Clinical Osteology of Chest Walls

Clinical Anatomy of Mammary Gland

Lecture 26

Compiled by Dr Revanoor
Learning Objectives
At the end of this lecture, the student will:
• Describe the general architecture of the chest wall
• Describe the bones of the thoracic cage, movements of ribs and
thoracic inlet and outlet
• List the contents of an intercostal space and describe flail chest
• Describe the development of the mammary gland.
• Describe the location, extent and relations with reference to fascial
planes.
• Describe the structure, relations and blood supply of the mammary
gland and mention its mode of lymphatic drainage.
• Distinguish the characteristics of the suspensory ligaments of Cooper
and lactiferous ducts and understand their role in clinical significance of
mammary cancer.

2
 Thorax
• Superior part of trunk between neck and abdomen
• Thoracic wall
• Consists of skin, fascia, nerves, vessels, muscles, and bones
• Thoracic cavity
▪ Lungs, pleura & mediastinum
- Contents of superior mediastinum including neurovascular
structures, trachea, upper part of esophagus, thymic remnants.
- Contents of inferior mediastinum including heart and
pericardium, neurovascular structures, lower part of esophagus,
thoracic duct and thymic remnants.
The abdominal cavity and its contents extend cranially under the thoracic
cage separated from the thoracic cavity by the diaphragm. Rib fractures
may also injure the liver and spleen.
 -The skin over the nipple is supplied by 4th intercostal nerve
-The skin over the umbilicus is supplied by 10th intercostal nerve
 Architecture of thoracic cage
Designed in the same way as the abdominal wall.

1. Skin

2. Superficial fascia - consists of the

mammary glands in both sexes.

3. NO DEEP FASCIA- helps in adequate

expansion of chest wall in respiration.

4. Muscles & bony structures

5. Endothoracic fascia – corresponds with the

transversalis fascia

6. Parietal pleura

7. Pleural cavity
5
 Thoracic Cavity Significance
The abdominal cavity and its contents extend cranially under the thoracic cage separated from the thoracic cavity
by the diaphragm. Many abdominal organs can get injured in stab wounds on the chest

• Liver lies in the right hypochondrium extends above

the right costal margin to the 5th rib
• Fundus of gall bladder lies just below the right costal
margin at the tip of the 9th CC in the midclavicular
line
• Spleen lies in the left hypochondrium extending
above the left costal margin. Lies in line with the 10th
rib posterior to the midaxillary line. Injured in knife
wound at the back of chest on the left in spaces 9;
10 & 11.

6
 Thickenings of endothoracic fascia
Fixed regions of fibrous pericardium

Apex : fixed to cervicopericardial ligaments

Base: fixed to the central tendon of

diaphragm by phrenicopericardial ligaments

Anterior : Fixed to the sternum by superior

and inferior sternopericardial ligaments

Posterior: Fixed to viscera (trachea, bronchi

and esophagus) by visceropericadial
ligaments and vertebrae by
vertebropericardial ligaments
7
 The Bony Thoracic Cage
Anterior Wall
Anterior end of the ribs
Sternum
Costal cartilages.

Posterior Wall
Vertebral column(T1 -T12)
Posterior part of the ribs

Lateral Wall
Body of the ribs
 Structure of thoracic vertebra

Body:
• Dense cortex & spongy medulla

• Labrum: rolled margins of fused epiphyseal plates with the body

– Scheuermann’s disease ( abnormal ossification of epiphyseal
plate)

• Bony trabeculae: vertical, horizontal & oblique

- Criss-crossing of trabeculae create strong zones and ONE
WEAK zone – reason for wedge-shaped compression fractures
in the body

9
 Typical thoracic vertebra

Typical thoracic vertebra

1) VERTEBRAL BODY:
•Transverse & AP diameters of bodies are equal
•On T1,(?T9),T10, T11 and T12 vertebrae there are
single facets for articulation of the corresponding ribs.
• All other ribs articulate with corresponding vertebra and
with the vertebra above.
• Each of these vertebral bodies therefore has superior
complete facets (for inferior facet on head of ribs) and
inferior hemi-facets.

2) PEDICLE:
• Connects body to neural arches. Superior costal facet
encroaches on the roots of the pedicles

3) VERTEBRAL FORAMEN:
• Allows for the passage of the spinal cord.

