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Female Breasts,

An anatomical
guide

Mia Bryan
Contents:
About the Project
Breastfeeding
Introduction to Breasts Benefits
Formula feeding
Breast Anatomy
Breast exams
External
Internal Evolution
Innervation Beginnings
Breast and Nipple Orgasm Mammary gland evolution
Vasculature of the Breast
Human Breast Theories
Embryology
1st trimester
2nd and 3rd trimesters Breasts and the Environment
overview BPA
Breasts at Puberty Breast Cancer
Menstruation
Histology
Lobule development Male Breasts
Inactive breast
Pregnancy and lactation Breasts and Society
Slides Implants
Breast Physiology
Breast Dissection Guide
Lactogenesis
Galatokinesis Superficial dissections
Galactopoeisis Hemisected dissections
Implant dissection
About the Project
This project was undertaken in order to provide a tool for those wishing to teach or learn
about the female breast. Numerous books and articles already cover an amazing array of
topics on the breast, but few provide a simple overview of the anatomy, embryology, and
physiology of the breast over the course of a lifetime like this guide has done.
Anatomy is often the first time that students are introduced to the complexities of human
variation. As a discipline and practice, it is centered on a supposedly stable claim that the
body is natural, essential, and knowable while often overlooking the social construction of
anatomy over time and within cultures, as well as the fact that anatomy is a contested
field. Anatomy texts are supposed to be authoritative texts about the body that present
fact for the medical community and students . However, anatomical texts construct
simplified and universalized models of culturally constructed, binary sexed bodies that
are infrequently scrutinized. Illustrations within texts rarely depict a range of bodies and
primarily show young, white, physically able men. Women appear more often today, but
historically males were considered the norm, and current illustrations of women are still
primarily white, young, and able-bodied. Furthermore, the breast is rarely depicted at any
stage in life other than that of a young adult female who has never breastfed. This has
intense universalizing effects that delete the range of variation in female sexual anatomy.
These texts are key means of conveying knowledge about sex and sex difference that
strongly shape our understandings of the body, normal female traits, and how our own
bodies compare. Therefore, it is important to note that the term female sexual anatomy
is not unambiguous. People who have anatomy described in a text may not call
themselves female or woman; people who label themselves woman may or may not
have the described anatomy and it may or may not look like images in a text; and people
may have parts of female sexual anatomy and parts of male sexual anatomy.
Because this guide could not include an atlas of female breasts celebrating their diversity,
the following link is a wonderful resource for anyone who would like to see galleries of
breast images of nearly every size, shape, and color.
007 Breasts
www.007b.com
Introduction to
Breasts
Breasts are mammary glands. All mammals, including humans,
have them. When developed, mammary glands secrete milk to
nourish young. Though all humans have breasts, they are more fully
formed, functional, and fixated on in women. Therefore, the
majority of this book discusses female breast biology.
The female breast receives a lot of attention in our society, but how
much do we really know about this remarkable organ? Breasts are
more than just fatty protrusions on the front of our chests. They are
phenomenally diverse, responsive, and dynamic parts of our bodies
that come in many shapes and sizes. The relationships we have
with are breasts are equally as diverse. Many women have a hard
time coming to love and accept a part of their body so sexualized
and idealized by their culture.
Self-image is often affected by our own or others reaction to our
breasts. Our feelings, whether positive or negative, are reinforced
by societys obsessive fixation on breasts. This makes it hard to
view our breasts as functioning parts of our bodies, especially in a
culture that heavily markets breast enlargement/augmentation.
Coming to know the biology of breasts can expand our lifelong
relationships to our breasts; hopefully, encouraging women to
celebrate breasts as key components of our sexual selves, powerful
providers for our children, and reminders of our connections to all
women, people, mammals, and mothers.
Breast Anatomy
The breast overlies the chest wall on either side of the sternum. It often
covers ribs 2-6 and 2/3 of the pectoralis major muscle, sitting on top of
underlying fascia and within the superficial fascia of the chest.
Mammary glands are exocrine glands. Their secretions (milk) travel
through ducts that open onto the surface of the skin. Mulitcellular
exocrine glands are formed by invagination, or in-pouching, of an
epithelial sheet that grows down from the surface into underlying
tissues and forms compound tubes. The blind end of the tube
constitutes the secretory parts of the gland and expands to form tiny,
round bags called alveoli.
Specifically, mammary glands are apocrine glands. They accumulate
their secretory product at the apical surface, the side of the cell facing
the opening. This accumulation then separates from the cell to form
the secretion (milk). Then the cell repairs itself to repeat the process.
External Anatomy of the
Breast
There is an enormous variety in the size and shape of
breasts. Women of roughly the same age can have 300 to
500 percent differences in breast volume . Sometimes the
left may be bigger than the right, or vice versa, sometimes
nipples lie flat, stick out, or retract (invert). The areola, the
area surrounding the nipple, may be large or small, dark or
light, and can be bumpy or even hairy. Part of the wonder of
the female breast is the variety in which they come!
The nipple and the areola are the darker parts of the breast.
The nipple is in the central area of the circular areola and
contains the openings of the milk ducts. Small bumps on the
external surface of the areola, Montgomerys Tubercles,
contain openings of Montgomerys Glands. These are
modified sebaceous (sweat) glands that secrete oils that
lubricate the areola to protect it and the nipple during
breastfeeding.
Breast glands are densely supplied with arteries and nerves
that allow them to respond to infant stimulation for lactation
and sexual stimulation. Breast size is not related to the
sexual responsiveness of the breast nor to the amount of
milk you can produce after giving birth.
Breast Anatomy
Internal Anatomy
All organs are made of functional parts, known as the parenchyma,
and structural parts, known as the stroma.
The functional parts, parenchyma, of the breast are called lobes. The
lobes are embedded in fat and separated by connective tissue.
Breasts are usually composed of 15-20 lobes. Each lobe is composed
of smaller lobules, and each lobule is composed of small tubes ending
in alveolar sacs. These alveoli drain into ductules that converge to
form lactiferous ducts ultimately opening at the surface of the nipple.
Fat and connective tissue compose the structural component
(stroma) of the breast; they account for the smooth contour and bulk
of the breast. The connective tissue creates fibrous septa within the
breast that run from the subcutaneous tissue overlying the breast
(just beneath the skin) to the fascia of the chest wall lying over the
pectoralis major muscle. Traditionally, these septa were known as
the Ligaments of Cooper for the anatomist who first described them.
Descriptions of breast anatomy hasnt changed much in the past 160
years. Female anatomy has been studied considerably little
compared with male anatomy, which for much of the history of the
biological sciences has been considered the norm. Consequently,
until very recently anatomists believed the breasts contained a
