• The breast lies on the chest wall and on the deep pectoral fascia • High spatial resolution is required to detect microcalcification: a short exposure time limits any movement artefact • There is a narrow range of inherent breast densities (as it is predominantly fatty tissue): low molybdenum energy peaks (17.5 and 19.6keV) provide high contrast (filtering reduces extraneous radiation) • Breast compression: this reduces geometric and movement unsharpness • Mediolateral oblique (MLO) view (standard): • Craniocaudal (CC) view (standard): • Paddle views (supplementary): • True lateral view (supplementary): • Magnification views (supplementary): • Eklund technique (supplementary): • Exaggeration of the normal cyclical proliferation and involution of breast tissue with the development of fibrosis • A benign tumour arising from the TDLU (fibrous stroma + epithelial ductal structures) • Requires biopsy for diagnosis unless <25 years old (to exclude malignancy) • Juvenile fibroadenoma: a more cellular variant occurring at a younger age • Phyllodes tumour: a fibroepithelial tumour similar to a giant fibroadenoma, affecting an older age group
Breast
NORMAL ANATOMY
the superficial pectoral fascia envelops the breast 
suspensory ligaments (Cooper’s ligaments) connect the two layers
2 components
METHODS OF IMAGING
Imaging in mammography
it requires a very small focal spot (0.1–0.3mm) 
grids are used to reduce scatter and increase contrast 
digital mammography is now used
it improves contrast (it reduces scatter) 
it reduces radiation dose (less tissue needs to be penetrated) 
it achieves uniform image density 
it separates superimposed breast tissues 
it highlights rigid tumours (glandular tissue is compressible)
Mammography (digital/analogue) (MMG)
Evaluation of breast symptoms and signs, including masses, skin thickening, deformity, nipple retraction, nipple discharge and nipple eczema
Follow-up of breast cancer patients
Guidance for biopsy or localization of lesions not visible on ultrasound
The XR beam is directed from superomedial to inferolateral (usually at 30–60°) 
compression is applied obliquely across the chest wall and perpendicular to the long-axis pectoralis major
The only view demonstrating the entire breast tissue on a single image
The XR beam travels from superior to inferior 
the breast is pulled forward and away from the chest wall with compression applied from above
INTRODUCTION
FIBROCYSTIC CHANGE
DEFINITION
regression with pregnancy and menopause 
increased risk for developing certain types of cancer (e.g. ductal carcinoma in situ (DCIS))
BENIGN MASS LESIONS
FIBROADENOMA
DEFINITION
it often enlarges during pregnancy and regresses after the menopause 
it is the most common cause of a benign solid mass in the breast
RADIOLOGICAL FEATURES
US
< 25% are locally aggressive requiring clear surgical margins 
large fibroadenomas or those rapidly increasing in size are excised to avoid missing a phyllodes tumour
Breast
ducts open onto the skin surface (and are seen as small raised nodular structures called Morgagni’s tubercles)
this is usually replaced by fatty tissues in older women with loss of the lobular units
the nipple is in profile 
the nipple is positioned at the level of the lower border of the pectoralis major, with the muscle across the posterior border of the film at 25–30° to the vertical
it demonstrates virtually all of the medial tissue and the majority of the lateral tissue (with exclusion of the axillary tail of the breast) 
the depth of breast tissue should be < 1cm of the distance from the nipple to the pectoralis major on the MLO projection
it defines the margins of a mass
it increases the accuracy of wire localizations of non-palpable lesions
T2WI: diffuse high SI (2nd half of cycle): T1WI + Gad: patchy enhancement
diffusely scattered calcifications
a ‘teacup’ configuration of calcium within the cystic spaces
common between 20 and 50 years old (peak between 40 and 50 years old)
perform cytology only if there are suspicious imaging features or if the aspirate is bloodstained
coarse mural curvilinear calcification
they can occur at any age and are often palpable
on histology it may be reported as normal breast tissue
peak incidence – 3rd decade 
multiple in 10–20%
coarse calcifications may develop (particularly in older women)
isoechoic or mildly hypoechoic relative to fat ± a thin echogenic pseudocapsule 
a surrounding halo (Mach effect) 
displaced normal vessels around the edge of the lesion
