Anatomy
Breast (Mammary Gland)
Dr. Nikhil Aggarwal
MBBS, MD (KGMU)
Certifications:
• ACMDC (Advanced Certificate Course in Management of Diabetes & Cardiovascular Diseases)
• CCCS (Certificate Course in Cardiovascular Diseases & Stroke)
• CCEBDM (Certificate Course in Evidence Based Diabetes Management)
Experience:
• Diabetes, Endocrinology & Metabolism (DEM) Centre, G.T.B. Hospital, New Delhi
• Hindu Rao Hospital (North MCD), New Delhi
• King George’s Medical University UP, Lucknow
• Maulana Azad Medical College, New Delhi
As per:
Competency based Undergraduate curriculum 1
AN9.2: Breast: Describe the location, extent, deep relations, structure,
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age changes, blood supply, lymphatic drainage, microanatomy, and
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applied
-
anatomy of breast.
AN9.3: Describe development of breast.
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Medical Council of India, Competency based Undergraduate curriculum for the Indian Medical Graduate,
2018. Vol. 1; pg 1-80.
2
Breast (Mammary Gland) e
Yu
Q. Describe the mammary gland under the
following heads: Location, extent, morphology,
structure, external features, relations, blood
supply, and nerve supply.
Q. Write a short note on applied aspects of
mammary gland.
• Peculiarity of mammals (class: Mammalia)
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-
(mamma = breast; in Latin)
• Located in the pectoral region
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• Well developed in female after the age of
-
puberty.
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Breast (Mammary Gland)
• In male and prepubertal female, it is
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underdeveloped or rudimentary.
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• In post delivery period, the breast
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secretes milk that is useful for feeding
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a newborn.
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4
al
eO
Location of breast
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• Lies in superficial fascia of the pectoral
region MCQ
al
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-
v
• Axillary tail of Spence – extension of
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breast from its superolateral part pierces
-
-
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the deep fascia in the axilla
- - -
Y
• foramen of Langer – Opening in the - -
deep fascia for tail of Spence O
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5
Shape
• Variable
Hemispherical, conical, pyriform,
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pendulous, or flat.
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Extent
Vertical
• from 2nd to 6th ribs 00
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Horizontal
• from lateral border of sternum to
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midaxillary line
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Deep Relations
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• Pectoral fascia
• Muscles:
- 1. Pectoralis major
- 2. Serratus anterior
- 3. External oblique muscle of
abdomen
• Loose areolar tissue (retromammary
space)
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Eg
E
Deep relations of breast (section of breast to show the deeper structures)
8
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Structure of Breast
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Components:
1. Skin
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2. Stroma
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3. Parenchyma
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~
L
Skin covering the breast
&
Nipple D
• Conical projection
• Location
Just below the center of breast
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In 4th intercostal space, about 10 cm
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from the midline
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• Structure
~
Pierced by 15–20 lactiferous ducts
D
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Skin covering the breast
Areola ~
• Circular pigmented area that surrounds
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the nipple DDD
3
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• Has numerous modified sebaceous
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glands that produces oily secretions
- -
• Skin of nipple and areola is devoid of
hairs D
*
• The color of areola becomes darker
- -
during pregnancy
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12
Stroma ~
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• Stroma – supporting framework
• Consists of fibrous tissue and fat
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• Suspensory ligaments of Cooper –
- Fibrous tissue septa or strands
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Extent: from clavicle and deep (pectoral)
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fascia to the overlying skin of breast.
- -
Function: Suspend the breast tissue and
mem
maintain normal shape of breast.
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• Fat forms main bulk of the gland
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*
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-
-
- ~
-
-
= -
Structure of breast (section of breast to show the deeper structures)
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Parenchyma -
-
• Glandular tissue
•Forms- mammary gland proper
• Modified sweat glandNeet Dac
-
=
•Consists of 15–20 lobes – radially
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-
arranged around the nipple
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Parenchyma L
• lobe consists = lactiferous
- -
duct + surrounding clusters of
- -
acini
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or alveoli
• Each -
lactiferous duct
converges toward nipple and
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open on the tip of nipple
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• Lactiferous sinus –dilatation of
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-
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lactiferous
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duct near its -
termination
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Blood Supply and Innervation
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Arterial supply
~1. Lateral thoracic artery – main
artery DDADD
e2. Internal mammary artery DDDD
-
~
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3. Lateral branches of posterior
intercostal arteries
u
~4. Pectoral branch of
thoracoacromial artery
>
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5. Superior thoracic artery.
