THE FEMALE

BREAST

SHAPEELA E
RN/OPN/BScMID
 INTRODUCTION
• Breasts (Mammary glands) are
accessory organs of reproduction. Are
present in both sexes and are present as
rudimentary (simple, underdeveloped)
glands at birth. In females they are
underdeveloped till puberty when they
develop and then further development
takes place during pregnancy and
puerperium due to the influence of
 SITUATION

• One breast is situated on each side

of the sternum and extends between
the levels of the second and sixth
rib. The breasts lie in the superficial
fascia of the chest wall over the
pectoralis major muscle, and are
stabilised by suspensory ligaments.
 SIZE
• The size varies with each individual
and with the stage of development as
well as with the age. It is common for
one breast to be a little larger than
the other.

SHAPE
• Each breast is a hemispherical swelling
and has a tail of tissue extending
GROSS STRUCTURE
OF THE BREAST
 THE AREOLA:
• Is the circular area of loose pigmented
skin about 2.5cm in diameter at the
centre of each breast.
• It is pale pink in colour in fair skinned
women and darker in brunettes, the
colour deepens with pregnancy.
 THE AREOLA:
• Within the areola lie approximately 20
sebaceous glands.

• During pregnancy these enlarge and are

known as Montgomery's tubercles.
THE AXILLARY TAIL:
• Is the breast tissue extending towards
the axilla.
 THE NIPPLE:
• Lies in the centre of the areola at the
level of the fourth rib. A protuberance
about 6 mm in length ,composed of
pigmented erectile tissue ,it is a highly
sensitive structure.
• The surface of the nipple is perforated
by small orifices, the openings of the
lactiferous ducts . It is covered with
epithelium.
MICROSCOPIC STRUCTURE
MICROSCOPIC STRUCTURE

• The breast is composed largely of

glandular tissue ,but also of some fatty
tissue, and is covered with skin.
• The glandular tissue is divided into about
18 lobes which are completely separated
by bands of fibrous tissue .
MICROSCOPIC STRUCTURE

• The internal structure is said to

resemble the segments of halved grape
fruit or orange.
• Each lobe is a self contained working
unit and is composed of the following
structures:
MICROSCOPIC STRUCTURE

• Alveoli:
• It contains the milk secreting cells (acini
cells) .
• The Acini cells line the alveolus and
they extract from the mammary blood
supply the factors essential for milk
formation.
MICROSCOPIC STRUCTURE

• Around each alveolus are the

Myoepithelial cells AKA basket or
spider cells.
• When these cells are stimulated by
oxytocin they contract ,releasing milk in
to the lactiferous duct.
MICROSCOPIC STRUCTURE

• Lactiferous tubules: small ducts

which connect the alveoli.

• Lactiferous duct: a central duct into

which the tubules run.
 MICROSCOPIC STRUCTURE

• Ampulla: the widened out portion

of the duct where milk is stored .
The ampullae lie under the areola.
• Continuation of each
lactiferous duct: extending from
the ampulla and opening onto the
nipple.
 BLOOD SUPPLY

• Blood is supplied to the breast by the

internal mammary artery, the
external mammary artery and the
upper intercostal arteries.
• Venous drainage is through
corresponding vessels into the internal
mammary and axillary veins.
 LYMPHATIC DRAINAGE

• This is largely in to the axillary

glands, with some drainage into the
portal fissure of the liver and
mediastinal glands. Lymphatic
vessels of each breast communicate
with one another.
 NERVE SUPPLY
• Though it’s function is largely controlled
by hormonal activity, the skin of the
breast is supplied by branches of the
thoracic nerves and also some
sympathetic nerve supply, especially
around the areola and nipple.
 STAGES OF BREAST
DEVELOPMENT
INTRAUTERINE LIFE:
• Primary breast development occurs in
both sexes and commences at about
the fourth week of intrauterine life.
• A longitudinal ridge of thickened
ectoderm appears on the ventral wall
of the fetus, extending between the
arm and limb buds on each side.
 STAGES OF BREAST
DEVELOPMENT
• This is the mammary or milk ridge.
• Normally it is only in the thoracic region
that there is continued development of
this ridge, the rest of the cells undergo
degeneration.
• 2 weeks later, there is some intrusion of
the ridge cells in the thoracic region into
the underlying mesoderm, forming about
20 mammary buds.
 STAGES OF BREAST
DEVELOPMENT
• These buds at the end of pregnancy
canalise to form the primitive milk-
secreting cells (alveoli and acini),
lactiferous ducts and myoepithelial
cells.
 STAGES OF BREAST
DEVELOPMENT
• A depressed area known as the mammary
pit forms were the lactiferous ducts open;
the cells here will form the nipple.
• Failure of the mammary pit to surface soon
after birth results in an inverted nipple.
• The areola appears as proliferation of the
mesoderm occurs towards full term.
 STAGES OF BREAST
DEVELOPMENT
AT BIRTH:
• Because of the action of maternal
hormones circulating in the blood stream
of the infant, breast tissue sometimes is
enlarged during the first few days of life.
• The condition ( mastosis) may arise in
both male and female babies and is
accompanied by milk secretion ( witches’
 STAGES OF BREAST
DEVELOPMENT