4) LAMINAE:
• Form bulk of neural arch. Higher than wider. Arranged
10
like tiles on a roof
5) SPINOUS PROCESS:
• Formed by the union of the two laminae.
• Sharply incline inferiorly and posteriorly. End as single
tubercles(unlike cervical spines)

6) TRANSVERSE PROCESS:
• This forms at the junction of lamina and pedicle and points
laterally and slightly posterior
• Transverse facets for tubercles of corresponding rib
• Note that the transverse processes of T11 & T12 have no costal
facets

7) SUPERIOR ARTICULAR PROCESS:

• Flat, convex transversely, faces posterior, superior and lateral

8) INFERIOR ARTICULAR PROCESS:

12th THORACIC VERTEBRA
• Flat, concave transversely, faces anterior, inferior and medial

9) 12th THORACIC VERTEBRA:

• Single costal facets for 12th rib
• Superior articular facets same as typical thoracic
• Inferior articular facets face lateral and anterior

11
 Sternum and Important Surface Marking
Parts -manubrium, body and xiphisternum.

 The manubrium is notched on

its superior margin forming
the jugular notch at lower
border of 2nd thoracic vertebra

 Angle of Louis (Sternal angle)

at lower border of 4th thoracic
vertebra.

 Xiphisternal joint at body of

9th thoracic vertebra.

Remember to review and list structures seen at:

1. Level of sternal angle
2. Superior mediastinum
3. Anterior mediastinum
4. Middle mediastinum
5. Posterior mediastinum
 Sternal Articulations
Sternoclavicular joints – at upper angles of
the manubrium sternum .

Costosternal (costochondral) joints

1st rib articulates with the manubrium.

(DOES NOT MOVE-synchondrosis)

2nd rib articulates at the manubriosternal

joint at the sternal angle or angle of Louis.

This joint is in the same plane as the lower

border of the fourth thoracic vertebra.
Ribs 3 thru 6 or 7 with the body

Ribs 8 to 10 indirectly through the 7th with the

xiphisternal junction.
 Sternal Biopsies
If a bone marrow needle
passes thru the manubrium....

It can hit the arch of aorta and

LBCV!!!
THORACIC INLET THORACIC OUTLET
Superior Aperture Inferior Aperture
6.5 cm anteroposteriorly
• Body of 12th thoracic vertebra.
11 cm transversely
• Lower 6 pairs of costal Cartilages
• Superior border of manubrium • Xiphisternal junction
• 1st rib and costal cartilage (Inner border) • Closed by the diaphragm inferiorly
• 1st thoracic vertebra.(upper border)

Referred to as THORACIC OUTLET by clinicians

15
16
 Anteriorly
Ribs
•Ribs 1 thru 7 articulate anteriorly through their
costal cartilages with the sternum (true ribs)

•Ribs 8 thru 10 articulate through a fused

cartilage with the sternum (false ribs).

•Ribs 11 & 12 do not articulate anteriorly with the

sternum (floating ribs).

1st to 7th ribs – vertebrosternal Posteriorly

8th to 10th ribs – vertebrochondral• the ribs articulate with the vertebral bodies
11th & 12th ribs - vertebral • the transverse processes articulates with the tubercle of
1st costosternal junction is a primary cartilaginous rib.
joint

2nd - 7th chondrosternal junctions - synovial joints

8th-10th chondral junctions - synovial joints

17
 Self Study
Atypical Ribs

18
 First Rib

• No Angle
• Shortest & flattest
• Has grooves for subclavian vein and artery
• Important because of
Its neck is related to: SVAN
• Sympathetic chain
• Superior intercostal V & A
• Nerve- T1
Its body is related to
• Subclavian A & V

19
 First Rib
Sc. Ant
Sc.
Scalene Tubercle Med
• On inner border-
Scalenius Ant. Serr. Ant.
muscle insertion
Subclavian Groove
• Post. to tubercle
• Subclavian a. and
lower trunk
• Anterior to tubercle
• Subclavian vein
3 diameters of respiration
➢Vertical diameter
➢Above→ suprapleural membrane
➢below→ mobile diaphragm
➢Can be increases by descent of diaphragm

➢Anteroposterior diameter
➢Can be increased by
raising ribs and sternum
(pump handle movement)
[more in upper ribs]

➢Transverse diameter
➢Can be increased by
raising out lower ribs (bucket
handle movement) [more in
lower ribs]
 Rib Movements at Costovertebral & Costotransverse Joints

•Movement at Costovertebral and costosternal joints

joints simultaneously cause movements at the
sternocostal joints EXCEPT FIRST
•These movements elevate the sternum and place the
ribs to almost at a horizontal level→ increasing the
vertical and transverse diameters of the chest wall
•Increase in both the anterior - posterior and
transverse diameters of the thorax.