structure known as a lactiferous sinus, thought to be a bulge in the
lactiferous duct prior to opening onto the surface of the nipple. This
structure can still be found in some anatomical texts, but it does not
actually exist in breasts and was a remnant of dissection
methodology by Sir Astley Cooper in the 19th century. Current
research is attempting to catch-up and deepen our knowledge of
female anatomy, the breast in particular.
Breast Anatomy
Breast Innervation
Sensation and innervation of the female breast is of great significance
for both lactation and nipple erection for sensual and sexual
experiences. Breasts are highly responsive organs that react to an
infants needs and swell during sexual arousal.
Breast nerve supply is still being researched. Most agree that the breast
receives its main nerve supply from the lateral and anterior cutaneous
branches of the upper intercostal nerves, 2-6, known as mammary
branches. Intercostal nerves are the ventral rami of the mixed spinal
nerves. The breast also receives innervation to its upper part from the
intermediate supraclavicular nerves.
Many researchers agree that there is a rich supply of nerves forming a
plexus just under the nipple and areola (nipple-areola complex) within
the superficial fascia. The extent of contribution from individual nerves
is variable between breasts and between women, but a deep mammary
branch from the anterior division of the fourth intercostal nerve is often
described as the primary nerve reaching the nipple-areola plexus;
however, it is not the only nerve to reach the plexus.
The male breast has a very similar nerve supply as the female breast,
but the nerves are closer together in males and more widely spread out
in females.
Breast and Nipple Orgasm
While orgasms are characteristically the result of genital
stimulation, other types of sensory stimulation can also
generate orgasms. Women and researchers have experienced
and reported orgasms from breast or nipple stimulation. Possible
neural explanations report that orgasm-induced breast or nipple
stimulation may be due to sensory information projecting from
the breast to the same neurons that receive sensory activity
from the genitals. These are neurons of the paraventricular
nucleus of the hypothalamus. They produce and secrete
oxytocin into the bloodstream in response to vaginal, cervical,
breast or uterine stimulation. Oxytocin is released in response to
suckling at the breast and stimulates contraction of the
glandular tissue in the breast as well as the uterus.
Breast, nipple, cervical, and vaginal afferent activity may
converge on the paraventricular nucleus of the hypothalamus.
This part of the hypothalamus is activated during orgasm.
Women experience a significant release of oxytocin into the
bloodstream after orgasm. It is likely that the activity of these
neurons and oxytocin are involved in the pleasurable sensation
of both nursing and breast and nipple orgasms. Researchers are
currently examining a potential second site of convergence
between the nipple and genital afferent activity in the sensory
cortex of the brain as well.
Vasculature of the
Breasts
Breasts receive blood primarily from the anterior and posterior medial
branches of the internal thoracic artery, also known as the internal
mammary artery, and the lateral thoracic branch of the axillary artery.
Smaller blood supplies stem from thoracoacromial branches of the
axillary artery and branches from the intercostal arteries.
The proportion of blood supplied by each artery is highly variable
between women and often between the right and left breast of a single
woman.
The venous drainage of the breast is divided into deep and superficial
systems. Both ultimately drain to the internal thoracic, axillary, and
cephalic veins. Deep veins follow the course of the arteries, but
superficial veins form a sub-areolar plexus that radiates out from the
nipple to drain into the periareolar vein. The periareolar vein circles
the nipple and connects the superficial and deep venous systems of the
breast.
Breast tissue extends side-to-side from the edge of the sternum to the
midaxillary line (the center of the axilla). A tail of breast tissue called
the "axillary tail of Spence extends up into the armpit. This is
important to note because a mass of breast cancer can develop in the
axillary tail of the breast.
In fact, approximately 75% of lymphatic drainage of the breast follows
the axillary vessels to axillary lymph nodes up the tail of the breast.
The internal mammary lymph nodes receive lymph from the deep
portion of the breast.
Embryology of the Breast
Breast development begins in the embryo
and continues to undergo changes well into
adulthood. In the embryo and during
childhood there is little to no variation
between females and males in breast tissue.
At puberty, the breast primarily continues to
develop in females. The lobules and alveoli of
the breast do not develop to their full
capacity unless a female becomes pregnant.
Pregnancy and lactation mark the
achievement of a completely developed
mammary gland. Breasts change again
around menopause when the parenchyma
regresses and stroma replaces it. The image
on the right summarizes the changes in the
breast over a lifetime.
In the next section, the embryology of the
breast is examined following the major
developmental changes occurring during the
three trimesters of pregnancy.
Embryology: 1st trimester
Mammary-specific progenitor cells develop within the embryo 4-6
weeks after fertilization.
At about day 35 of embryological development post-fertilization,
there are paired areas of epithelial cell proliferation in the
epidermis of the thoracic region that extend in a line between the
fetal axilla and inguinal regions. These form two ridges known as
the mammary crests, or milk lines. In humans, most of the milk line
atrophies except for paired masses in the pectoral region. These
are the primary mammary buds.
Supernumerary nipples, also known as polythelia, occur in about
5% of people anywhere along the embryonic milk lines. These
could appear as a small pigmented area or as a fully developed
nipple-areola complex, though they are rarely functioning
Near the end of the 1st trimester, the primary mammary buds grow
into underlying mesenchyme (loose embryonic mesoderm),
enlarge, and develop indentations.
Embryology: 2nd & 3rd trimesters
During the second trimester, secondary epithelial buds appear from the
indentations on the primary bud. The secondary buds grow vertically into
the surrounding tissue as a stalk with a bulbous end. Throughout gestation,
these buds lengthen, branch, and eventually canalize (become hollow)
giving rise to the lactiferous ducts. The ducts are lined with two layers of
epithelial cells. The layer exposed to the lumen gains secretory function.
By 6 months gestation there is a tubular network in a bed of dense fibro-
connective tissue stroma.
In the 3rd trimester, the tubes from the secondary buds end in rudimentary
lobules or end buds. They converge and drain into a depression, the
mammary pit, formed in the epidermis of the future nipple. The nipple
develops from smooth muscle fibers aligned in longitudinal and circular
fashion.
During embryological development, there is a complex relationship
between fetal, placental, and maternal hormones that induce limited breast
secretory activity in late-term fetuses and newborn infants. At birth, falling
levels of maternal estrogen stimulate the babys pituitary gland to produce
prolactin which stimulates breast enlargement and milk secretion in about
70% of newborns. Though there is no difference in breast appearance
based on sex at birth, breast tissue in female infants may persist longer
than male infants due to higher levels of estrogen.
Soon after birth, the proliferation of underlying mesoderm sometimes
everts the nipple. However, it is not uncommon for nipples to remain
inverted until puberty or for life.
Embryology: Overview

