the front of the chest, especially the modified cutaneous, glandular structure it bears, the mamma. In women the breasts are secondary sex organs with the function of producing milk after childbirth. The term breast is less commonly used to refer to the breasts of the human male, which neither function nor develop.
At the tip of each breast is an area called the areola, usually reddish in color; at the center of this area is the nipple
. About 20 separate lactiferous ducts empty into a depression at the top of the nipple. Each duct leads from alveoli within the breast called lobules, where the milk is secreted. Along their length, the ducts have widened areas that form reservoirs in which milk can be stored. The ducts and lobules form the glandular tissue of the breasts. Connective tissue covers the glandular tissue and is itself sheathed in a layer of fatty tissue. The fatty tissue gives the breast its smooth outline and contributes to its size and firmness.
Breast, with detail and cross section.
Breast self-examination. From Lowdermilk et at., 2000. 1. The best time to do breast self-examination is after your period, when breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, do it on the same day every month. 2. Lie down and put a pillow under your right shoulder. Place your right arm behind your head (Fig. 1). 3. Use the finger pads of your three middle fingers on your left hand to feel for lumps or thickening. Your finger pads are the top third of each finger. 4. Press firmly enough to know how your breast feels. If you're not sure how hard to press, ask your health care provider, or try to copy the way your health care provider uses the finger pads during a breast examination. Learn what your breast feels like most of the time. A firm ridge in the lower curve of each breast is normal. 5. Move around the breast in a set way. You can choose either circles (Fig. 2, A), vertical lines (Fig. 2, B), or wedges (Fig. 2, C€). Do it the same way every time. It will help you to make sure that you've gone over the entire breast area and to remember how your breast feels. 6. Gently compress the nipple between your thumb and forefinger and look for discharge. 7. Now examine your left breast using the finger pads of your right hand. 8. If you find any changes, see your health care provider right away. 9. You may want to check your breasts while standing in front of a mirror right after you do your breast self-examination each month. See if there are any changes in the way your breasts look: dimpling of the skin, changes in the nipple, or redness or swelling. 10. You may also want to do an extra breast self-examination while you're in the shower (Fig. 3). Your soapy hands will glide over the wet skin, making it easy to check how your breasts feel. 11. It is important to check the area between the breast and the underarm and the underarm itself. Also examine the area above the breast to the collarbone and to the shoulder.
Surgery of the Breast
. Surgical operations of the breast are done for a variety of reasons. mammoplasty
refers to reconstructive surgery of the breast and includes procedures to enlarge the breasts (augmentation mammoplasty
), reduce their size (reduction mammoplasty
), or reconstruct one or both breasts so that they are equal in size and contour. With the advent of less radical surgery for breast malignancies, postmastectomy plastic surgery of the breast has become more commonplace. mastectomy
is surgical removal of breast tissue; it is most often done to treat breast cancer. Procedures can vary from a simple lumpectomy to a radical procedure in which the surgeon removes the internal mammary chain of lymph nodes, the entire breast, the underlying pectoral muscles, and the adjacent axillary lymph nodes.
malignancy of the breast; it is second only to lung cancer as a cause of cancer deaths in North American women. It currently affects 1 in 9 women in the United States (11 per cent) and is called an epidemic by authorities. The incidence of breast cancer appears to be rising each year, even though when all age groups are considered its death rate has slightly declined in the past two decades. Risk factors include age over 40, close family member with breast cancer, onset of menses before age 13 or continuation beyond age 50, nulliparity, and first child after age 30.
. Women should train themselves to perform a simple self-examination of the breasts (see illustration). The best time for this is just after menstruation when the breasts are normally soft. If any lump in the breast can be felt, a health care provider should be consulted immediately.
As with other forms of cancer, early detection and prompt treatment of malignancy of the breast are the keys to eradication of the disease. Studies have shown that breast self-examination has contributed to earlier detection and improved survival rates. It should be done monthly; more than 90 percent of breast cancers are discovered by the patients themselves either by chance or by routine self-examination. The American Cancer Society reports that only about 69 percent of women polled in the past had done self-examination at any time during the past year and less than 29 percent did it routinely each month.
Screening should begin by age 40 and should consist of a clinical examination every year and screening mammography every one or two years. Beginning at age 50, both the clinical examination and the mammography should be done once a year. mammography
is considered to be the best diagnostic method for early detection when tumors are small and not readily found by palpation. Other diagnostic techniques include thermography, ultrasonography, magnetic resonance imaging, and computerized tomography, but none of these is believed to be as accurate as mammography. The first symptom noted is usually a lump or nodule in the breast tissue; however, dimpling of the breast skin or changes in the nipple may be noted before a lump is found. Diagnosis of a malignant tumor is confirmed by biopsy.
Treatment. Options for treatment of breast cancer are based on the clinical stage of the disease when first diagnosed or when re-evaluated. Formerly, the most common procedure was radical mastectomy. However, improvements in irradiation equipment and procedures, alternative surgical techniques that are less mutilating, and more active participation of patients in making decisions about the mode of therapy have all resulted in significant changes in the treatment of breast cancer.
Additional information can be obtained by calling the National Cancer Institute's Cancer Information Service Hotline at 1-800-4-CANCER.