• The axis passing through

costotransverse joint and head of
rib literally suspends the rib
 Rib Movements at Costovertebral & Costotransverse Joints
x
Costovertebral and costotransverse joints serve as a y’
mechanical couple which share only rotation
• Orientation of axis of rotation relative to the sagittal y
plane determines the direction of movement of the rib x’
• The axis passing through costotransverse joint and
head of rib literally suspends the rib

Elevation of ribs:

the upper ribs coupled axes(y-y’) lie almost in the coronal

direction obliquely→ (pump handle movement increasing the
AP diameter of the thorax)

the lower ribs coupled axes (x-x’) lie almost in the sagittal
direction obliquely → (bucket handle movement increasing
the transverse diameter of the thorax - most lateral part of the
rib moves further away from the axis of symmetry of the body
than the most anterior part of the rib during inspiration)

- the middle ribs, both transverse and AP diameters are

increased
23
 Rib Fractures

Ribs 5 through 10 are the most commonly fractured ribs.

The first four ribs are protected by the clavicle and pectoral
muscles anteriorly and by the scapula and its associated
muscles posteriorly.

The 11th and 12th ribs float and move with the force of
impact.

Jagged ends of a fractured rib may penetrate the pleura & lungs and present as a pneumothorax
24
 Intercostal Spaces
The space between adjacent ribs, the intercostal space is filled in by the intercostal muscles.
•There are 11 intercostal spaces.
•Spaces are wider in front than behind.
•Spaces 3 to 6 are typical.
Contents of ICS
•Spaces 1,2 & 7 to 11 are atypical. Muscles- external, internal & innermost (transverse
•Contain VAN structures. thoracis)
Arteries- 2 anterior & 1 posterior intercostal arteries in
each space
Veins- corresponds to the arteries
Nerves- 1 thoracic spinal nerve & its branches
1 & 2(atypical) – to arm
3-6 (typical) - to chest wall
7-11 (atypical) - to abdominal wall
Lymph vessels- anterior → sternal group
posterior→ posterior intercostal group

25
FLAIL CHEST
➢Portion of rib cage is separated from rest of chest wall (multiple
rib fractures in severe blunt trauma)

➢Respiratory efficiency is reduced → respiratory distress

➢Common site of fracture- Middle ribs. Weakest part of ribs- just

anterior to angle

➢Condition is quite painful and may cause difficulty in ventilation

leading to reduction in oxygenation

➢Paradoxical respiration wherein the broken segment of the

chest wall moves in with inspiration and out with expiration.
(Exactly opposite of normal respiration)

26
 Pathological Condition of Thorax
PNEUMOTHORAX (1)
•Entry of air into pleural cavity due to tear either from an
external wound or rupture of a bronchus or
emphysematous bulla. There is recoil of lung due to its
elasticity
•When the pleura no longer pulls on the lung, it collapses
due to increased volume and pressure in the pleural cavity
(Tension pneumothorax)
•When blood enters – hemothorax
BRONCHIAL OBSTRUCTION WITH ATELECTASIS (5)
•Territory supplied by the bronchus receives no air and the
segment collapses
INFLAMMATORY PLEURAL THICKENING (6)
•Shell-like sclerotic pleura hugs the lung and prevents it
from expanding in inspiration. Occurs in pleurisy,
pyothorax/hemothorax
ACUTE GASTRIC OR INTESTINAL DISTENSION (7 & 8) hinders
movement of diaphragm
PHRENIC NERVE PALSY (FIG 44) diaphragm eventrates on
the side of nerve injury
27
 Objectives
At the end of this lecture, the student should be able to:

1. Describe the development of the mammary gland.

2. Describe the location, extent and relations with reference to
fascial planes.
3. Describe the structure, relations and blood supply of the
mammary gland and mention its mode of lymphatic
drainage.
4. Distinguish the characteristics of the suspensory ligaments
of Cooper and lactiferous ducts and understand their role in
clinical significance of mammary cancer.
 •Ingrowths occur along a
mammary ridge or line.