This image shows the embryological development of the mammary gland. (A.) Ventral view of an embryo at 28-days
gestation with milk lines present. (B.) 6 weeks gestation after the mammary crests have been reduced to just the
thoracic region. (C-F) Transverse sections of the developing mammary gland between the 12 th week of gestation and
birth. (Reprinted from Moore KL, The Developing Human: Clinically Oriented Embryology. 9th ed. 2013)
Breasts at Puberty
Breasts are usually the first dimorphic secondary sexual
characteristic to develop in puberty. Their development is
heavily influenced by sex hormones, particularly estrogen.
Pubertal changes begin at a cellular level. First, there is an
increase in fibrous and fatty tissue (stroma). This starts out as
a bud of tissue behind the nipple-areola complex and can grow
slowly throughout puberty or appear to sprout over night. The
future functional part of the breast, the lobes and ducts, further
elongate and branch, sometimes even forming a few alveoli.
Ductal elongation and branching, caused by estrogen and
progesterone, originates from mammary stem cells in the
terminal end bud of the primary ducts formed during gestation.
It is not uncommon for one breast to develop more quickly than
another and for breasts to be different sizes. Breast
development during adolescence has been previously
categorized by the Tanner Stages. However, girls bodies grow
at different times in many different ways and it is hard and
unnecessary to try to fit them all into a normal stage during
their unique process.
Menstruation and Breasts
During a womans reproductive years, monthly hormonal
rhythms determine the timing of ovulation and
menstruation. The menstrual cycle regulates fertility, and
many women experience signs of this rhythm as changing
emotions, sexual arousal, and/or food preferences. Breasts
also change in response to our menstrual cycles.
During the luteal phase of the menstrual cycle, the lobules
and alveoli develop further. Lumens of ducts open and
there is a marked increased in mitotic activity. The breasts
are reacting to sex hormones, estrogen and progesterone,
and can become slightly bigger and fuller after ovulation.
This can sometimes result in breast tenderness that can be
felt up into the armpit in the part of the breast called the
tail. These changes generally regress with the onset of
menstruation.

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Histology: Lobule Development

Histology of the breast examines the structure of mammary glands


on a microscopic level. Histology of the breast changes over a
lifetime. This is particularly evident in the glandular structures of
the breast. There can be four types of lobules in the female breast:
Lobule type 1 consists of a short terminal duct stemming from a
cluster of alveoli.
Lobule types 2, 3 and 4 have terminal ducts that subdivide to form
terminal ductules with an increasing number of alveoli.
A collection of alveoli from one terminal duct and its surrounding
intralobular stroma is known as a terminal duct-lobular unit, the
functional unit of the breast.
The adult nulliparous breast is usually complete in ductal and
stroma maturation by 18 to 20 years, and lobules are mainly type 1.
Lobule type 4 is found in women who have gone through pregnancy
and lactation.

