ANATOMY OF THE BREAST

Breasts are present in both sexes, but in men they remain rudimentary. In women,
their development varies according to age. The breast is made up of three types
of tissues : glandular tissue, which produces milk, connective tissue, which
connects the lobes, and adipose tissue that occupies the space between the lobes.

QUADRANTS OF THE BREAST

What is breast self-examination?

Breast self-examination is a procedure performed by women to examine
themselves physically and visually and detect any changes in their breasts or
armpits. Breast cancer is one of the most common and aggressive malignant
tumors. Detected and treated promptly, it can be completely curable.

When should you do a breast self-examination?

By regularly doing self-examination, you can establish what you normally look like
and be better prepared to detect any changes.
Women should do this self-examination starting at age 20 and throughout their
lives; even if they are pregnant or after menopause.
The self-assessment must be done every month. Become familiar with the normal
look and feel of your breasts to notice any changes.

 If you are still menstruating, the best time to get tested is several days or
about a week after your period ends. These are days when your breasts are
less likely to be sore or swollen.
 If you are no longer menstruating, choose a day, such as the first day of
each month, to remember to do a breast self-assessment.
 If you are taking hormones, talk to your doctor to find out when you should
have the test and your medical checkups.

Changes to take into account:

Consult your doctor if you find any changes in your breasts that cause concern.
Among the changes they may have are:

 Appearance of a lump
 Discharge other than breast milk
 Breast inflammation
 Irritation or dimpling of the skin
 Nipple abnormalities (such as pain, redness, peeling, or sinking)

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2d183abe67ca4dcdb539f7eaa1a4f2e0
What does mammography consist of: basic and additional projections
Screening mammography is a specific type of breast imaging that uses low-dose x-
rays to detect cancer early (before a woman has symptoms) when it is most
treatable.
INDICATIONS FOR PERFORMING THE MAMMOGRAM
Tell the doctor about any breast problems or symptoms, previous surgeries,
hormone use, whether you have a family or personal history of breast cancer, and
if there is any chance you may be pregnant. If possible, obtain copies of your
previous mammograms and show them to your technologist on the day of your
exam. Leave jewelry at home and wear loose, comfortable clothes. You may be
asked to put on a robe. Do not put deodorant, powder, or perfume under your arms
or on your breasts because these products can show up on the mammogram and
interfere with the correct diagnosis.
What are the basic projections of a mammogram?
The conventional study consists of two projections of each breast, one
craniocaudal (CC) and another mediolateral oblique (OML). Performing two
projections in each breast is essential to avoid overlooking lesions visualized in a
single projection, as well as to correctly localize them.

ADDITIONAL AND EXAGGERATED PROJECTIONS These are projections that

are made, in addition to conventional ones, to rule out or solve a specific doubt,
and they are unlimited.
 Laterally exaggerated craniocaudal view (PCCEL): If a lesion is suspected
in the lateral half of the breast, this view can be obtained.
 Axillary prolongation view: used to isolate the axillary tail and any lesions
within it.
PROJECTION OF THE MEDIAL TISSUES OF THE BREAST . Intermammary fold
projection: it is very rare for the craniocaudal incidence to not include the medial
tissues, so additional images of them are rare.
 Pure mediolateral projection: it is the third most useful projection, since it
can be done to clear up doubts about the existence of an injury visible in
one of the two standards but not visible in the other, and it can be used to
determine if the injury is real and to its three-dimensional location.
 Latero-medial projections: in the event that blurriness and lack of sharpness
affect a mammographic image, because it is far from the detector, the
latero-medial projection can be used for lesions in medial tissues of the
breast, to obtain images with greater sharpness.
PROJECTION OF THE UPPER TISSUES . Sometimes the lesion can be located
in the upper tissues of the breast. In cases where compression for the caudal skull
produces a release of the lesions due to the compression.

BI-RADS Classification
BI-RADS 1: normal exam.

BI-RADS 2: benign findings.

BI-RADS 3: findings that most likely correspond to something benign, but that
require control in a short interval, at six months.

BI-RADS 4: findings that make the radiologist suspect the possibility of cancer, for
which a biopsy is necessary.
 BI-RADS 5: finding highly suggestive of cancer. Essential biopsy.

BI-RADS 0: incomplete study, additional projections and/or ultrasound are

necessary.