•Mammary line extends from axilla to groin.

 Development of Mammary Gland
•Modified and highly specialized sweat gland.

•Mammary buds develop as solid down-growths of

epidermis in 6th week.
•Epidermis at site of origin gets depressed into a
mammary pit by late fetal period.
•The nipples rise with the proliferation of the areola.
•Rudimentary mammary glands of newborn males and
females are identical.
•Nipples are poorly formed and depressed in infants.
• Initial secretion “Witch’s milk”is caused by
maternal hormones Only main ducts are formed at
birth.
• Both sexes have the same structure until puberty.
• Full development occurs by 20 years.
Developmental anomalies of the Mammary Gland
 Developmental anomalies of the Mammary Gland
Amastia-absence of the gland-Rare, due to failure of development of
mammary ridges. More common in association with gonadal agenesis
and Turner’s syndrome.
Micromastia-small gland-Small sized on one side or both. Often
associated with rudimentary pectoralis major.(Poland syndrome)

Gynaecomastia-male breast develops to become a female type..

•Occurs sometimes during puberty in males.
•Decreased ratio of testosterone to estradiol is present.
•80% of males with Klinefelter’s have this condition.

Supernumerary (Polymastia)-extra or accessory breast along the milk

ridge.

Athelia-absence of nipple
Polythelia-more than one nipple on one side
 Supernumerary breasts/nipples
• Common minor congenital
malformations that consist of
nipples and/or related tissue in
addition to the nipples normally
appearing on the chest.
• Located along the embryonic milk
lines.
• Can appear complete with breast
tissue and ducts and are then
referred to as polymastia, or they
can appear partially with either of
the tissues involved.
• Found in a number of syndromes
– Turners syndrome, Fanconi,
General Considerations
 General Considerations
• 75% of the mammary tissue lies lateral
to the nipple --because of the contour of
the chest wall and the “tear drop” shape
of the breast with its axillary tail.

• The tail of Spence extends obliquely up

into the medial wall of the axilla

• Present in both sexes.

• Develops along the mammary line.

 General Considerations
•Modified sweat gland in the superficial fascia.
•Retromammary space is b/w gland and deep fascia
•Thus, glands NOT firmly attached to deep fascia

•Fatty tissue and glandular milk-producing tissues - ratio varies among

individuals.

•Menopause decreases estrogen levels - the relative amount of fatty

tissue increases as the glandular tissue diminishes.

•Commonest cause of cancer death in women worldwide.

•Malignancy in male is very rare BUT FATAL.

Skin Structure
Structure
Nipple- lies in 4 intercostal space –
th

perforated by 15-20 lactiferous ducts

contains circular and longitudinal
muscles that can erect it.
Richly supplied by nerves

A large or erect nipple may be may be

mistaken for an intrapulmonary
nodules on a radiograph.

Areola:
pigmented circular area around the
nipple

Montgomery tubercles -due to

sebaceous glands deep to skin surface
Montgomery tubercles
 Structure
Glandular tissue:
Compartmentalized fat bounded by
CT septa
-15-20 lactiferous ducts open on
surface
-a dilated lactiferous sinus is a dilated
part of the duct before it opens onto
the surface.
-each duct drains number of lobules
which are collectively present in a
lobe.
-the ducts are placed radially from the
nipple - so incisions over the breast
are made radially
 Structure
Stroma:
•Numerous septae divide the gland.
•These septae are suspensory ligaments of Cooper
- fibrous strands that connect the ducts and alveoli to
the skin and pectoral fascia.

•Involvement of Cooper’s ligaments in a malignancy

may cause “Peau de orange” appearance of the
skin –An edematous pitted skin surface overlying
carcinoma of the breast in which there is both
stromal infiltration and lymphatic obstruction with
edema.

•Involvement of lactiferous ducts cause retraction of

the nipple
Fat: main bulk of gland
•Increases at puberty-replaced in old age by fibrous tissue
•Maintains the shape
•Interalveolar and inter ductular
•Retromammary space is filled with loose areolar tissue

The upper, outer quadrant of the breast contains a large

amount of glandular tissue and is the site of 60 per cent of
carcinomas of the breast.
 Relations
Extent (surface anatomy)

•Vertical - 2nd to 6th rib

•Medially to lateral sternal
line
•Laterally to mid axillary
line.
 Situation:

•Medial 2/3rd on fascia over

P.major
•Lateral 1/3rd over Serratus
Anterior.
•Below over external
oblique and its aponeurosis
 Axillary Tail of Spence
Extends upward and laterally
along the inferior border of
pectoralis major.