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Histology: Inactive Breast
In inactive mammary glands, connective tissue is more
abundant and glandular/secretory tissue is minimal.
As mentioned previously, the mammary gland consists
of 15 to 20 lobes. Each lobe is an individual compound
tubuloalveolar gland with its own lactiferous duct
opening onto the surface of the nipple. Between lobes,
interlobular stroma is made of dense collagenous
connective tissue with varying amounts of fat. Within
each lobe, intralobular connective tissue separates
lobules.
A lobule contains groups of small tubules lined with
cuboidal or low columnar epithelium that resemble
ducts but remain in this state during gland inactivity.
Potential tubules may also be present in an
undifferentiated form as solid cords of cells.
Tubules are surrounded by a loose fine-fibered vascular
connective tissue, intralobular connective tissues, with
fibroblasts, lymphocytes, plasma cells, and eosinophils.
Histology: Pregnancy &
Lactation
Breasts are the only organs not fully grown by adulthood. During
pregnancy, the breast continues on with its development into a milk-
secreting gland.
Throughout the first half of pregnancy, proliferation of the duct system
continues. Buds forming at the ends of the smallest ducts differentiate into
alveoli. Most alveoli are empty, though some contain secretion.
The lobules are filled with alveoli and the intralobular loose connective
tissue begins to appear reduced in amount. The lymphocytes and other
cells in this tissue are numerous. The interlobular dense connective tissue
now appears as septa between the lobules of glandular tissue.
Interlobular ducts, lined with tall columnar cells, course in the septa and
empty into large lactiferous ducts lined with pseudostratified columnar
epithelium. Each lactiferous duct collects the secretions of a lobe and
transports them to the free surface of the nipple.
At seven months, alveoli expand and their cells become secretory.
Secretion can be seen in the alveolar lumens and the intralobular ducts.
Further reduction is seen in the amount of intralobular and interlobular
connective tissue.
The main differences in the histology of a lactating breast compared to
what has been discussed previously are the various sizes and irregular
shapes of the alveoli and the presence of secretion in most of the lumens.
All alveoli are not in the same state of activity at the same time. Some are
storing secretion; these cells are large, broad, and contain vacuoles.
Others are in a resting state in which the epithelium is low cuboidal. The
alveoli can be reduced in size since the secretory products in their apical
portions are released into the lumen of the alveolus.
Histology: Slides

Left: Inactive breast tissue. CT- connective tissue. L- lobe


Middle: Breast tissue during pregnancy. Lobes (L) are more developed, connective tissue is diminished
slightly, and more fat deposits (A) can be seen.
Both Right: Lactating breast tissue. Secretions can be seen within ducts (D) and alveoli (A).
Breast Physiology
The physiology of the breast is referring to its function, milk-
secretion. During pregnancy the breast undergoes
numerous internal (see Histology) and external changes:
blue veins may become visible on the surface of the breast,
the areolae may get darker and larger, and Montgomery
glands begin to form more fully on the areolae to help keep
nipples clean and moisturized for breastfeeding. This is all in
preparation for lactation, the primary function of the breast.
The physiological process can be divided into four parts:

1. Mammogenesis: the growth and development of the


mammary gland. This has been described in previous
sections, so the next section will begin with stage 2.
2. Lactogenesis: synthesis and secretion of milk from breast
alveoli
3. Galactokinesis: ejection of milk outside of the breast
4. Galactopoiesis: maintenance of lactation

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Breast Physiology:
Lactogenesis
Lactogenesis is the onset of milk secretion and includes the
changes in the mammary epithelium necessary to prepare to
breast feed after parturition (birth). There are two different control
systems for lactogenesis: endocrine and autocrine (local) control.
Lactogenesis begins during pregnancy. Placental estrogens and
progesterone stimulate further development of the mothers
mammary glands, potentially doubling their size. During this time
and for the first few days postpartum, milk supply is under an
endocrine (hormonal) control system. Estrogens cause the ductile
systems to grow and branch and stimulate the deposition of fat
around the ducts, while progesterone stimulates the development
of the alveolar glands at the ends of the ducts. However, high
levels of these two hormones inhibit milk production and secretion.
At birth, the loss of the placenta causes a sudden decrease in the
levels of estrogens and progesterone. The withdrawal of
progesterone and high levels of the hormone, prolactin, increase
milk secretion and volume 30-40 hours postpartum. Often around
this time, breasts become engorged, tense, tender, and feel warm.
After the birth, control of lactation switches from a primarily
endocrine to a primarily autocrine control system. Hormones still
play a role in lactation, but milk production is now in a
maintenance stage and milk synthesis is controlled at the breast.
Milk Secretion
Milk removal is the primary control mechanism for milk supply. A
full breast stimulates slower milk production and an empty
breast stimulates faster milk production.
However, the hormone prolactin must also be present for milk
synthesis to occur. Lactocytes, milk-producing cells in the alveoli,
have prolactin receptors in their walls. Prolactin is released from
the anterior pituitary, travels through the blood stream and into
the lactocyte receptors to stimulate the synthesis of breast milk
components. This process is known as milk secretion.
When the alveolus is full of milk, the walls stretch, altering the
prolactin receptors shape, preventing prolactin from entering
the cells and decreasing the rate of milk synthesis.
The prolactin receptor theory suggests that frequent milk
removal in the early weeks postpartum increases the number of
prolactin receptor sites which allows for increased milk
production capability.
Milk also contains a protein called Feedback Inhibitor of Lactation
(FIL). FIL slows milk synthesis when the breast is full; since there
is more milk, there is more FIL. When the breast is empty, less
FIL is present and milk accumulates at a faster rate.
The fat content of the milk is also determined by how empty the
breast is. An emptier breast produces milk higher in fat.
Galactokinesis
Discharge of milk from the mammary glands is known as
galactokinesis. Milk ejection requires the initiation of a reflex that
causes the contraction of specialized myoepithelial cells, microscopic
bands of muscle, surrounding the alveolar glands and ducts.
Autocrine or mechanical stimulation, suckling, of the nipple and
areola elicits the reflex. Mechanoreceptors in the nipple send
impulses from the breast to the hypothalamus. The hypothalamus
then stimulates the posterior pituitary gland to release oxytocin.
Oxytocin travels through the blood stream to the breast and
stimulates the myoepithelial cells around the alveoli and ducts to
contract. Milk is let-down, ejected, from the alveoli into the ducts and
finally into the suckling infants mouth within about 30 seconds.

