able to describe:
? Shape and position of the female breast.
? Structure of the mammary gland.
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? List blood supply of the female breast.? Lymphatic drainage of the female breast.
? Applied anatomy in the female breast
INTRODUCTION
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? Mammary Glands exist in both sexes.
? Rudimentary in males throughout life
? Start developing at puberty in females
? Most of the development occurs
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during later months of pregnancy and
lactation
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Parts, Shape & position of the Gland? It is conical in shape.
? It lies in superficial fascia
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of the front of chest.
? It has a base, apex and tail.
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? Its base extends from 2ndto 6th ribs.
? It extends from the
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sternum to the
midaxil ary line lateral y.
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? It has no capsule.--- Content provided by FirstRanker.com ---
SHAPE AND POSITION OF FEMALE BREAST? 2/3 of its base lies
on the pectoralis
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major muscle, while
its inferolateral 1/3
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lies on:? Serratus anterior &
? External oblique
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muscles.? Its superolateral
part sends a process
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into the axil a cal ed
the axil ary tail or
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axil ary process.SHAPE AND POSITION OF FEMALE BREAST
? Nipple:
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? It is a conical eminence thatprojects forwards from the
anterior surface of the breast.
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? The nipple lies opposite 4th
intercostal space.
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? It carries 15-20 narrow poresof the lactiferous ducts.
? Areola :
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? It is a dark pink brownishcircular area of skin that
surrounds the nipple.
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? The subcutaneous tissues of
nipple & areola are devoid of
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fat.--- Content provided by FirstRanker.com ---
STRUCTURE OF MAMMARY GLAND? It is non capsulated gland.
? It has fibrous strands
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(ligaments of cooper) which
connect the skin with deep
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fascia of pectoralis major.? Retromammary space.
What is its Importance?
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STRUCTURE OF MAMMARY GLAND
? It is formed of 15-20 lobes.
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? Each lobe is formed of anumber of lobules.
? It has from 15-20 lactiferous
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ducts which open by the same
number of openings on the
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summit of the nipple.ARTERIAL SUPPLY
? 1. Perforating
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branches of internal
thoracic (internal
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mammary) artery.? 2. Mammary
branches of lateral
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thoracic artery.
? 3. Mammary
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branches ofIntercostal arteries.
VENOUS SUPPLY
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? Veins are
corresponding to
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the arteries.? Circular venous
plexus are found
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at the base of
nipple.
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? Final y, veins ofthis plexus drain
into axil ary &
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internal thoracic
veins.
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AXILLARY LYMPH NODES
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? They are arranged into 5groups which lie in axillary
fat :
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? Pectoral (Anterior) group :
which lies on the pectoralis
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minor along lateral thoracicvessels.
? Subscapular (Posterior)
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group : which lies on
posterior wall of axilla on
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lower border ofsubscapularis along
subscapular vessels.
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AXILLARY LYMPH NODES
? Brachial (Lateral) group : lies on
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lateral wall of axilla along 3rdpart of axil ary vessels.
? Central group : lies in axillary fat
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at the base of axil a.
? Apical group : lies at apex of
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axil a.? Subclavian lymph trunk:
? it is formed by union of efferent
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lymph vessels of apical group. It
usually opens in subclavian vein.
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On the left side it usually opensinto thoracic duct.
LYMPHATIC DRAINAGE
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? Subareolar lymphatic
plexus :
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? Lies beneath the areola.? Deep lymphatic plexus:
? Lies on the deep fascia
covering pectoralis
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major.
? Both plexuses radiate in
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many directions anddrain into different
lymph nodes.
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APPLIED ANATOMY- CANCER BREAST
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? It is a common surgical condition.
? 60% of carcinomas of breast occur
in the upper lateral quadrant.
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? 75% of lymph from the breast
drains into the axil ary lymph
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nodes.? In case of carcinoma of one breast,
the other breast and the opposite
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axil ary lymph nodes are affected
because of the anastomosing
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lymphatics between both breasts.? The lactiferous
ducts are radial y
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Applied Anatomy
arranged from the
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nipple, so incisionof the gland should
be made in a radial
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direction to avoid
cutting through the
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ducts.? Infiltration of the
ligaments of Cooper
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by breast cancer
leads to its
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shortening givingpeau de'orange
appearance of the
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breast.
Mammary ridge
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? Mammary ridgeextends from the axil a
to the inguinal region.
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? In human, the ridge
disappears EXCEPT for a
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smal part in thepectoral region.
? In animals, several
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mammary glands are
formed along this ridge.
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Skin /sebaceous glandWhat is the difference
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Axillary Lymph nodeAxillary (ipsilateral): interpectoral (Rotter's) nodes and lymph
nodes along the axillary vein and its tributaries that is divided into
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the following levels:
a. Level I (low-axilla): lymph nodes lateral to the lateral border of
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pectoralis minor muscle.b. Level II (mid-axilla): lymph nodes between the medial and
lateral borders of the pectoralis minor muscle and the
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interpectoral (Rotter's) lymph nodes.
c. Level III (apical axilla): lymph nodes medial to the medial
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margin of the pectoralis minor muscle and inferior to the clavicle.These are also known as apical or infraclavicular nodes.
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Sentinel node biopsy and axillarydissection
? Sentinel node biopsy is the most common way to
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check the axillary lymph nodes for cancer.
? Before or during the procedure, a radioactive
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substance (called a tracer) and/or a blue dye isinjected into the breast. These substances help the
surgeon find the nodes to remove.
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? The first lymph node(s) to absorb the tracer or dye is
called the sentinel node(s). This is also the first lymph
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node(s) where breast cancer is likely to spread.Sentinel node biopsy and axillary
dissection
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? The surgeon removes the sentinel node(s) to
get it checked if the node(s) contain cancer
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cells.? If cancer is not found, it's likely the other
nodes do not contain cancer. So, no more
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surgery is needed.
? If the node(s) do contain cancer, more lymph
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nodes may be removed, which is called axillarydissection.
Lymphedema
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? When lymph nodes are removed, some of the
lymph vessels can become blocked and cause
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lymphedema. Lymphedema is a build-up oflymphatic fluid. It causes swelling in the arm
or other areas such as the hand, fingers,
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breast, chest or back.
Lymphedema
? Lymphedema isn't common when only a few
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lymph nodes are removed. The cases that do
occur are less severe than when more nodes
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are removed.? Today, sentinel node biopsy is the preferred
way to remove lymph nodes (only a few nodes
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are removed). So, most people don't get
lymphedema.
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Clinical anatomy? Skin incisions over breast
? Retraction of skin and nipple
? Congenital anomalies- `'thelia'' and `'mastia''
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? Lymphadenopathy? Krukenberg's tumour
? Breast examination
1-
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? A 40 years female presents with pain along themedial side of arm. On examination- she has
palpable lump in upper outer quadrant of breast
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and enlarged axil ary lymph nodes. This referred
pain is due to enlarged lymph nodes compressing
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-? A- long thoracic nerve
? B- Intercostobrachial nerve
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? C- lateral pectoral nerve
? D- medial cutaneous nerve of arm
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2? Which of the fol owing is correct about lymphatic
drainage of mammary gland?
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? A- pectoral group of lymph nodes lie along lower
border of pectoralis major
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? B-medial group of axil ary lymph nodes draininner quadrants
? C- 75% of lymphatics from mammary glands
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drained by Internal mammary nodes
? D- lymphatics from breast can transmit to ovarian
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surface