Region of tail of breast contains

large amount of breast tissue
and a great % of breast tumours
occur here
 Axillary Tail of Spence

The breast tail enters a

hiatus(opening) (foramen of Langer)
in the deep fascia on the medial
axillary wall.

The only breast tissue found beneath

the deep fascia

May be visible as a definite mass

mistaken for an axillary tumor or
supernumerary breast.
 The Retromammary Space
•The breast rests on a rich vascular
and lymphatic network over the
pectoral fascia.

•This represents the retromammary

space which is positioned between
the pectoral fascia and the gland

•Deep fascia on anterior surface of

pectoralis major should not fuse to
the fascia of the mammary gland
•If it does fuse it is an important
clinical sign indicating breast
disease
ARTERIAL SUPPLY

Internal
thoracic
branches
Arterial supply
•Branches of axillary artery—
Sup. Thoracic A; lateral thoracic A and
thoraco acromial A

•Branches of internal thoracic A-

perforating arteries of Anterior
intercostal arteries - 2nd-4th intercostal
spaces

•Lateral branches of posterior intercostal

arteries of 2nd-4th spaces.

All these enter the anterior surface of the

gland –so posterior surface is relatively
avascular and is called “Lake of
Marcelli”
 VENOUS DRAINAGE

Venous drainage
•Run towards the base of the nipple
to form circulus venosus
•End in the internal thoracic and
axillary veins.
•Posterior intercostal veins may
connect with the vertebral venous
plexus.(Pathway for metastasis)
convey sympathetic fibres Main secretion is
however controlled by
hormones from pituitary
and ovary- oxytocin and
prolactin.
LYMPHATICS OF BREAST

Upper
outer
quadrant

Lower medial
quadrant
 Lymphatics of the Mammary Gland

1. Skin over mammary gland EXCEPT the nipple

& areola

2. Parenchyma of glandular tissue and skin of

nipple and areola
 General concepts of lymphatic spread in cancer of breast

There are 2 sets of lymphatic channels

- 2 superficial channels - cutaneous (dermis) & subcutaneous
- 2 deep channels – lobes & pectoral fascia

Level I lymph nodes include the pectoral (anterior), subscapular

(posterior) and humeral (lateral) axillary lymph nodes.
Level II lymph nodes are the central ones and possibly some apical
lymph nodes, interpectoral (Rotter’s nodes)
Level III lymph nodes include the majority of apical axillary lymph
nodes
In most cases, dissemination of neoplastic cells from the breast towards
the axilla occurs sequentially, initially affecting level I, then level II and
finally, level III lymph nodes
American Joint Committee on Cancer and their anatomical
correspondence.
Surgical Level Corresponding lymph nodes (anatomical)

I Pectoral (anterior); subscapular (posterior);humeral (lateral)

II Central & some apical

Interpectoral (Rotter’s)

III Apical

FREGNANI, J. H. T. G. & MACÉA, J. R. Lymphatic drainage of the

breast: from theory to surgical practice. Int. J. Morphol., 27(3):873-878,
2009.
 Lymphatics of the Mammary Gland
2 sets of superficial lymphatic plexus –
cutaneous (dermis) & subcutaneous
From the skin excluding skin of nipple and areola
Upper marginal →apical nodes after piercing CP fascia →infraclavicular nodes.
b. Upper and lateral with axillary tail→pectoral group
c. Lower and lateral → pectoral + ant. Abdominal wall
d. Medial →sternal group of same and opposite side.

b a

d
Sternum

c
2 sets of deep lymphatic plexus –
lobes & pectoral fascia

From the parenchyma and glandular tissue including skin of nipple

and areola

Periglandular and periductal channels communicate with

1. Sub-areolar plexus of Sappey
2. Pectoral fascia nodes (retromammary space)
a) Subcutaneous plexus

d) Retro-mammary
plexus

c) Perilobular
plexuses

b) Subareolar plexus of
Sappy
 a
From retromammary space b&c
Sternum
a. Upper part →Apical group after
piercing CP fascia.
b. Upper and lateral parts→pectoral d
c. Lower and lateral→pectoral + ant
abdominal wall
d. Upper and medial→sternal group
of same and opposite side. c e
e. Dangerous area → plexus on
rectus sheath; along falciform Rectus sheath
ligament to hepatic nodes and into
peritoneal cavity. Secondaries on Peritoneal cavity
ovaries.
 Distribution of lymph from mammary gland
•75% to axillary nodes- anterior or pectoral group.