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Colostrum
About halfway through pregnancy and just after child
birth, the secretory activity of the breast produces
Colostrum, first milk.
Colostrum is a thick, yellowish fluid that has more protein
but less carbohydrate and fat than milk. It is produced in
small amounts during pregnancy and during the first
couple of days after the baby is born. Colostrum has
immunological properties and contains antibodies from
the mothers immune system that protect the newborn. It
contains high concentrations of secretory immunoglobulin
A (aIgA), an anti-infective that coats a babies GI tract to
protect against germs and foreign proteins that could
create allergic sensitivities.
Milk and colostrum also contain pancreatic secretory
trypsin inhibitor (PSTI), which further protects and repairs
infant intestines. The acidic level of colostrum encourages
the ideal ratio of beneficial bacteria within the gut.
Colostrum is a laxative that helps the baby pass
meconium, a tar-like stool, that built up in their system
before birth.

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Galactopoeisis &
Milk Storage
Lactation is maintained, galactopoeisis, through the
combined effects of prolactin, oxytocin, and continuous
breastfeeding.
A womans milk storage capacity is the amount of milk
that the breast can store between feedings, it varies
widely from mom to mom, it is not determined by breast
size, and most storage sizes can produce plenty of milk
for an infant.
A small storage capacity likely means that a mother will
need to nurse more often to satisfy a babies appetite and
to maintain milk supply. Her breasts will become full
more quickly and, as we read earlier, full breasts slow
milk production. Like the storage capacity of a cup for
water, a smaller cup will just need to be refilled more
often.
Milk synthesis can be increased and sped up by removing
milk from the breast quickly and frequently by nursing
more often and/or pumping between nursing sessions.
Breastfeeding
Breastfeeding is critically important. It effects both children and
mothers emotionally and physically for the entirety of their lives.
Breast milk has every vitamin, mineral, and other nutritional element
that a babys body needs, including many that have yet to be
discovered. Breast milk changes subtly throughout the meal, day and
year to match small changes in a babys requirements. Should a
baby pick up germs from the grocery store, she communicates those
germs to the mothers breast at her next nursing, and it starts
producing specialized antibodies.
At birth, a babies instincts and reflexes help them crawl to the nipple
and latch on to begin breastfeeding. One of the oldest breast
feeding methods, laid-back breastfeeding, involves leaning back at a
reclined angle with your babies belly on your own.
Many babies start searching for the breast immediately when in this
position, others may need some time to calm. Babies, sometimes
with a little help from their mothers, rely on their senses of feel and
smell to find their way to the breast. This position also allows the
newborn to open their bottom jaw wide and latch onto a good
amount of the nipple AND surrounding areola lessening moms
likelihood of pain and nipple soreness (after all its breast-feeding,
not nipple-feeding). This baby-led approach means the newborn can
organize herself, sense her landmarks, and choose her moment to
feed.
Breastfeeding:
Benefits
Breast milk contains powerful anti-infectives that can treat eye
infections and speed up skin healing! Mature breast milk contains
interferon, interleukins, and white blood cells all building up the
babys immune system. Breast milk also contains insulin for
digestion, long-chain fatty acids for heart health, and lactose for
brain development. During breast-feeding, the muscles in a babies
jaw are exercised and massaged in a way that causes the bones of
the face and jaw to develop more fully.
Mothers also benefit from breast feeding. Many women, though not
all, lose weight more readily while breastfeeding. Breastfeeding can
also make a woman less susceptible to breast, uterine, and cervical
cancers. The hormones oxytocin and prolactin surge during every
breastfeeding, as we learned previously, to stimulate milk secretion
and milk let-down. They also stimulate feelings of love and nurturing
in breastfeeding mothers. Oxytocin and prolactin help foster a
connection between mom and baby and help mothers recover from
the emotional and physical stress of birth. Without these hormones,
mothers tend to talk to their babies less, interact less, and touch less.
Breast-feeding is a miraculous, specialized ability that allows
dynamic communication between a baby and her mother. In many
ways, breasts are personal health centers for our babies. The World
Health Organization and other national pediatric associations advice
exclusive breastfeeding for at least six months, with the gradual
introduction of solid food and continued breastfeeding for at least
two years.
Breastfeeding:
Formula feeding
Breastfeeding itself does not reduce risks of infection or disease in
mothers and babies. Rather, breastfeeding is the norm, so it results
in normal good health. When mom and baby dont breastfeed they
are at increased risk for short and long-term illnesses.
Babies who do not breast feed are at higher risk for ear infections,
intestinal upsets, respiratory problems, allergies, and dental
problems.
Formula fed babies have a different metabolism, a higher chance of
sudden infant death syndrome, and their kidneys and livers work
harder to eliminate waste products from formula. They are also at
greater risk of Crohns disease, ulcerative colitis, type 1 diabetes,
heart disease, and certain cancers as an older child or adult.
Women who havent breastfed are at greater risk for metabolic
syndrome, which makes heart disease and diabetes more likely.
Formula-feeding mothers blood pressure is likely to be higher and
she is at increased risk for autoimmune diseases.
However, breastfeeding is not always a reasonable option for
mother and baby. The choice to breastfeed or formula feed is a
personal one that depends on a number of factors including
mothers comfort level, lifestyle, and medical considerations. If a
woman chooses to use formula feeding, it still provides important
connection time between baby and mom, and formula is prepared
as a nutritious alternative to breast milk.
Breastfeeding:
Breast Exams
Scientific studies designed to measure the efficacy of
monthly breast self examinations have not found that
women who perform breast self examinations are any less
likely to die of breast cancer than women who dont
perform them. However, exploring your breasts is a good
way to get to know your body and become familiar with
what is normal for you.
Specialist, Cheryl Chapman, suggests that all women,
pregnant and nursing mothers especially, move their
breasts at least twice a day. She believes this produces
many benefits including improved lymph drainage to
remove toxins and improve the immune system, reduced
breast tenderness during pregnancy, and improved
awareness about changes in your breast.
Bend at the waist, cup your hands under your breasts, and
gently move your hands up and down. Give them a chance
to shift and move.