• Anxious parents must be

reassured ,that it is temporal and no
treatment is required and will subside
once maternal hormones are fully
withdrawn.
• Following neonatal period there is
normally no activity of breast tissue
until puberty.
 STAGES OF BREAST
DEVELOPMENT
AT PUBERTY:
• With the rise of hormone levels in
females at puberty further development
of the breasts occurs and usually
precedes the onset of menstruation by
about 2 years.
 STAGES OF BREAST
DEVELOPMENT
• Rising oestrogen levels stimulate growth
of lactiferous vessels and the nipple and
areola become more pronounced.
• Rising amounts of progesterone
stimulate proliferation of the alveoli.
• The amounts of fat and fibrous tissue
are increased, fat accounting for the
increase in breast size.
 STAGES OF BREAST
DEVELOPMENT
CHILD BEARING YEARS:
• During child bearing years, women
complain of breast changes similar to
those that take place during pregnancy.
• These changes are caused by
progesterone produced by the corpus
luteum and soon disappear with the
onset of menstrual flow and decreasing
 STAGES OF BREAST
DEVELOPMENT
• PREGNANCY:
• Breast changes are one of the early
signs of pregnancy and occur in
response to oestrogen first then later
progesterone from the corpus luteum
then the placenta.
 STAGES OF BREAST
DEVELOPMENT
• Oestrogen causes growth of lactiferous
ducts, tubules and development of the
areola and the nipple.

• While progesterone causes

proliferation of alveoli in readiness for
milk production.
 STAGES OF BREAST
DEVELOPMENT
• 6th to 8th week of pregnancy; soft
tissues of the breast become nodular to
touch. Sensation of fullness ,tenderness
and tingling occur and women dislike
breasts being touched at this time.
• Subcutaneous veins become visible
because of increased blood supply.
 STAGES OF BREAST
DEVELOPMENT

• 12 week; nipple and areola become

more pigmented and accentuated.
Sebaceous glands within the areola
enlarge and secrete sebum an oily
substance for lubricating the breast,
the glands are now called
 STAGES OF BREAST
DEVELOPMENT
• Colostrum may start to leak from
the nipples of the breast of a
multigravid woman who has
successfully breast fed before.
• Primes will only produce colostrum
until later in pregnancy.
 STAGES OF BREAST
DEVELOPMENT
• Colostrum at this stage acts as a
precursor of milk ,to prepare the
secreting milk structures for a free
flow of milk postnatally.
• Colostrum appears as a clear watery
fluid at first.
 STAGES OF BREAST
DEVELOPMENT
• 16 weeks; secondary areola appears,
and is more pronounced in dark haired
women, following child birth it
disappears.
• True colostrum appears after the 16th
week and is yellow in colour and has
creamy consistency.
 STAGES OF BREAST
DEVELOPMENT
• POSTNATAL PERIOD; only when
lactation has been established and
maintained are breasts regarded as
fully functional organs.

• Following delivery of the

infant ,colostrum appearance continues
 STAGES OF BREAST
DEVELOPMENT
• It looks more like milk, paler in colour
and thinner in consistency.

• This is a transitional phase, for the

progression to true milk may take
some 10-14 days.
 PHYSIOLOGY OF
LACTACTION
• Two factors governed by hormones
are involved in the physiology of
lactation namely;
• Production of milk; Milk production is
influenced by the increase in the
effects of the hormone;
 PHYSIOLOGY OF
LACTACTION
• Prolactin and the increased blood
supply to the breast during puerperium.
• Following the delivery of the placenta
there is a marked drop in the level of
oestrogen and progesterone, there by
enhancing the effects of prolactin.
 PHYSIOLOGY OF
LACTACTION
• Prolactin is released by the anterior
pituitary gland as a response to the fall
in oestrogen and progesterone after the
delivery of the placenta.
• Prolactin changes the dormant alveolar
cells in the breast into metabolically
active cells which are able to produce
milk.
 PHYSIOLOGY OF
LACTACTION

• Milk production starts at about the

3rd day after delivery.
• Raised levels of prolactin inhibit
ovulation and therefore have a
contraceptive function, but the
mother needs to breast feed 2 to 3
hourly for this to be effective.
 PHYSIOLOGY OF
LACTACTION

• This is because prolactin levels are

highest during the night.

