause could
be attributed to the absence of ovarian hormones in postmenopausal women (Ellis and
Mahadevan, 2013, p. 13). As a result, there is a degeneration of the secretory cells of the alveoli
and the breast gland atrophy. The fibrous tissues also degenerate and the degeneration is
accompanied by a decrease in stromal cells and collagen.

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Part 2: Research
Differential Diagnoses
For a woman of Carol’s age, the differential diagnosis for palpable lumps could include
cysts, fibrocystic changes, cancer, and fat necrosis. A cyst is a common cause of palpable lumps
in women aged above 40 years like Carol. Cysts fluctuate depending on the menstrual cycle of
the woman and are more common when there are irregular hormones (Errolozdalga.com, 2018).
They are characteristically round, soft, mobile, and usually tender. Fibrocystic changes are
characterized by rope-like or lumpy breast tissues. It is normally painful and the pain gets worse
accompanied by an increase in size during pre-menses (Errolozdalga.com, 2018). This condition
increases the risk of breast cancer if there is a variant with the proliferation of the epithelial. Fat
necrosis, on the other hand, is a rare lesion that produces a mass accompanied by a retraction of
the skin or nipples. It is presumed that this condition is caused by trauma and biopsy is used to
diagnose it (Errolozdalga.com, 2018). Finally, cancer, the other differential diagnosis is
characterized by firm, stellate, and irregular tissues. It results in a clear delineation from adjacent
tissues.
Main risk factors of breast cancer
The following are some of the risk factors associated with breast cancer (Stuckey, 2011, p. 100)
i. Gender
ii. Age
iii. A history of breast cancer in the family
iv. Genetics
v. Individual history of breast cancer

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vi. Obesity
vii. Menstrual history
viii. Alcohol
ix. Dense breasts
x. Smoking
These risk factors, however, differ in postmenopausal and premenopausal women. The
chances of having breast cancer increase as a woman ages and therefore women who experience
menopause past the age of 55 years possess a greater risk of suffering from breast cancer (Butt et
al., 2012, p. 120). It is additionally worth noting that women who started experiencing their
menses before the age of 12 years are at an increased risk of having breast cancer to long-term
exposure to estrogen hormone.
Several studies have revealed that breast cancer is more prevalent in late menopause and
an early onset of menarche in both premenopausal and postmenopausal women (Nelson et al.,
2012, p. 640). Additionally, failure to practice breastfeeding has been discovered to increase the
risks of breast cancer between both sets of women. Longer duration of breastfeeding has been
reported to lower the risks of breastfeeding in premenopausal women; however, the same may
not be confirmed in postmenopausal women (Butt et al., 2012, p. 120). Finally, having dense
breast tissues also increased the risk of breast cancer among both sets of women.
The Clinical Presentation for Breast Cancer
A history of breast cancer in the family is very significant in the risk assessment of this
condition. In fact, breast cancer in a first-degree relative is the most commonly recognized risk
factor for breast cancer. Women who have a member of the family with a history of ovarian or

Breast Anatomy 6
breast cancer should be screened to ascertain the family history that may be linked to increased
risks for mutations of the susceptibility genes of breast cancer. These genes include BRCA1 and
BRCA2. Positive screening results should mean that the women receive genetic counseling
(Robertson et al., 2010). Conversely, women without such a family history should not be
subjected to BRCA testing or genetic counseling.
Physically examining the breast can also be useful in identifying the possibility of breast
cancer. The presence of lumps, an increase in the size of breasts, changes in the skin such as
swelling and redness, axillary lump, and nipple discharge could be some of the signs and
symptoms of breast cancer (Robertson et al., 2010, p. 365). An assessment of the patient’s
breasts should be done to detect changes in the contour of the breasts and skin tethering. From
the assessment, some of the following findings should be a cause for concern; dilated veins,
inverted nipples, ulceration, skin tethering, and mammary page disease. Palpable lumps can be
characterized by irregularity, hardness, focal nodularity, and fixation to muscles or skin.
Robertson et al. (2010) further ascertain that a complete examination of the sites of skeletal pain
and the chest in addition to a neurological and abdominal examination should help in identifying
some of the following symptoms; pain in the bones, breathing difficulties, jaundice, and
abdominal distention among others p. 365.
Part 3: Diagnosis and Test Results
Grading of Lesions
Lesions are graded on a scale of one to three depending on the aggressiveness of the
cancerous cells. These grades include low grade (1), intermediate grade (2), and high grade (3)
(Ward and Thoolen, 2011). Low-grade tumors share a resemblance with normal tissues when

