SU25.1 | Breast Anatomy and Investigation — Summary & Reflection

KEY TAKEAWAYS

A breast complaint is triaged first by history — lump characteristics, mastalgia (usually benign), the character of any nipple discharge, skin/nipple changes, and risk factors (age above all, plus family history, reproductive factors). The applied anatomy explains the clinical signs: Cooper's ligaments cause skin dimpling when tethered, the retromammary space explains deep fixity, and the upper outer quadrant/axillary tail is where most cancers arise. Lymphatic drainage is chiefly to the axillary nodes, classified into levels I-III relative to pectoralis minor, with a smaller internal-mammary share. Every suspicious finding undergoes triple assessment — clinical examination + imaging + pathology — interpreted by concordance. Ultrasound is first-line imaging in younger/dense breasts (and pregnancy); mammography is first-line over ~35-40 years and detects microcalcifications; reporting uses BI-RADS 0-6. Pathology should preferably be a core needle biopsy (histology + ER/PR/HER2), as FNAC gives cytology only; MRI is for selected cases.

REFLECT

Think back to a breast examination you have observed or performed, or imagine clerking the next woman who presents with a lump. Did you inspect with the arms in the three positions, palpate every quadrant including the axillary tail, and examine the axillary and supraclavicular nodes — and did you document it cleanly enough that a colleague could follow you? Now consider the work-up: would you have chosen ultrasound or mammography correctly for her age, and could you explain to her why you are recommending a core biopsy rather than a simple needle aspiration? Reflect on one habit you will build — perhaps always relating a clinical sign back to the anatomy that produces it — so that your breast assessments are both reassuring and safe.