Published on 10/03/2015 by admin
Filed under Obstetrics & Gynecology
Last modified 10/03/2015
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Chapter 40 The breast
CHAPTER CONTENTS
The adult breast is of various sizes and is divided into 15–25 lobes, separated from each other by fibrous septa which radiate from the nipple. Each lobe has its own duct system, which terminates in a dilated area beneath the nipple and then opens on to the surface of the nipple as a punctate orifice. Each lobe is divided into lobules, each of which contains 10–100 acini surrounded by fatty tissue, lymphatics and blood vessels.
During the menstrual cycle, the female breast undergoes cyclical changes induced by oestradiol and progesterone. Oestradiol induces growth of the acini and, combined with progesterone in the luteal phase, causes duct development, increased vascular congestion, and fluid transudation into the breast tissues. The result is that in the late luteal phase the breasts are fuller, heavier, and may be painful.
Current fashion decrees that to be beautiful a woman’s breasts should be large (but not too large), full and well supported. Many women have small breasts and some have breasts that are large and pendulous. A woman who has breasts which she perceives as too small or too large may seek medical aid. In most cases the woman is secreting normal quantities of oestrogen, so oestrogen ointments or creams will not increase breast size nor will any hormone decrease breast size.
The size of the breasts may appear larger if the woman has a good posture and contracts her pectoral muscles. Increase in breast size may be obtained by inserting a shaped ‘form’ behind the breast tissue and in front of the pectoral muscle, via an incision at the lower margin of the breast. Augmentation mammoplasty should only be undertaken by an experienced cosmetic surgeon.
Large, pendulous breasts not only appear unattractive (or so some women believe) but may cause shoulder pain. Treatment consists of wearing a supporting bra or undergoing a reduction mammoplasty.
In some women the normal cyclical enlargement of the breasts is exaggerated, with the result that the duct systems increase in size and the breasts become tender and nodular. The change may affect one segment of each breast – usually the upper, outer segment – but may involve all segments.
The condition is termed benign breast disease, which has replaced the previous diagnostic terms of mazoplasia, fibroadenosis and chronic mastitis. Benign breast disease may be localized or diffuse. Its aetiology is not known.
This type of breast disease is usually found in women aged 25–45 years and in premenopausal women, when single large cysts are found. The woman has few if any symptoms, but the discovery of the breast lump causes fear of cancer. The breast should be examined carefully, an ultrasound image made and a mammogram arranged. Once cancer has been excluded, treatment is reassurance.
Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology
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