Anatomy clinical correlates: Breast

00:00 / 00:00


Anatomy clinical correlates: Breast

USMLE® Step 1 questions

0 / 5 complete

USMLE® Step 2 questions

0 / 5 complete


USMLE® Step 1 style questions USMLE

of complete

USMLE® Step 2 style questions USMLE

of complete

A 30-year-old man comes to the office with his wife for evaluation of infertility. They have been married for two years and have attempted to conceive without success. The patient’s wife has a child from her previous marriage. The patient reports decreased libido but finds it challenging to maintain an erection. Past medical history is unremarkable. He takes no medications besides a multivitamin daily. Family history is noncontributory. The patient’s height is 185cm (6ft 1inch), and weight is 66 kg (145.5 lb). Vital signs are within normal limits. Physical examination shows sparse facial and body hair and enlarged breasts. Olfactory sensation and visual field testing are within normal limits. Genital examination shows normal male external morphology and firm testes with a volume of 6 ml (normal 18-25 mL). Which of the following is the most likely underlying cause of this patient’s breast enlargement?  


The breasts, formally known as the mammary glands, are situated in the subcutaneous tissue overlying our pectoralis muscles. There are many conditions that can affect the breast, the most well known being breast cancer. Breast cancer, as well as other conditions that can affect the breast, can often go unnoticed, which has serious clinical consequences; so It is important to understand and recognize these conditions as early as possible.

So let’s start with breast cancer, which causes changes to the structure and appearance of the breasts. One of the classic changes is the presentation of a palpable breast mass, which is typically a hard, immobile lesion with irregular borders most commonly found in the upper outer quadrants.

Another indication of more advanced disease are skin changes, specifically the orange-peel appearance, also called the peau d’orange sign, which happens when there’s prominent edema and dimpling of the overlying skin. Larger dimpling of the skin can result from cancerous invasion of the glandular tissue and fibrosis, which may also pull on the suspensory ligaments of the breast and can cause retraction of the nipple.

If the cancer interferes with the lymphatic drainage this can lead to lymphedema, which is when there’s excess fluid in the subcutaneous tissue. This in turn results in deviation of the nipple and the skin appears thickened and leather-like. Cancer cells can spread through contiguity, which is when the adjacent tissue is invaded.

When breast cancer cells invade the retromammary space or the pectoral fascia, or when they metastasize to the interpectoral nodes, the breast elevates when the muscle contracts, and this usually signals advanced cancer. Furthermore, the local cancerous invasion to the pectoral fascia and pectoralis major muscle below may result in deep fixation of the breast tissue.

Breast cancer usually spreads through lymphatic vessels, which basically carry cancer cells from the breast to the lymph nodes, especially those in the axilla. Communications among lymphatic pathways and among axillary, cervical and parasternal nodes can cause metastases from the breast to develop in the supraclavicular lymph nodes, in the opposite breast or in the abdomen, but the most common site of metastasis of breast cancer remains the axillary lymph nodes.


  1. "Lymphedema" Journal of the American Academy of Dermatology (2017)
  2. "Supernumerary Breast Tissue" Southern Medical Journal (2000)
  3. "Gynaecomastia" BMJ (2016)
  4. "World Cancer Report 2014" NA (2014)
  5. "Lymphatic vessels in cancer metastasis: bridging the gaps" Carcinogenesis (2006)
  6. "Gray's Anatomy for Students" Churchill Livingstone (2005)

Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.