• If night feeds are the first to be

withdrawn, then more reliable modes
of contraception need to be implored.
 PHYSIOLOGY OF
LACTACTION
Passage of milk; two factors are involved
in the passage of milk from the secreting
cells to the nipple.
a. Back pressure: here the force of new
globules forming in the cells push the
foremost ones into the lactiferous
tubules and the suckling infant
stimulates the secretion of more milk.
 PHYSIOLOGY OF
LACTACTION
• Neurohormonal reflex (Let-down reflex):
when a baby is a put to the breast.

• The rhythmical sucking movement

produces nervous stimuli causing a
reflex action in the posterior pituitary
gland.
 PHYSIOLOGY OF
LACTACTION
• This results in the release of oxytocin
from the PPG ,which will cause the
basket cells around the alveoli to
contract and push milk into the
lactiferous vessels and so more milk
flows to the ampullae.
 PHYSIOLOGY OF
LACTACTION
• The let-down reflex can be inhibited by
pain e.g. From perineal sutures thus it
is important to ensure the mother is
comfortable during feeding times.

• The same oxytocin also causes the

uterus to contract aiding in involution.
 MAINTENANCE OF
LACTATION
• Supply of milk is maintained in
response to demand. If the infant is not
put to the breast the infant milk supply
will not be initiated.
• If a mother of twins puts both to the
breast, supply will be adequate for the
two.
 MAINTENANCE OF
LACTATION
Two factors are essential for the
maintenance of lactation;
1. Stimulus
2. Complete emptying of the breast
 MAINTENANCE OF
LACTATION
• Stimulus: it is important that the infant is
fixed at the breast correctly to promote
the right amount of stimulus.
• The infants' gums should be on the skin
of the areola so that pressure is exerted
on the underlying ampullae where milk is
stored.
• If the mother complains of nipple pain
 MAINTENANCE OF
LACTATION

• Fixing : correct apposition of the infant’s

tongue and gums to the mother’s nipple
and areolar.
Complete emptying of the breast: it is
important that the infant is fed as much
as it wants and complete emptying of the
breast is achieved because if milk is not
removed as it is produced, lactation may
 MAINTENANCE OF
LACTATION
• Milk engorgement of the alveoli occurs
and the basket cells cannot contract.
• The infant should empty one breast
before being offered the second. If it
does not empty the second breast then
it should be offered that one, first, at
the next feed.
 MAINTENANCE OF
LACTATION
• Alternatively ,it may be fed completely
from one breast.
• If the baby is to be really satisfied he
needs both foremilk and hind milk.
 ADVANTAGES OF
BREAST FEEDING
• Less risk of contamination; milk
taken directly from the breast by
the infant is less likely to be
contaminated by pathogenic
organisms and the incidence of
neonatal infection is thus reduced.
 ADVANTAGES OF
BREAST FEEDING

• Protection ;the protective factors

present in colostrum are essential for
the infants immunity and protection
against disease.
• Composition ; human milk provides
food constituents in the correct
balance for human growth.
 ADVANTAGES OF
BREAST FEEDING
• Convenience; time and money can
be saved by breast feeding, feeds
do not require preparation nor is
there any need to buy costly
equipment for its preparation which
will need to be cleaned and
sterilised.
 ADVANTAGES OF
BREAST FEEDING
• Family planning: the hormone
produced during breast feeding
prolactin prevents ovulation thus
providing contraception.
• Breast feeding also aids in uterine
involution during pueperium
because of oxytocin production
 ADVANTAGES OF
BREAST FEEDING
• With the tendency of our society to
suppress lactation in its early weeks or
even suppress its initiation, breast
tissue changes occur which cause an
increased risk to breast cancer, thus
breast feeding is one way of
preventing cancer of the breast.
 10 STEPS TO
SUCCESSFUL BREAST
FEEDING
• Have a written breastfeeding policy that
is routinely communicated to all health
care staff.
• Train all health care staff in skills
necessary to implement this policy.
• Inform all pregnant women about the
benefits and management of
 10 STEPS TO
SUCCESSFUL BREAST
FEEDING
• Help mothers initiate breastfeeding
within a half-hour of birth.

• Show mothers how to breastfeed and

how to maintain lactation even if they
should be separated from their
infants.
 10 STEPS TO
SUCCESSFUL BREAST
FEEDING
• Give new-born infants no food or
drink other than breast-milk, unless
medically indicated.
• Practice rooming-in—allow mothers
and infants to remain together—24
hours a day.
• Encourage breastfeeding on demand.
 10 STEPS TO
SUCCESSFUL BREAST
FEEDING
• Give no artificial teats or pacifiers
(also called dummies or soothers) to
breastfeeding infants.
• Foster the establishment of
breastfeeding support groups and
refer mothers to them on discharge
from the hospital or clinic.
 FACTORS THAT
PROMOTE LACTATION
Fluids and Nutrition
• Lactating women need a well balance
diet and at least 2 liters of fluids in
24 hours. This helps in the production
of high quality and quantity milk.
 FACTORS THAT
PROMOTE LACTATION
Physical condition of the mother and
baby
• The mother and baby should be in
good physical health in order to breast
feed successfully.
• Ill health affect the both the mother
and baby’s emotional and physical
 FACTORS THAT PROMOTE
LACTATION