Image from the cover of The Happy Breast Book, by Cheryl Chapman (2003) .

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Evolution: Breast
Beginnings
Our breasts are one of the many things that make us,
humans, so unique. While all mammals have
mammary glands, none have breasts quite like ours.
Most mammals only have pronounced mammary
tissue during pregnancy and lactation, but ours stick
around after puberty for our whole lives regardless of
reproductive status.
Some of our most strongly conserved genes, about
six thousand, play a role in lactation. Lactation at its
most basic is a fat-delivery system that has changed
little over millions of years.
All mammary glands provide specialized nourishment
for newborns, and each mammal has its own ratio of
fats to carbohydrates to proteins that provide
immune support for offspring, produce hormones
that work as natural contraception ensuring
adequate birth spacing, and provide a learning
window for young mammals to acquire skills rather
than hunt for food.
Evolution: The Mammary
Gland
The earliest lactating species appeared at the end of
the Triassic period, 200 million years ago, but
mammals didnt flourish until the Cenozoic after the
extinction of the dinosaurs. Scientists speculate that
mammary glands first evolved for immune support.
Mammary glands evolved receptors on their cells to
listen for and collect estrogen, as well as
progesterone, prolactin, lactogen, and many other
hormones from the surrounding environment before
bodies began producing these hormones
themselves. These hormones tell the glands when to
mature and when to regress.

Image by Aliki
Evolution: Human Breast
Theories
Many antiquated but popular theories of breast
evolution attempt to examine and explain it as a
consequence of sexual selection.
The breasts as sex signals theory of origin looks at
mate/male choice for an explanation of our unique
breast development.
However, while breasts may attract mates/males,
that is not their primary function and, therefore, an
unlikely explanation for their evolution. This and
other sexual-selection theories on breast evolution
over sexualize breasts. They detract from infant
health and contribute to body image problems in
women. Reinforcing that breasts are exclusively for
sex also undermines the idea that breastfeeding is
normative.
More and more scholars agree that the breast
evolved through natural selection rather than sexual
selection.

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Evolution: Human Breast
Theories
Current theories of breast evolution speculate that
breasts likely helped increase womens fat reserves
which in turn helped women sustain pregnancy and
lactation in unpredictable environments. Humans
need to store more fat than other primates because
they dont have fur to keep them warm, and they
need to be able to mobilize more fat to maintain
the development of big brained babies.
Consequently, women do no ovulate unless a body-
fat threshold has been crossed and on average
store twice the fat that men do.
Fat and cholesterol make estrogen, so since we are
fatter than other primates we have more estrogen.
Interestingly, mammary glands contain numerous
estrogen-sensitive cells. One theory speculates
that we needed to be fatter to produce human
babies, our fat made estrogen, and estrogen made
our breasts.
Evolution: Human
Breast Theories
Another theory also postulates that the breast
developed as an adaptation to hairlessness. Since
human babies cannot cling to their mothers fur to
feed, they need to be held and the pendulous
human breast brings the nipple close to the baby
while in the crook of her mothers arm.
Researcher, Gillian Bentley, suggests that the shape
of the human skull drove the development of a
loose, rounded breast. One of our distinguishing
differences from other mammals is our lack of a
snout. A lack of a snout could have been the
consequence of a more varied diet that included
cooked meats. Large mandibles were no longer
needed to tear flesh. We also have very large brains
and heads at birth, five times as big as a primate
our size. Our flat faces help us get our large heads
through narrow bipedal hips., and rounded breasts
allow babies to suckle farther from their mothers
chest with room to breathe. Again, pendulous
breasts allow the nipple to come down to a baby
Breasts and the Environment

