Breast
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Breast(mammary gland)
By
Dr Manah Chandra Changmai MBBS MS
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Breast are present bilaterally inpectoral region
They are modified sweat glands
In male and immature female,breastare rudimentary
After puberty,female breast are fullydeveloped.
Mammary gland
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Extent:Vertically-2nd to 6th ribshorizontally- from lateral border of sternumTo mid-axillary line along fourth rib.
Mammary bed: Rest upon following structures1.Pectoralis major- In medial two thirds2.Serratus anterior- lateral one third.3.External oblique aponeurosis- In infero-medial quadrant.
Female mammary gland
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Retro-mammary space:Intervenes between base of the gland and the deep Fascia covering the mammary bed.
Axillary tail of spence:-occasionally present-projection from the upper and outer quadrant of the gland.-enters the axilla through an opening in the axillary fascia(foramen of langer).
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Features in the skin overlying the breast
Nipple : -conical or cylindrical projection below the centre of the breast.-usually present at the fourth intercostal space.-pierced by 15-20 lactiferous ducts.-contains circular and longitudinally disposed smooth muscle.
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Areola-pigmented circular area of the skin around the base of the nipple.-irreversibly darkened after first pregnancy.-outer margin contains modified sebaceous gland -these galnds enlarged during pregnancy and lactation(tubercles of montgomery)
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Structure of the breast
Made up of three parts.
1.Glandular tissue
2.Fibrous tissue
3.Interlobar fatty tissue.
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Glandular tissue
Lobes-15-20 lobes pyramidal in shape drained by a lactiferous duct.-All lobes converge towards the areola.-Near the areola each lactiferous duct dilates to form lactiferous sinus.-each duct drain open onto the nipple..
Lactiferous duct and Lobules-Each lactiferous duct drains a segmental segments of smaller duct.-segmental duct divides into small terminal duct-terminal duct gives rise to numerous sectretory pouches (alveoli) like cluster of grapes.-breast parenchyma drain by lactiferous duct is known as lobules.-the ducts possess myopeithelial cells.
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From birth to pre-pubertal life: lactiferous ducts without alveoli
At puberty: Ducts undergo branching,form solid spherical masses precusors of alveoli.
In pregnancy: Further proliferation,epithelial growth of terminal duct increase in the alveoli per lobule.
During lactation: Alveoli are distended by milk secretion,line by single layer of epitheium.
After lactation: Glandular tissue returns to resting condition.
Structural differentiation of mammary gland
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Supports lobes and form septa’s
Septa anchor the parenchyma to overlyingskin.
These fibrous bands are called ligament ofcooper.
Fibrous tissue
Interlobar fatty tissue
Makes the organ rounded in contour
Absent beneath areola and nipple.
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Peu de orange
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Histology of breast
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Arteries
Branches of the axillary artery, the internal thoracic artery, and some intercostal arteries.
Veins
Forms circular venous plexus around the areola
Blood drains in veins which accompany the corresponding arteries that supply the breast, i.e. to the axillary, internal thoracic and intercostal veins.
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4th to 6th intercostal nerves.
Innervation of breast
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Consists of two sets
Draining the parenchyma ofbreast including nipple andareola
Draining overlying skin excludingnipple and areola
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75% of lymphatics drain into axillary nodes.
20% drain into parasternal(internal mammary) from both medial and lateral parts of the gland.
5% from lateral and posterior part drain into posterior intercostal nodes.
From parencyma of the breast
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From the outer part : Axillary nodes
From the upper part: Supraclavicular group of lymph nodes
From the inner part: Parasternal nodes
From the lower part: communicates with subperitoneal lymphatic plexus,drains to sub-diaphragmatic lymph nodes.
From the overlying skin
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Male breast
Composed of duct system without alveoli.
Breast tissue doesnot extent beyond the marginsof alveoli
Hypertrophi of male breast observed in klinefelter’ssyndrome.
Male breast richly supplied by lymphatics.
Prognosis of breast carcinoma in male worst thanin females.
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Gynaecomastia
Causes :
Thyroid problems
Kidney and liver disease
Klinefelter’s syndrome
Obesity
Drugs
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At seventh week of intra uterine life two ectodermal milk ridges appearon each side from axillae to inguinalregion.
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Amastia : bilateral agenesis of mammary gland.
Polythelia: supernumerary nipples may be found irregularly over the breast and along milk ridges.
Polymastia: accessory breast may occur along milk ridges,occasionally functional.
AmastiaPolythelia
Polymastia
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Right accessory breast Left accessory breast
Polymastia
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Frequency of breastcarcinoma at various sites
Palpation of axillary regionfor enlarged nodes
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Ductal carcinoma
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Mammography Only 15-20% of studies are abnormal High % are false positive
To be seen on mammogram, tumor isusually 8-10 years old
Expensive
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Factors Favoring Breast ConservingTherapy:
Patient preferenceTumor size and location favorableUnifocal tumorSmall or no intraductal portionPatient cannot tolerate general anesthesia
Factors Favoring Mastectomy:
Patient preferenceTumor size and location not favorableMultifocal tumorExtensive intraductal componentInability to observe postopInability to ahcieve negative marginsContraindication for radiotherapy
Cosmetic procedures include breast lifts (mastopexy), breast augmentation with implants, and procedures that combine both elements. Implants containing either silicone gel or saline are available for augmentation and reconstructive surgeries
Treatment of carcinoma of breast
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Thank you