•20% to internal mammary nodes

•5% to posterior to posterior intercostal nodes

•Some pass to abdominal cavity from lower medial

quadrant→ in the pelvis (Krukenberg’s tumor of the
ovary)
 Surgical Anatomy of Radical mastectomy
Sentinel lymph node biopsy has brought benefits to breast cancer
patients, through avoiding unnecessary axillary lymphadenectomy and
its subsequent morbidity
In level III dissections, the nerve fasciculi (cords) of brachial plexus are
in a lateral (cranial) position in relation to the axillary vessels may be
injured.
In level II dissections, the medial and lateral fasciculi(cords) are more
susceptible to injury, while the posterior fasciculus is protected by the
axillary artery, which is located anteriorly to it.
In level I dissections, the roots of the median nerve are located anteriorly
to the axillary artery and will be damaged if the lymph node dissection
goes beyond the limit
However, 2 nerves are more likely to be injured in this procedure:-
• Long thoracic
• Thoracodorsal
Applied anatomy of the Mammary Gland
Inverted nipple
• Failure of epithelial pit to evert
• High suspicion of malignancy
• When congenitally retracted, should not be a cause for concern except
in breast feeding.
• This is often assisted by nipple shields which revert the retracted
nipple.
Applied anatomy of the Mammary Gland
• Breast abscess- incisions to drain
the pus should be done radially,
parallel to the lactiferous ducts to
avoid cutting them.
• Cancer breast- prognosis
depends on the area of drainage
- Upper lateral-most favorable
- Lower lateral less favorable
- Upper medial-most dangerous
due to its close proximity to
the mediastinum
- Lower medial –most
dangerous due to its close
proximity to the peritoneal
cavity.
Applied anatomy of the Mammary Gland
• Retraction of nipple is due to the involvement of
lactiferous ducts in fibrosis.
• Peau de orange- depressions or dimpling at the site
of openings of sweat glands with blockage of
lymph causes edema of the overlying skin.
• Occurs due to involvement of Ligaments of Cooper
• Fixation of the breast occurs due to involvement of
ligaments of Cooper attached to the pectoralis
major muscle
• Metastastic cells from Ca breast can travel through
posterior intercostal veins into vertebral venous
plexus and spread to bone and brain. During rise in
intrathoracic pressure (coughing, straining) there is
a reversal of blood flow in the vertebral veins
(Radiological evaluation of skeleton is
mandatory!!)
• Metastastic cells from Ca breast can spread to
subdiaphragmatic and hepatic nodes via
subperitoneal plexus→ ovaries (KRUKENBERG’s
tumor)
Carcinoma is the term used to describe
most common cancers that arise from
epithelial (surface or lining) tissues.

By contrast, sarcoma is the term used

to define tumors that arise from bone,
muscle, fat, or connective tissue.
 Lobular carcinoma and ductal carcinoma
2 common types
•Cells from the tumor may break away, travel, and grow
within other parts of the body (metastasis )to sites such as the
lung, bone, liver, and brain.
•They can be either invasive (spreading) or noninvasive
(generally known as 'in situ' - confined to the original site).
•The majority of breast cancers (70% - 80%) arise from the
ducts, which make up the bulk of breast tissue.
•Since lobular and ductal cells are found in the glandular
tissues of the upper, central, and outer regions of the breast,
this is where most breast cancers occur.
• Breast tumors rarely arise in the fatty or nonglandular
tissues. Such tumors, when they appear, are usually sarcomas.
Additional diagnostic tests:
Ultrasound - high-frequency sound waves into the breast, for
imaging
Needle aspiration determines whether a lump is solid or
fluid-filled.
Needle core biopsy (also called stereotactic breast biopsy and
mammo-test) is used to remove a core of tissue from a solid
lump.
Surgical biopsy is still the predominant method of confirming
a suspicion of cancer.
 Surgical Treatment

Lumpectomy Radical mastectomy

Segmental (Simple) Total mastectomy
mastectomy