Download MBBS Anatomy PPT 23 Mammary Gland Notes

OBJECTIVES

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By the end of the lecture, the student should be

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 2nd

to 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.

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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 that

projects 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 pores

of the lactiferous ducts.

? Areola :

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? It is a dark pink brownish

circular 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.

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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 a

number 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 of

Intercostal 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 of

this 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 5

groups which lie in axillary

fat :

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? Pectoral (Anterior) group :

which lies on the pectoralis

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minor along lateral thoracic

vessels.

? Subscapular (Posterior)

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group : which lies on

posterior wall of axilla on

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lower border of

subscapularis along

subscapular vessels.

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AXILLARY LYMPH NODES

? Brachial (Lateral) group : lies on

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lateral wall of axilla along 3rd

part 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 opens

into 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 and

drain 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 incision

of 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 giving

peau de'orange

appearance of the

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breast.

Mammary ridge

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? Mammary ridge

extends 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 the

pectoral region.

? In animals, several

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mammary glands are

formed along this ridge.

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Skin /sebaceous gland


What is the difference

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Axillary Lymph node

Axillary (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 axillary

dissection

? 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 is

injected 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 axillary

dissection.

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 of

lymphatic 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 the

medial 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 drain

inner 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