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viewed under the microscope and are thus referred to as well-differentiated. These tissues tend to
spread at a slower rate when compared to the tissues in grade 2 and grade 3. In the intermediate
grade, the tissues are moderately differentiated and slight abnormalities can be viewed under a
microscope. High-grade tumors, on the other hand, show more abnormalities than the normal
tissues under a microscope (Ward and Thoolen, 2011). Additionally, their growth and spread are
more aggressive compared to the other grades.
Infiltrating ductal carcinoma and DCIS
DCIS implies that the cancer is contained in the milk and has not invaded any other
breast tissues out of the ducts. It is caused by an unrestrained growth of cancerous cells within
the breast ducts. It usually does not cause breast lumps that can be felt (Harris, Lippman Osborne
and Morrow, 2012). It is characterized by bloody discharge from the nipples and breast pains.
Infiltrating ductal carcinoma, on the other hand, begins at the duct and spreads to other breast
tissues. It can be characterized by hard, immovable lumps in a woman’s breast. It may also cause
an inversion of the nipples.
Estrogen and Progesterone Receptors
During a biopsy, the cancerous cells in the breast are taken out and tested for the presence
of proteins that may act as estrogen and progesterone receptors. The growth of breast cancer is
fueled when estrogen and progesterone attach themselves to the receptors (Chlebowski et al.,
2010, p. 1687). From Carol’s test results, we are told that the estrogen and progesterone
receptors were negative. This implies that cancer has been contained from growing and
spreading to other tissues. Knowledge of the hormone receptor knowledge is important in

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making decisions on the best treatment options (Liu et al., 2010, p. 53). It is worth noting that
treating this type of cancer with hormone therapy drugs may not be helpful.
Complications of Surgery and Radiotherapy
The two most common treatments for breast cancer are surgery and radiotherapy. These
two methods are highly effective and are in most cases done in combination. They, however,
have several side effects that may be dangerous to the patient. Surgery can be in the form of
lumpectomy, mastectomy, or bilateral mastectomy. One of the most common side effects of
surgery as a treatment option for breast cancer is the change in breast sensation. This can further
affect a woman’s sexual well-being. Additionally, the risks of lymphedema are increased due to
the removal of lymph nodes during surgery which is normally an incurable swelling that is
experienced on the arm located on the same side as the breast where the surgery had been
performed (Veronesi et al., 2010, p. 148). Furthermore, there are increased risks of infection with
the procedures involved I mastectomy and lumpectomy. Some patients may also experience
adverse anesthetic reactions that can also be dangerous medical risks.
Radiotherapy is normally prescribed after surgery to kill any remaining cancerous cells.
Radiotherapy could be responsible for both acute and chronic side effects. The acute side effects
show up during treatment while the chronic side effects are experienced may be months or years
after treatment. Acute side effects may consist of skin irritation, a painful swelling of the breast,
sore throat, loss of air in the armpits, and elevated risks of lymphedema (Veronesi et al., 2010, p.
148). The chronic side effects may include lung, heart and nerve problems. Additionally, patients
who survive initial cancer may develop secondary cancer due to radiotherapy.
Part 4: Post Treatment

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Wide Re-excision Lumpectomy
Wide re-excision lumpectomy may be defined as an additional surgery performed by the
surgeon to remove any remaining cancerous cells that may be found in the margin that extend
outwards the edge of the breast tissues that had been removed due to cancer.
Differences between a seroma and a haematoma
A seroma results from the buildup of fluids in the regions of the body where tissues had
been initially removed. It may be one of the complications of a surgery. According to Lee et al.
(2010), the seroma is normally filled with a serous fluid which is yellowish-to-white in color.
Hematoma, on the other hand, results from the collection of blood in a dead space due to the
opening up of small blood vessels as a patient recovers from a surgery p. 1389.
Significance of a Post-operative Seroma or Haematoma
Post-operative seroma and hematoma pose significant effects to wound healing and the
subsequent patient morbidity. Additionally, seroma and hematoma causes tension on flaps due to
the accumulation of fluids (Lee et al., 2010, p. 1392). These complications may further result
into an overall negative diagnosis that may significantly affect the safety of the patient thus
limiting the possibilities of regaining the original physical appearance. It is additionally
important to note that these complications may call for the need of therapeutic antibiotics to treat
infections of wounds. There could also be a prolonged use of suction drains to get rid of the
accumulated.