Biopsies in mammography (TRU-CUT, BACAF)

The breast biopsy procedure can be done in three ways:

 Fine-needle aspiration biopsy: Uses a very thin needle to remove a sample of

cells or fluid from the breast
 Core needle biopsy: Uses a larger needle to remove a sample
 Surgical biopsy: Removes a sample in a minor outpatient procedure

Types of breast nodules

Normal inflammation and discomfort associated with the menstrual cycle

Hormonal changes that occur during the menstrual cycle can cause pain,
tenderness, or swelling of the breasts. These symptoms usually occur the week
before your period and normally disappear after the start of your menstrual period.
2
These alterations may be called fibrocystic changes, although this is not
currently considered an appropriate term. Wearing a well-fitting bra that provides
adequate support, applying dry heat, or pain relievers may relieve these
symptoms. Some women find that reducing their intake of salt and stimulants, such
as caffeine, can help relieve symptoms. 3

 Fibroadenomas
Breast fibroadenomas are usually round or oval nodules, usually painless and
of a firm, elastic consistency that move slightly when pressure is applied. They are
more common in women under 40 years of age. They can disappear
spontaneously, but sometimes they grow and are painful, so they need to be
removed. 2

If they do not present symptoms, intervention is not necessary. Sometimes it is

necessary to perform a puncture to confirm the diagnosis, although in most cases it
is sufficient to confirm that they do not change or decrease in size during a follow-
up of no more than two years. The presence of a fibroadenoma does not
significantly increase the risk of breast cancer. 4

 Cysts
Cysts are types of fluid nodules that are detected at any age, although they
are more common as menopause approaches. They are usually oval or round-
shaped lumps, smooth and firm, that move slightly when pressure is applied. 2 If
they are palpated or found in areas of the breast that rub against the bra, they can
be painful. 3 Frequently, they appear two weeks before the start of the menstrual
period and disappear afterwards. If during the examination your doctor thinks you
may have a cyst, he or she may ask you to return when your period ends to repeat
his or her evaluation.

It is necessary to drain some cysts when they are palpable and painful, but this
intervention will be carried out in a specialized clinic and after having performed at
least one ultrasound study. 2 Wearing a well-fitting bra that provides adequate
support, applying dry heat, or pain relievers may relieve symptoms. 3

 Mastitis and abscesses

The cause of mastitis or abscesses is infection. They are more common in
lactating women. 2 This is because bacteria or germs can penetrate the breast
tissue more easily through the cracks in the nipples. The ducts that carry milk can
become blocked. Pus (leukocytes that fight bacteria) can accumulate and
abscesses form. Infection and abscesses are also possible in non-breastfeeding
women. The infection can cause pain and inflammation in the affected area, with
redness of the skin and pain on palpation. Fever, headache and other flu-like
symptoms are also common. 5 You can apply dry heat and take pain relievers,
such as paracetamol; Antibiotics may be necessary. 2 If there is an abscess
(accumulation of pus), it will have to be drained and the treatment with antibiotics
completed. 5

Inflammatory breast cancer is a special type of cancer that can cause a look and
feel similar to mastitis; Therefore, if the inflammation and symptoms do not resolve
a few days after starting treatment, it is important to return to the doctor. 5

 Fat cysts (fat necrosis breast nodules)

Fatty cysts are usually caused by an injury to the fatty tissue of the breast,
caused by a blow or an operation . They usually disappear spontaneously and
very rarely need to be removed. 2 They can be painful, although they usually are
not. The skin overlying the nodule may appear thicker, swollen, or red. 6

 Lipomas
Lipomas are benign nodules formed by fat , similar to those that occur in other
parts of the body. They are easily diagnosed with mammography and ultrasound
and do not need treatment, unless they are large and cause discomfort. 2

 Breast adenosis
Breast adenosis is caused by an increase in the number of milk-producing
glands . It usually does not need treatment, but follow-up may be necessary. 7
  Intraductal papillomas
Intraductal papillomas are benign warty tumors that form in the milk ducts .
They can be found near or far from the nipple. If they develop near the nipple, clear
or bloody fluid may come out and stain clothing, which is very typical of this type of
benign tumors; Sometimes, they are painful.

It is always necessary to study them with a biopsy to confirm the diagnosis of

papilloma and their removal is usually necessary. 8

 Phyllodes tumors of the breast

Phyllodes tumors of the breast are rare breast tumors that are usually benign
. However, one in ten can be malignant, although in these cases they are not
breast cancers as such and the treatment is different. They can grow rapidly,
causing tightness in the skin. They may be painful and feel like a lump if they are
large.

It is always necessary to perform a biopsy and remove the entire tumor if the
diagnosis is confirmed. 9

 Duct ectasia
Duct ectasia usually occurs in women over 50 years of age and is caused by
a thickening of the walls of the breast ducts . Although it may be asymptomatic,
sometimes oozing of a greenish or black viscous liquid is seen from various ducts
in the nipple (several drops of different colors are observed on the nipple). There
may be redness and pain in the nipple and surrounding tissue when they become
inflamed. Very rarely, a hard nodule forms. If a nodule is present, a biopsy may be
necessary to rule out cancer. 10 It may be necessary to apply dry heat and treat
with antibiotics. 10

* There are other types of benign breast lesions that can present as a lump, but
they are rare. Among them would be:
1. Hamartoma:
eleven
Nodules formed by normal breast tissue, usually smooth and painless.
2. Hemangioma:
Rare benign tumor formed by blood vessels. eleven
3. Hematoma:
Nodule caused by blood pooling after trauma, needle biopsy, or surgery.
eleven

4. Neurofibroma:
Benign tumor caused by an overgrowth of nerve cells within the breast.