We are designed to be biologically responsive to the


world around us. This is called phenotypic plasticity, and
our hormone receptors are sensors that allow us to gauge
the world we live in. Unfortunately, the ring structure of
estrogen is very similar to synthetic compounds, such as
plastics, solvents, and pesticides, which allows them
entry into our bodies. Our breasts have more varied and
sensitive hormone receptors than other organs and are
the most sensitive to these pollutants.
In the United States, only a few hundred of eighty-two
thousand new chemicals have been tested for health
effects, and only five chemicals have ever been banned.
Every chemical is assumed safe until proven otherwise.
In 2007, independent scientific testing found 216
chemicals that cause mammary gland tumors in animal
studies. 73% of these are found in consumer products or
food. Simultaneously, incidence rates for endocrine-
related cancers, such as breast cancer, are notably rising.
Breasts and the Environment: BPA
Because our breasts evolved to be sensitive to
environmental estrogens, they face an increased risk from
environmental pollutants, specifically endocrine disruptors
and xenoestrogens. These foreign hormones can interfere
with our normal hormonal systems causing cancer, birth
defects, and other developmental disorders.
Bisphenol A, BPA, is an example of an artificial estrogen that
has been widely used to make polycarbonate plastic. Two
million pounds of BPA are produced a year in the USA
despite researchers finding that BPA causes early puberty,
lower sperm counts, changes in animal mating behavior,
predisposition to obesity, increased rates of breast and
prostate cancer, and increased rates of miscarriages in
rodents.
Numerous studies have confirmed that BPA activates
estrogen receptors on breast cells. In addition, BPA has
been shown to cause normal breast cells to act like cancer
cells, growing invasively, and rats exposed to BPA have
altered mammary glands that are more susceptible to
getting cancer later in life.
Breast Cancer
In 2013, approximately 39,620 women were
expected to die from breast cancer, as well as 410 men.
Excluding cancers of the skin, it is the most common
cancer among US women. Known genetic factors account
for only about 10 percent of all breast cancers.
Girls today are getting breasts earlier than ever
before. Girls are developing breasts and sprouting pubic
hair one to two years younger than expected, with
African American girls getting breasts at a mean of 8.8
years and white girls at 9.8 years. Known as precocious
puberty, experts have lowered the age range from 8 to 7
years in white girls and from 7 to 6 in African American
girls.
Early puberty is a problem.If you get your first
period before age twelve, your risk of breast cancer is 50
percent high than if you get it at age sixteen. Not to
mention, young girls are not emotionally equipped to
handle the challenges of puberty in a culture that
sexualizes their bodies before they even reach junior
high school. Studies have shown that prematurely
developed girls are at greater risk of substance abuse,
depression and suicide. The exact causes of precocious
Breast Cancer: The environment
and puberty
The breast is the only organ that still has most of its basic
construction well after birth. With change comes instability and an
organ incredibly responsive to cues both outside and inside our body
may be increasingly susceptible to damage. During puberty, when
the organ is growing fast is the most vulnerable time for exposure.
We can try to protect ourselves and our girls by watching what we
eat, but in order for change to be meaningful and healthful the
government and chemical companies need to change the way they
test, manufacture, and market these substances.
Nearly all plastics in our lives are estrogenic. They appear to be
bypassing the bodys normal hormone-making process and either
attaching to estrogen receptors in girls breast tissue and switching
them on before their time or acting like obesogens altering gene
expression that governs fat storage. Their exact effects are still
unknown and some women seem to be at higher risk than others.
African American women in their twenties have a nearly 50% higher
rate of breast cancer than white women of the same age. While
there are likely numerous social and biological explanations for the
difference in cancer incidence based on race/ethnicity, a study by
the Breast Cancer and Environmental Research Centers found that
African-American girls had four times the amount of environmental
pollutants in their blood than white and Asian girls. African American
girls are four times more likely than white girls to reach puberty by
age 8; putting them at further risk of developing breast cancer in the
future.
Male Breasts
As I mentioned before, men also have breasts!
However, they are usually non-functional and
rudimentary. Just like female breasts, male breasts are
composed of small ducts, though without alveoli, within
a fibrous network of connective tissue and fat. Male
breasts are still susceptible to the same diseases that
affect the female breast and can also be key
components of male sexual pleasure.
Sometimes men grow more developed breasts and on
rare occasion have been able to produce milk-like fluid.
When male or female breasts produce milk unrelated to
pregnancy, the condition is called galactorrhea.
Gynecomastia is the enlargement of breasts in men or
boys most often caused by an imbalance of the
hormones estrogen and testosterone. Environmental
pollutants may also play a role.
Breasts and Society: Breast
implants
In 2009, the American Society for Aesthetic and
Plastic Surgery reported that 289,000 women had
surgery to have their breasts enlarged.
Breast implants are prosthetics used to change the
size, form and texture of a womans breasts for
medical or aesthetic purposes.
There are two general types of breast implants:
saline and silicone. The saline implants are rounded
shells filled with saline solution. They are the less
expensive option. Silicone implants are shells filled
with a silicone gel.

