Synopsis Breast (2)

7/27/2019 Synopsis Breast (2)

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Surgical Anatomy of the Breast

Dr Adeoso A A

Dept. Of Histopathology

Uduth


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SYNOPSIS

INTRODUCTION

EMBRYOLOGY

ANATOMY ARTERIAL SUPPLY

VENOUS SUPPLY

LYMPHATIC SUPPLY


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Introduction

The breast is said to be a modified sweat gland

and present in all mammals

Develops as early as the fouth week usuallyprotuberant in females as a hallmark of

pubertal development Provides nutrition to the infant via lactation

Consist of a glandular epithelial part andlactiferous duct.

After menopause there is progressive atrophyof the ducts and lobes.

It is a rudimentary gland in males


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Embryology Starts as a thickening in the epidermis in a bandlike manner forming

a mammary line or ridge

Majority of the line do disappear,that of the thoracic region persistand penetrate the underlying mesenchyme

Forms 15-24 sprouts,small buds these canalise to form lactiferousducts.

The lactiferous ducts open into epithelial pit,shortly after birth theepithelial pit transforms into the nipple


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ANATOMY

Located in the superficial facia of the anterior

thoracic wall.

The base is between the 2nd rib and 6th riband the sternal edge to the mid axillary

line,overlies the pectoralis major overlappinginto the serrantus ant.rectus sheath and asmall part into external oblique muscle.

In 95% of women there is an extension

towards the axilla,may rarely penetrate thedeep facia lie adjacent to lymph nodes


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Cont.

Each breast is composed of 15-20 lactiferous

ducts,each draining a lobe of the breast .

The lobes converge on the tip of the

nipple,the projection at the center of the

breast

Surrounding the nipple is an area of

pigmentation called the areola


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( SKIN-The areola in the female at puberty is

pigmented and at each pregnancy there is an

increase in melanin deposit. Some large sebaceous glands under the areola

may enlarge to form small elevations especiallyduring pregnancy

The dermis of the skin merges with the superficialfacia which envelopes the parenchyma of thebreast .

The superficial facia enveloping the breast iscontinous with the superficial abdominal facia(ofCamper)below and the superficial cervical faciaabove


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Cont.

Behind the breast, the upward continuation of

the deep facia (Scarpas) is condensed to forma posterior capsule.

Strands of fibrous tissue (suspensory ligament

of Cooper) connect the dermis of theoverlying skin to the ducts of the breast ,this

helps to maintain the protuberance of the

young breast.


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Cont.

The fibrous strands may undergo fibrosis

when associated with certain cancers of thebreast leading to dimpling of the breast.

Between the capsule and the deep facia over

the pectoralis major is a space known as theretromammary space which is rich in

lymphatics


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Arterial supply Lateral thoracic artery,

Internal thoracic artery and

Intercostal arteries.

Internal thoracic arteries and its perforatingbranches supply a medial part of the breast.

Lateral thoracic artery supplies a lateral part of

the breast.

Most of the lateral part is supplied by

intercostal arteries and their branches.


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Venous Drainage describe an anastomotic circle round the base

of the nipple, called Haller circulus venosus.

From this, large branches transmit the blood

from medial part of the breast into internal

thoracic veins and

from the lateral part of the breast into lateral

thoracic vein and intercostal veins this

communicates with the vertebral venous

system


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h d


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Lymphatic drainage

In general the lymphatic drainage follows the

blood supply.

75% of the the lymphatic drainage passes to the

axillary group of lymph nodes,mainly to theanterior group,posterior group and rest.

Much of the medial part of the breast is drainedby the parasternal group of lymph nodes.

The liver via rectus abdominis mucle

Opposite breast and axilla


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Axillary lymph nodes- there are about 30 to 40

of these are supplied by lymph vessels that

pass to them.

They are divided into few groups:

apical lymph nodes, central lymph nodes,

lateral lymph nodes, pectoral lymph nodes

and subscapular lymph nodes


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Innervations

Intercostal nerves innervate the breast.

Branches of the supraclavicular nerves also

innervate superior part of the breast


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Thank you for

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Synopsis Breast (2)

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