The document provides information on the anatomy and physiology of the breast and axilla. It discusses the location, structures, size, shape, appearance and development of the breast. It also covers the blood supply, lymph system and lymph nodes of the axilla. The document outlines aspects of health history to inquire about including the reason for seeking care, personal and family medical history, and current health. It describes examining the breasts and axillae by inspecting and palpating them.

1. THE BREAST AND THE AXILLA

4. A N A T O M Y B R E A S T OF THE

8. I. ANATOMY AND PHYSIOLOGY / BREAST / Structures ! The male breast resembles the rudimentary female breast and has no lobules or alveoli .

12. Human breast tissue begins to develop in the sixth week of fetal life. I. ANATOMY AND PHYSIOLOGY / BREAST / Development (Uterine development)

13. Breast tissue * initially develops along the lines of the armpits and extends to the groin (called the milk ridge) . I. ANATOMY AND PHYSIOLOGY / BREAST / Development (milk ridge & supernumerary nipples)

14. I. ANATOMY AND PHYSIOLOGY / BREAST / Development (milk ridge & supernumerary nipples) Supernumerary nipples develop along the mammary line. !

15. Anne Boleyn Second wife to Henry VIII of England, and mother of Elizabeth I, is said have had a third nipple or even a third breast. This may well have been a slanderous rumour, as in Tudor times these "malformations" were considered to be a sign of the person having been a witch. The circumstances of her marriage to the king, who had divorced his first wife, made her a controversial figure. Carrie Underwood During her American Idol audition admitted to have had a third nipple which looked like a mole Famous personalities or characters known to have Extra or Supernumerary nipples are….

16. Krusty the Klown In an episode of The Simpsons, Bart, among other things knows Krusty the Klown has a third nipple, to see if he isn't an imposter.

17. I. ANATOMY AND PHYSIOLOGY / BREAST / Development / Tanner’s Stage Tanner’s Stage expounds the 1 st 3 columns on Breast Development found in page 11 Tanner's stages are based on studies of white English girls. An American survey found that black girls tended to advance more quickly. Genital and pubic hair development is also classified by Tanner. Tanner's stages The preadolescent breast (Stage 1 per Tanner's sex maturity ratings) consists of a small elevated nipple with no significant underlying breast tissue. Puberty begins (usually between ages of 8 and 13, average age is 11) with the development of breast tissue and pubic hair. With the hormonal changes of puberty, breast buds form. This second stage of breast development is the breast bud stage. Here, there is elevation of the breast and nipple as a small mound; the areola begins to enlarge. Milk ducts inside the breast begin to grow. In Stage 3, there is further enlargement and elevation of the breast and areola (with no separation of their contours) The areola begins to darken in color. The milk ducts give rise to milk glands that also begin to grow. Next, there is projection of the areola and nipple to form a secondary mound (stage 4). In the mature adult breast (stage 5), there is projection of the nipple only (though in some woman the areola continues to form a secondary mound .

18. Edward Tanner also developed different Bra Classifications based on his Stages of Breast Development I. ANATOMY AND PHYSIOLOGY / BREAST / Development / Tanner’s Bra Classificaion Breast and bra classification is as follows (from smallest to largest): A, B, C, D, and DD F, G, H (and larger) also exist. These biggest bra sizes are often needed by very large-breasted women, or women whose size increases with pregnancy and nursing. A training bra for developing girls (usually Tanner Stage 2, 3, or 4) is also available and is smaller than the A cup. This is sometimes called AA. (also known as Double D or sometimes called E). Though less common, the larger cup sizes of (double A) B 36 32 B C 38 D 42 C 34 32 AA 36 A 32A 30 AA D / F / G / H D / F / G / H D 40

19. The breasts grow further during pregnancy. This growth is much more uniform than that at adolescence. ANATOMY AND PHYSIOLOGY / BREAST / Development

20. ANATOMY AND PHYSIOLOGY / BREAST / Development Breasts sag if the ligaments become elongated, a natural process that can occur over time and by gravity (like the breast bouncing while exercising). ! The breasts revert to previous size with some sagging and stretch marks After pregnancy

21. To avoid the post-pregnancy effects on the breast, some women wears Pregnancy Support bras. This woman admits to wear Support bras during pregnancy. “ I wear Support bras almost 24 hrs. a day. I only remove it when taking the shower! - Sweet Life

22. The breasts of an aging woman diminish in size as the milk glands degrade. The breasts often become more saggy as this occurs and as the effects of gravity pull the breast tissue downwards. I. ANATOMY AND PHYSIOLOGY / BREAST / Development / Tanner’s Stage Because the breasts become less dense after menopause, it is often easier for radiologists to detect breast cancer on an older woman’s mammogram films, since abnormalities are not hidden by breast density. !

24. ANATOMY AND PHYSIOLOGY / AXILLA, LYMPHATICS & BLOOD SUPPLY / Lymph System Arteries carry oxygen rich blood from the heart to the chest wall and the breasts and veins take de-oxygenated blood back to the heart. The axillary artery extends from the armpit and supplies the outer half of the breast with blood; the internal mammary artery extends down from neck and supplies the inner portion of the breast.

25. Venous – axillary vein, internal thoracic vein, intercostal veins ANATOMY AND PHYSIOLOGY / AXILLA, LYMPHATICS & BLOOD SUPPLY / Lymph System

27. ANATOMY AND PHYSIOLOGY / AXILLA, LYMPHATICS & BLOOD SUPPLY / Lymph System They are thin channels similar to blood vessels; they do not carry blood but collect and carry tissue fluid which ultimately re-enters the blood stream. Debris moves through the balancing processes of various pressure gradients.

28. ANATOMY AND PHYSIOLOGY / AXILLA, LYMPHATICS & BLOOD SUPPLY / Lymph System It is a one-way transport system that can get easily clogged because it doesn’t have a pumping system of its own but rather the lymph itself is contractile that could propel the fluid ahead or, as a resistance vessel which have valves tending to stop the lymph in its place.

30. I. ANATOMY AND PHYSIOLOGY / AXILLA, LYMPHATICS & BLOOD SUPPLY / Lymph System *

31. I. ANATOMY AND PHYSIOLOGY / AXILLA, LYMPHATICS & BLOOD SUPPLY / Lymph System * The lymphatic drainage of the breasts and other organs is particularly relevant to oncology, specifically to the diagnosis and treatment of cancer. The lymphatic system, because of its physical proximity to many tissues of the body, is responsible for carrying cancerous cells between the various parts of the body in a process called metastasis. The intervening lymph nodes can trap the cancer cells. If they are not successful in destroying the cancer cells the nodes may become sites of secondary tumors. The cancer cells can also break away from a tumour and spread to other parts of the body through the lymph system.