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Breasts and Society: Silicon
implants
There have been five generations of silicone implant models. The
first were silicon rubber bags filled with silicone gel with patches
of Dacron to bind them to the chest wall to prevent the implant
from migrating.
Silicone implants today only last between ten and twenty years.
Surgery to replace or remove the implants, explantation, is more
involved than the initial surgery and often requires the cutting
away of dense scar tissue, calcifications, and siliconomas (hard
nodules).
After 10 years, between 25 to 70 percent of women with the
original silicone implants suffered capsular contracture, an
immune response in which the body partially or completely seals
the implant in a hard mass of scar tissue that shrinks and
tightens around the implant causing pain or discomfort and
aesthetic distortions.
In 2007 the worldwide market for breast implants was 820$
million a year and growing by 8 percent each year. Between five
and ten million women have implants. Women buying implants
today may still need recurrent surgeries in the future, regular MRI
scans to detect silent ruptures, have reduced ability to detect
early breast cancer, and have problems with nipple sensation
and breast-feeding.
Breast Dissection Guide

Breasts can be dissected in a number of ways. Two


different methods were used for this cadaver dissection guide.
The first is a superficial dissection of the entire breast, and the
second is a deep dissection of a removed and hemisected breast.

Breast dissection objectives include:


1. Making surface cuts on the thorax and removing
the skin overlying the breast by going around the nipple
2. Removing the other mammary gland from the chest
wall exposing the pectoralis major muscle and bisecting the
breast down the middle into two equal halves
3. Identifying the fat and connective tissue of the breast,
ducting, nerves and vasculature, and compartmentalization.
4. A dissection of a cadaver with breast implants was
also included.

*The following pages contain photos of cadaver dissections.


Breast Dissection Guide:
Superficial

Dissection should begin with a midline incision in the skin running down the center of the sternum
from just below the level of the clavicle down beneath the fold of the breast. Two butterfly cuts
should then be made above and below the breast to the midaxillary line. Trace the outside border
of the areola with the scalpel to leave it and the nipple attached to the underlying breast tissue.
Breast Dissection Guide:
Superficial

Left: Anterior view. Slowly and carefully peel back the skin, cutting the connective tissue as near to
the skin as possible. Leave the areola and nipple attached.
Right: Anterior view. Just under the skin, we can see some of the stroma, structural components of
the breasts; primarily adipose tissue (fat)
Breast Dissection Guide:
Superficial
suspenso
ry
ligament
nippl s
e

areol
a

fibrou
s
septa

Anterolateral view. Clear away the superficial fat using blunt dissection to reveal the
suspensory ligaments of the breast.
Breast Dissection Guide:
Hemisection
nipple

Midsagitt
al cut fat

duct
sept
a

Nipple-
areola
complex

Left: Anterior view. This breast has been removed from the chest wall and hemisected by a midline
sagittal cut through the center of the areola and nipple.
Right: Medial view. Here we can see the skin overlying mammary gland adipose tissue. The fat is
compartmentalized by septa and embedded with ducts.
Breast Dissection Guide:
Hemisection

Interlobular
septa Lactifer
ous
ducts
nipple
lobule
lobu

lactiferous
duct
Top: Medial view. Pockets of fat can be cleared out of small compartments separated by fibrous septa. Tracing back
from the surface of the nipple, locate the lactiferous ducts and use blunt dissection to separate them from the stroma.
Bottom: Medial view. Tracing back from the surface of the nipple, the functional component of the breast, the ducts
and lobules, can be followed as they fan out radially.
Breast Dissection Guide:
Hemisection

mammary
artery

nerve

Left: Medial view. Small mammary arteries, branches of Internal Mammary arteries, can be found
running with the ducts up and around the nipple.
Right: Medial view. Thin, whitish nerves, branches of the nipple-areolar nerve plexus, can also be
found among the lactiferous ducts coursing towards the nipple.
Breast Dissection Guide:
Implants

Left: Anterior view. Cadaver with breast implants prior to dissection. Implants have migrated laterally on the chest wall.
Right: Anterior view. The dissection followed the same steps as presented in the superficial breast dissection guide
previously with a midline cut and two horizontal cuts above and below the breast; again preserving the nipple. Once the
skin is removed, the underlying fat and connective tissue are visible.
Breast Dissection Guide:
Implants
pectoralis
deep fascia major
underlying
stroma

capsular
contractur
e

Left: Anterior view. A midline incision was made in the fatty breast tissue to reveal the implant. The breast implant
was located under the stroma, on top of the pectoralis major muscle, and completely encased in a calcified capsule.
Right: Lateral view. Here we can see the encapsulated implant lying under the a layer of fat and connective tissue
and attached to underlying fascia over pectoralis major.
Breast Dissection Guide:
Implants
Silicon
implant

calcifie
d
capsule

Dacron
patch

Left: Anterior view. The capsule containing the implant was completely removed from the body.
Right Top: Anterior view. Scissors were used to make a midline cut through the capsule. The capsule was hard,
calcified scar tissue that the body likely produced as an immune response to the foreign silicone implant.
Right Bottom: Posterior view. The back of the silicone implant was covered in roughened strips of material, possibly
Dacron patches, to help secure the implant to the chest wall. The presence of the patches leads me to believe
these are first generation silicon implants. Many became encapsulated and/or migrated around the chest wall.
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