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The Breast is Not an Organ

Ackerman, A Bernard MD

The American Journal of Dermatopathology: June 2008 - Volume 30 - Issue 3 - p 304
doi: 10.1097/DAD.0b013e31817af2e7
Letters to the Editor

Director Emeritus Ackerman Academy of Dermatopathology New York, NY

To the Editor:

In his “Letter to the Editor” titled “The Breast is a Distinct Organ” (Am J Dermatopathol. 2008;30:204), Cassarino wrote, in part, as follows:

“The breast is easily recognized (by even first year medical students) both grossly and histologically as distinct from any other tissue, and the function of lactation is obviously unique to the breast alone. Therefore, there is no compelling reason to jettison our concept of the breast as an organ.”

In a series of articles captioned, “The breast is not an organ per se but a distinctive region of skin and subcutaneous tissue: Part I-Embryological Development, Part II-Anatomy and Histology, Part III-Pathology” [Dermatopathol Pract Concept. 2002;8(3), 2003;9(1), 2003;9(3)], we set forth a thesis, summarized in an article with the same title but under the general heading “Contrary view” (Am J Dermatopathol. 2007;29:211-218 ), with these words:

“Common to breast, axilla, and external auditory canal are epidermis, dermis, and subcutaneous fat. In the case of the axilla and external auditory canal, apocrine glands are mostly clustered in the deep reticular dermis; however, some apocrine glands may be seated in the subcutaneous fat. In the breast, apocrine glands may reside in the deep part of the dermis, but the vast majority of them (mammary glands) are stationed in the subcutaneous fat. The apocrine nature of the glands in the subcutaneous fat of the breast is not identifiable readily in non-secretory tissue, but it is obvious in the lactating breast. If the breast is deemed to be an organ, separate and distinct from the skin and subcutaneous fat, merely because of the presence of an apocrine glandular component that is dependent on hormones, then a similar argument can be made both for the axilla and the external auditory canal.”

Surely a first-year medical student (and even a child) who glances at a breast, postpubescent female or male, can tell, in a nanosecond, that the surface of it is skin. A first-year medical student who looks at the breast at scanning power magnification of a conventional microscope recognizes, at a glance, that it consists of epidermis, dermis, subcutaneous fat, and all of the constituents adnexal, both epithelial and nonepithelial, that are expected of skin and subcutaneous fat elsewhere. In short, it is for Dr. Cassarino who contends, conventionally, that the breast is an organ independent of skin and subcutaneous fat, to justify that assertion. If his claim that the breast is an organ because apocrine glands in it are capable of lactation, then he is obligated to explain why the axilla and the external auditory canal are not organs; apocrine glands in them also produce secretion different from one another and from colostrum. I welcome compelling arguments by him.

A. Bernard Ackerman, MD

Director Emeritus

Ackerman Academy of Dermatopathology

New York, NY

© 2008 Lippincott Williams & Wilkins, Inc.