Title: SonoSim Breast Anatomy & Physiology

Instructions: Open SonoSim on your computer and click SonoSim courses

from the main page. This will open a new window. Select and complete the
appropriate course (based on the above title). Note that some information
presented in the SonoSim courses is review and/or outside the scope of the GER
course. Complete each online course in its entirety, but use the course video study
guide below to focus your studying. Once you complete the course video, make sure
to view any of the SonoSimulator cases described below (note: not all courses
have relevant cases).

Objectives:
1. Review the anatomy and blood supply to the breast. Focus on their
anatomic relationships to the layers of tissue superficial and deep to it.
2. Review the hormonal influences to breast development and describe
their effects on sonographic appearance.
Breast anatomy is dynamic and is heavily influenced by specific body hormones. Estrogen
stimulates stromal and parenchymal breast development during puberty in females; this is
termed thelarche. Breasts become more dense and more glandular during puberty.

Each month, women experience breast changes in response to hormonal fluctuations

associated with menses. Estrogen produced by the ovaries stimulates lactiferous duct
proliferation in the first half of the menstrual cycle. Following ovulation, at mid-cycle,
progesterone secretion stimulates proliferation of acini within mammary glands (Oakes). This
results in breast tenderness, swelling, and occasional discomfort that occurs prior to
menstruation. If pregnancy does not occur, breasts regress to their normal size, and the
cycle begins anew.

Following menopause, there is reduction in estrogen stimulation of breast tissue. This results
in atrophy and loss of glandular tissue within the breast. Breast tissue becomes less dense
and becomes more fatty. The connective tissue of the breast also becomes inelastic, and the
breasts begin to lose shape and sag.

Lactation refers to the process and time interval of milk production by the mammary glands.
During pregnancy, milk production is made possible through a series of changes in the
breasts. The anterior pituitary gland controls milk production by secretion of prolactin.
Prolactin stimulates development of the breast milk secretory system.

Prolactin secretion is inhibited by prolactin-inhibiting factor, also known as dopamine,

secreted by the hypothalamus, until milk production becomes necessary after childbirth.
Prolactin-inhibiting factor secretion is decreased following childbirth, and prolactin secretion
occurs. Progesterone produced by the placenta further stimulates breast lobule development
during pregnancy. Insulin, cortisol, and thyroxine also play stimulatory roles in breast tissue
development during pregnancy.

Following childbirth, suckling by the newborn results in additional hormonal secretion in the
mother that results in breast milk secretion. Suckling releases oxytocin from the posterior
pituitary gland. Oxytocin is produced in the hypothalamus and stored in the posterior
pituitary gland. Oxytocin stimulates lactiferous ducts to produce milk.

Structure identification: Be able to identify the following structures on a

sonogram. Note these during the course video and review them using the cases and
locations indicated below from the SonoSimulator.
Organs/Tissues: adipose of the breast (seen within subcutaneous layer or
interspersed in mammary layer), breast parenchyma (mammary layer), breast duct,
Coopers ligaments, pectoralis major
The breasts of younger patients have greater mammary layer mass and less fatty tissue, as
compared to older adults. Hence, breast tissue is more dense in younger patients and
therefore easier to visualize sonographically. With aging, breast parenchyma is progressively
replaced by fatty tissue. This causes the subcutaneous layer to take on a more dominant
appearance as the mammary layer atrophies and accounts for a smaller percentage of
overall breast tissue.
Cases to review in SonoSimulator:
SonoSimulator Case list Breast Basic Breast Case 1Any point (esp. D)