The Breast

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Part 1: Knowing the breast
Part 2: In your clinic
Part 3: Benign breast disease
Part 4: Managing the diagnosis
Part 5: Unusual presentations
Part 6: Holistic care

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Thank you to our multidisciplinary team at the Netcare Breast Care Centre in Johannesburg who have contributed to the writing of this book, in either big or small ways. Dr K Applebaum Dr D Chetty Dr G Demetriiou Dr C Maske Dr SD Moodley Dr B Rappaport Dr E Retter Dr R Seider Dr LCJ Serrurier Dr J Slabbert Dr T Ibrahim Dr E Joseph Dr S Nayler Dr M Venter Ms J Belloni To the readers, I hope the change in structure and order makes this a clear and comprehensive guide for both the general public, and health care providers, feedback is always helpful. This book is dedicated to our families, and to the many women whom we treat both in government and private. We are continually humbled by your dignity and strength.

Yours truly Dr Carol Benn Johannesburg 2014 Dr Benn and Dr Rayne are specialist surgeons with an interest in breast health. They work at both the Helen Joseph Breast Care Clinic and the Netcare Breast Care Centre in Johannesburg, set up by Dr Benn. Both lecture, present papers (locally and internationally), and are passionate about public education and ensuring access to good health care. For further information or advice contact: Telephone: 0860 233 233 Email: breasthealth@netcare.co.za Website: www.breasthealth.co.za Managing breast cancer in South Africa: the multi-disciplinary approach.

Part 1:                                                         




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The breast develops from a thickening of this ectodermal layer in the developing foetus. This means that the breast is a skin accessory structure. This thickening forms a idge on each side of the embryo and is called the milk or mammary streak. Each streak extends from the axilla (armpit) to the groin on each side. Mammals can therefore develop multiple breasts along these two milk streaks. In most humans, only the primordial tissue in the pectoral region of the embryo persists whilst the remainder of these ridges regress and disappear. However in some people accessory breasts and nipples can be felt or seen along the mammary line. This thickened primordial ectoderm then sinks below the surface, forming the eighteen or so outgrowths (lobules) which extend into the surrounding mesoderm (fat and other connective tissue). Both men and women have breasts. Men have breast ducts and fatty tissue but no breast lobules and cannot produce milk, although they can get breasts and rarely breast cancer. Structure Anatomically the breast is made up of about eighteen lobules of glandular tissue. These lobules resemble bunches of grapes and each grape (alveolus) represents a secreting unit (pleural: alveoli). The alveolus consists of cells which line the unit and produce the milk. Each lobe or lobule of glandular tissue is embedded or buried in fat.      2015-11-12 11-43-48 A2This fat is what gives the female breast its shape, contour and its size. It also explains why a person’s breast size may change with weight gain or loss. Each lobule (grape) joins with other lobules to form the lobular unit (bunch of grapes). The milk or secretions produced here are delivered via a duct system to the nipple. Each duct opens separately onto the nipple and thus the nipple is perforated by approximately eighteen holes. These perforations are arranged radially and when the milk is ejected, it comes out like eighteen small fountains. The lobules within their respective fatty coats are separated by bands running from the pectoralis muscle to the skin of the breast called the ligaments of Cooper which thus connect the chest wall to the skin. These ligaments give support to the breast fat, preventing it from deforming. Breast size outside of pregnancy depends to some extent on the amount of fat present although this does not necessarily mean that fat women have big breasts and thin women do not. The axillary tail of Spence is the extension of the breast towards the axilla or armpit. It is breast tissue that lies between the breast proper and the axilla.