Download MBBS Breast Lecture PPT

Mammary glands
v Modified sweat gland in sup fascia
v No connective tissue covering.

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v Accessory female reproductive organ.

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MAMMARY GLAND
? Superficial & deep surface
? Superficial surface
? Skin, nipple & areola

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? Under skin, superficial fascia has
nerves/vessels
? Nipple and areola - No
subcutaneous fat and hair.
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Nipple
? 4th ICS, 4 inch from

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midline
? 15 ? 20 lactiferous ducts
open
? Presence of circular
muscle, longitudinal

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muscle
? Rich nerve supply.

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Areola
Nipple-areola-complex. (1)

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Papilla. (2) Areola. (3) Tubercula.

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STRUCTURE
? Glandular portion with

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parenchyma
? Connective tissue i.e stroma
Fibrous tissue
Fat y tissue
Suspensory lig of cooper

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The breast contains 15-20 lobes and each lobes comprises of 20-40 TDLUs.
The ductal system begins at the nipple where the lactiferous sinuses open onto the skin. These lead into the lactiferous ducts
which divide repeatedly to form the terminal ducts that open into a lobule comprising multiple acini (ductules). This terminal

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duct and associated lobule is termed the terminal duct-lobular unit, which is the morpho-functional unit of breast. TDLU is the
most important glandular structure of breast secretes milk and it is basically a grapelike cluster of small alveoli that comprises
lobule and terminal duct. The terminal ducts drain in to the subsegmental and segmental duct which drains into the lactiferous
duct and collecting duct. TDLUs are effective functional unit. The secretory parts are surrounded by specialized connective
tissue. So, TDLU consists of ?

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1. Extralobular terminal duct.
2. Intralobular terminal duct.
3. Lobule (functional unit).

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Although traditionally the breast is described as containing 15 to 20 distinct lobes, observation reveals that there are

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usually approximately six openings onto the nipple (galactophores), as some of the lobes join at the level of the
collecting duct or even into the lactiferous sinus. Otherwise, there is no direct anatomical connection between the
various lobes.

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Anatomic origin of common breast lesions

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Mammary Gland: Structure
Suspensory ligament running from skin to P Major
Alveoli opening into du1c4 t

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BLOOD SUPPLY
1. Internal thoracic artery
(subclavian)
? perforating br ? 2,3,4 ICS

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2. Br from Axil ary :
? Sup thoracic Art
? Thoraco acromial ?
pectoral br
? Lat thoracic art

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? Subscapular art
2. Intercostal art ?
? 2,3,4th ICS lat br
? 2nd IC Art largest br ?
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supply upper breast, Nipple
and areola)
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Mammary Gland : Blood Supply
Branches of Axillary

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1.Sup thoracic Art
2.Thoraco-
acromial
pectoral br
3.Lat thoracic art

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4.Subscapular art
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VENOUS DRAINAGE
? Superficial and deep veins

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? Circulus venosus (part of
superficial vein): sub areolar
plexus of vein
? Superficial and deep vein drain
into

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? Int mammary V
? Axil ary V
? Post IC vein ? which drain
Communication via Post IC vein, Azygous and Internal vert plexus
into Azygous vein

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which in turn communicate with transverse and sagittal sinus spreads
malignancy to abdominal organs, bra
16 in, vertebrae, ribs and skul

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Lymphatic drainage
Of Mammary gland

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Young Women
In young women, the breasts tend to protrude forward from a circular base.

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Pregnancy
Early
In the early months of pregnancy, the duct system rapidly increases in length and
branching. The secretory alveoli develop at the ends of the smaller ducts, and the
connective tissue becomes filled with expanding and budding secretory alveoli. The

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vascularity of the connective tissue also increases to provide adequate nourishment
for the developing gland. The nipple enlarges, and the areola becomes darker and
more extensive as a result of increased deposits of melanin pigment in the epidermis.
The areolar glands enlarge and become more active.
Late

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During the second half of pregnancy, the growth process slows. However, the breasts continue to enlarge, mostly because of the distention of the
secretory alveoli with the fluid secretion called colostrum.
Postweaning
The breasts return to their inactive state once the baby has been weaned. The remaining milk is absorbed; the secretory alveoli shrink, and most of
them disappear. The interlobular connective tissue thickens. The breasts and the nipples shrink and return nearly to their original size. The

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pigmentation of the areola fades, but the area never lightens to its original color.
Postmenopause
The breast atrophies after the menopause. Most of the secretory alveoli disappear, leaving behind the ducts. The amount of adipose tissue may
increase or decrease. The breasts tend to shrink in size and become more pendulous. The atrophy after menopause is caused by the absence of
ovarian estrogens and progesterone.

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APPLIED ANATOMY
? Investigations
? Mammography
? Soft tissue radiographs of breast.
? Cyst (well defined smooth opacity) and

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carcinomas (irregular density, distortion of breast
tissue, calcification)
? FNAC (fine needle aspiration cytology)
? Used for cell diagnosis
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? AXILLARY TAIL
? Well developed axillary tail mistaken for enlarged lymph
nodes/Lipoma
? Nipple
? Cracked nipple

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? in later pregnancy and lactation.
? Nipple to be washed, and lubricated with lanolin
? Discharges
? management depends upon presence of lump
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? Infections and inflammations ? cause mastitis with abscess
? Cysts
? Tumors
? Benign ? Lipoma, fibro adenoma
? Malignant ? carcinoma "more in nulliparous and bearing

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child protective"
? Spread by local, lymphatic and blood stream.
? LN involvement shows metastatic potential.
? Advanced disease ? involve supraclavicular LN
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? Malignant tumours continued
? Presentation ?
?Hard lump with retracted nipple
?Peau d orange (orange like skin) ? involvement of skin of breast
due to cutaneous lymphatic oedema

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?Advanced ? ulceration, fixation to chest wall, metastatsis to
viscera, bone
? Treatment
?Mastectomy
?Radiotherapy

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?Hormone therapy
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?chemotherapy

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Breast Cancer

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v Breast cancer
? Peau'd orange
A - Dimpling of skin
B - Retracted
? nipple retraction,

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nipple
? skin dimpling
? Metastasis :
? skull and brain (Batsons
plexus of veins)

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C - Peau d
orange
A ? due to pul by lig of cooper
B - due to retraction of milk ducts
C ? due to lymphatic obstruction

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KRUKENBERGS TUMOUR
Secondary deposits in ovaries due to spread from Ca breast :
? Lymph inferomedial part
? communicate with rectus sheath ?

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? pierce Linea alba ? forms Sub peritoneal
? plexus ? drain into subdiaphragmatic LN ?
? pass through Falciform lig ?
? reach hepatic node ?
? ? Cause obstructive jaundice

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? Tumor cells drop from sub peritoneal
? plexus into general cavity ?
? reach surface of ovary and enter through Ostia left by ovulating Graafian
follicle ? KRUKENBERGS (secondary deposits on surface of ovary)
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Congenital anomalies
? Polythelia
? Supernumery nipples
over breast
? Athelia

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? No nipple over breast
(mainly accessory breast)
? Polymastia
? Accessory breast along
milk ridge

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? Amastia
? No breast development
? Amazia
? Nipple developed, no
breast development

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