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References
Errolozdalga.com. (2018). Breast Lump/Mass. [online] Available at:
http://errolozdalga.com/medicine/pages/KC/BreastLump.mass.ck.8.2.10.html [Accessed 8 May
2018].
Butt, Z., Haider, S.F., Arif, S., Khan, M.R., Ashfaq, U., Shahbaz, U. and Bukhari, M.H., 2012.
Breast cancer risk factors: a comparison between pre-menopausal and post-menopausal
women. JPMA-Journal of the Pakistan Medical Association, 62(2), p.120.
Chlebowski, R.T., Anderson, G.L., Gass, M., Lane, D.S., Aragaki, A.K., Kuller, L.H., Manson,
J.E., Stefanick, M.L., Ockene, J., Sarto, G.E. and Johnson, K.C., 2010. Estrogen plus progestin
and breast cancer incidence and mortality in postmenopausal women. Jama, 304(15), pp.1684-
1692.
Ellis, H. and Mahadevan, V., 2013. Anatomy and physiology of the breast. Surgery
(Oxford), 31(1), pp.11-14.
Gabriel, A. and Long, J.N., 2016. Breast anatomy. Medscape Drugs & Diseases.
Harris, J.R., Lippman, M.E., Osborne, C.K. and Morrow, M., 2012. Diseases of the Breast.
Lippincott Williams & Wilkins.
Hassiotou, F. and Geddes, D., 2013. Anatomy of the human mammary gland: Current status of
knowledge. Clinical anatomy, 26(1), pp.29-48.
Johnson, M.C. and Cutler, M.L., 2016. Anatomy and physiology of the breast. In Management of
Breast Diseases(pp. 1-39). Springer, Cham.

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Lee, J., Nah, K.Y., Kim, R.M., Ahn, Y.H., Soh, E.Y. and Chung, W.Y., 2010. Differences in
postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surgical
endoscopy, 24(12), pp.3186-3194.
Liu, S., Chia, S.K., Mehl, E., Leung, S., Rajput, A., Cheang, M.C. and Nielsen, T.O., 2010.
Progesterone receptor is a significant factor associated with clinical outcomes and effect of
adjuvant tamoxifen therapy in breast cancer patients. Breast cancer research and
treatment, 119(1), p.53.
Nelson, H.D., Zakher, B., Cantor, A., Fu, R., Griffin, J., O'meara, E.S., Buist, D.S., Kerlikowske,
K., van Ravesteyn, N.T., Trentham-Dietz, A. and Mandelblatt, J.S., 2012. Risk factors for breast
cancer for women aged 40 to 49 years: a systematic review and meta-analysis. Annals of internal
medicine, 156(9), pp.635-648.
Pandya, S. and Moore, R.G., 2011. Breast development and anatomy. Clinical obstetrics and
gynecology, 54(1), pp.91-95.
Robertson, F.M., Bondy, M., Yang, W., Yamauchi, H., Wiggins, S., Kamrudin, S.,
Krishnamurthy, S., Le‐Petross, H., Bidaut, L., Player, A.N. and Barsky, S.H., 2010.
Inflammatory breast cancer: the disease, the biology, the treatment. CA: a cancer journal for
clinicians, 60(6), pp.351-375.
Stuckey, A., 2011. Breast cancer: epidemiology and risk factors. Clinical obstetrics and
gynecology, 54(1), pp.96-102.
Veronesi, U., Orecchia, R., Luini, A., Galimberti, V., Zurrida, S., Intra, M., Veronesi, P.,
Arnone, P., Leonardi, M.C., Ciocca, M. and Lazzari, R., 2010. Intraoperative radiotherapy

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during breast conserving surgery: a study on 1,822 cases treated with electrons. Breast cancer
research and treatment, 124(1), pp.141-151.
Ward, J.M. and Thoolen, B., 2011. Grading of lesions.