W
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Blood Supply and Innervation
Venous drainage
–- Superficial veins drain into
internal thoracic vein.
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– Deep veins drain into axillary
and posterior intercostal veins.
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Blood Supply and Innervation
Innervation (nerve supply)
• 2nd to 6th intercostal nerves –
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through anterior and lateral
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cutaneous branches.
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19
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Lymphatic Drainage ~
GOODD
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>
of Breast -
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-
Q. Write a short note on lymphatic -
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drainage of breast. Important -
Lymphatic vessels
v
• Divided into two groups:
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– Superficial lymphatics: drain the skin
-
- -
& -
over breast except for the nipple and
- -
areola.
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– Deep lymphatics: drain parenchyma
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of breast, nipple, and areola
- - -
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Lymphatic Drainage of Breast
I
Lymphatic vessels DDD
--- &
• Subareolar plexus of Sappey: plexus of lymph
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vessels deep to the areola – drains into
- - -
anterior group of axillary lymph nodes
- -
• Previous concept: For lymphatic drainage, the
breast is divided into 4 quadrants: upper
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lateral, upper medial, lower lateral, and lower
⑧---
medial. Currently, this concept is not in use.
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Lymph nodes draining breast
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1. Axillary lymph nodes: drain most of the
breast tissue
-
-
2. Internal mammary lymph nodes: lie
along internal thoracic (mammary)
-
artery – drain medial part of the
- -
mammary gland.
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3. Posterior intercostal nodes: Few
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lymphatic vessels from lower lateral
- -
quadrant of breast follow posterior
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intercostal vessels and drain into
posterior intercostal nodes.
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Lymph nodes draining breast
-
4. Subdiaphragmatic and subperitoneal lymph
plexuses: Few lymphatics from lower
medial quadrant of the breast pierces
anterior abdominal wall and drain into
subdiaphragmatic and subperitoneal
lymph nodes.
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5. Rotter’s nodes: These lie between
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pectoralis major and pectoralis minor
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(hence called interpectoral nodes) – also
drain mammary gland.
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6. Apical group of lymph nodes: The
lymphatics from deep surface of breast
pierces pectoralis major muscle, and
clavipectoral fascia and drain into apical
axillary lymph nodes.Neet - 24
25
Congenital malformations of breast
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Athelia – absence of nipple.Neet
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Amastia – absence of mammary gland.Neet
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Polythelia – supernumerary nipple.Neet
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Polymastia – supernumerary mammary glands. Polymastia is seen in about 1%
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of the female population.Neet
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Inverted or crater nipple: Due to a failure of the underlying
~ -
mesenchyme to proliferate and push nipple out, the nipple fails to
develop and evert afterbirth.
w
• Gynecomastia –-
v unusual enlargement of male mammary glands.
Y
• Mastectomy – the removal of the breast. It may be partial or
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complete based on the nature of the tumor.
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-
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Clinical Integration -
t
Q . Explain: Metastasis from carcinoma of
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inferomedial quadrant of breast may take E
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place in pelvic cavity.
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Q. Write a short note on retraction and
puckering of its skin and retraction of nipple.
- -
S
&
:
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Clinical Integration W McC
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vira
• Peau d’orange appearance of skin –
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Obstruction of superficial lymph vessels by
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cancer cells → edema of skin → appearance of
orange skin
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• Krukenberg’s tumor
Lymphatics from breast communicate with
- -
subperitoneal lymph plexus. Through this route,
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cancer cells from breast enter in the
peritoneum and may migrate to ovary, where
they develop secondary tumor called
-D
Krukenberg’s tumor
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Breast cancer
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• Q. Write a short note on breast cancer.
• Most common cancer in the female
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• Incidence: It affects 14% of woman worldwide.
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• Pathophysiology: occurs in females between 40 and 60
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-
years of age.
• Breast cancer arises from epithelial cells of lactiferous
ducts. -
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Breast cancer
- - - -
• Cause: heredity, genetic, mutations, drinking of
alcohol, high intake of cholesterol, and so on.
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Signs and symptoms
– Presence of painless lump -
– Fixed and immobile breast -
– Retraction of skin -
– Retraction of nipple -
– Peau d’orange appearance of skin -
– Enlarged lymph nodes -
– Discharge from nipple on squeezing it. -
31
Breast cancer
• Investigations ~ -
– Self-examination for symmetry,
color of -skin, retraction of
L nipple,
discharge from
- nipple, palpation
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for lump, mobility of-breast.
– Mammogram for cancerous
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mass.
– Fine needle aspiration cytology
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for detection of cancer cells. FNAC
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