Early feeding after delivery

• This is essential as it stimulates

lactation, there by ensuring a good
supply of milk for the baby.
 FACTORS THAT
PROMOTE LACTATION
Rooming in

• Rooming in enhances early

introduction of the baby to the
breast and maintenance of breast
feeding.
 FACTORS THAT
PROMOTE LACTATION
 Demand feeding

• Enables the baby to feed effectively

as it does so at a time when it is
ready to feed.
 FACTORS THAT
PROMOTE LACTATION
Frequent feeding
• Frequent feeding in the first few
hours of birth ensures that the
baby takes in enough and also
stimulate further milk production
by frequent nipple stimulation.
 FACTORS THAT
PROMOTE LACTATION
Correct length of feeding (3-5
minutes on each breast)

• The longer the baby is put to the

breast the more milk it take in and
the high the breast stimulation for
milk production.
 FACTORS THAT
PROMOTE LACTATION
Not supplementary feeds
• Not giving supplementary feeds
especially by bottle help avoid nipple
confusion. Supplementary feeds may fill
the babies stomach and satisfy their
hunger and the baby may not want to
breast feed.
• The baby may also develop preference
for artificial feeds due to the high sugar
 BREAST PROBLEMS
SORE AND DAMAGED NIPPLES

• These are due to trauma from the

baby’s mouth and tongue as a result
of poor attachment to the breast.
May also be due to fungal infection
of the breast (candida albicans-
thrush).
 BREAST PROBLEMS

• Can be prevented by good breast

attachment to the breast and treatment
is by resting the affected breast
(lactation should be enhanced by
expressing). If the condition is due to
infection, both the mother and baby
should be treated with a fungicide
(miconazle, nystatin)
 BREAST ENGORGEMENT
• Breast engorgement could be due to
inadequate emptying of the breast as a
result of inadequate let-down or feeding
at long intervals.
• Clinical features of engorged breasts
include;
• Painful and lumpy breast, edematous
and red underlying skin and prominent
 BREAST ENGORGEMENT

• The aims of management are; to relieve

edema and congestion and to promote
the flow of milk.

• This can be achieved by draining the

breast by expressing or feeding the
baby more frequently.
 BREAST ENGORGEMENT

• Warm compress may be done to

enhance milk flow.

• A breast pump may be used in severe

cases as this will help relieve tension

• Analgesics may also be given e.g.

brufen.
 MASTITIS
• This is inflammation of the breast and it
could be infective or non-infective.
• Non-infective (acute intramammary)
mastitis
• Results from milk stasis which is as a
result of unresolved engorgement or
due to poor feeding technique resulting
in milk from one or more segments of
the breast not being efficiently
 MASTITIS

• This could be associated with

pressure from tight clothes or
supporting fingers. Milk stasis may
provide room for pathogens to
replicate.
 MASTITIS
• The solution is to continue feeding the
baby from the affected breast and also
help the mother improve feeding
technique and encourage her to ensure
complete emptying of one breast
before she can move the baby to the
other breast. Prophylactic antibiotics
such as; cephalexin or flucloxacilin may
be given
 MASTITIS

Infective mastitis

• This is mainly due to entry of micro-

organisms through broken epithelium.

Damage to the skin could be due to poor

attachment of the baby the breast.

 MASTITIS

• The mother should be helped to

improve on attachment technique
and given appropriate antibiotics.
• Abscess may form despite all
measures taken.
 BREAST ABSCESS
• May come as a complication of
infective mastitis and the breast will
develop fluctuant swelling in a
previously inflamed area.
• Pus may discharge from the nipple.
• Treatment could be by needle
aspiration of I & D.
 BREAST ABSCESS

• Breast feeding from the affected

breast should be withheld and resumed
as soon as it is practical as this helps
prevent further abscess formation.
• Meanwhile, breast emptying should
continue by expression.
 BLOCKED DUCTS

• This is associated with uneven milk

removal following poor attachment. The
milk distends the alveoli and may
subsequently be pushed into the
connective tissue of the breast there by
causing inflammation. Inflammation
causes narrowing of the ducts by
exerting external pressure.
 BLOCKED DUCTS

• The solution is to improve milk removal

by ensuring good attachment and
expression. Analgesics are given to
relieve pain. Massage is not encouraged
as it may worsen the condition by
forcing more milk into the tissues
THE END….

THANK YOU.!!