BreastLymphatic Drainage of Upper

Limb

DevelopmentStructure

Lymphatic DrainageClinical Importance

Breast

Development of breast

Before birth Develop from a invagination of

ectoderm during 4th week of development along mammary ridge (Milk line)

Milk line runs from axilla to mid inguinal region

Breast is a modified sweat gland

Development of breast

Development of breast

After birth Lobule formation occurs in female

breast after puberty Development of female breast is

divided into five phases

Structure of the Breast

Male breast is a rudimentary structureStructure of the female breast depends on the age of the female parity of female stage of pregnancy & lactation Stage of the menstrual cycle

Before puberty Very few glands & fat No alveoli

Puberty Increase in size due to the increase in

fatty tissue Areola & nipple are formed Breast lobules are formed Fibrous tissue separates breast lobules

Pregnancy & lactation Alveoli bud off from smaller ducts

within a lobule Breast enlarge in size (400g) Secretary fat globules are present

inside alveoli When lactation ceases atrophy of

lobules and glands, replaced with fatty tissue

Stages of breast development

During menstrual cycle Increase in size in mid cycle due to

increase in blood flow

After menopause Involution of glandular tissue replaced

by fatty tissue Decrease in size Decrease in elasticity of connective

tissue

Structure Of The Breast

Structure Of The Breast

Structure Of The Breast

Macroscopic structure of Breast

Size & shape may vary greatlyExtent of base of the breast is usually constantBase Extends from sternal edge to mid

axillary line Extends from 2nd to 6th ribs Over lies pectoralis major, seratus

anterior, rectus sheath & external oblique muscle

Axillary tail Smaller projection of upper outer quadrant

of the breast Usually lies in subcutaneous fat of the axilla Rarely it penetrates the deep fascia of

axillary floor & lie with the axillary lymph nodes (frequently mistaken for axillary lump)

Nipple Pigmented projection of skin 15 – 20 lactiferous ducts drain each lobe of

breast drains to the surface Smooth muscles of the nipple cause

erection to sexual stimuli Terminal part of the lactiferous ducts are

dilated to form sinuses

Nipple

Areola Pigmented skin surrounding the

nipple Large sebaceous glands & areolar

glands form small projection on the skin (Tubercles of Montgomery)

Longitudinal section of breast

Section of breast

Glandular Arrangement Of The Breast

Glands are arranged as 15 – 20 lobesEach lobe is drained by an individual lactiferous duct, arranged in radial directionDucts drain on to the flat surface of the nippleLobes are separated from each other by fibrous bands connecting overlying skin & the capsule of the breast (Suspensory ligament of cooper)

Glands of the Breast

Non Lactating/ Lactating Breast

Non Lactating Breast

Lactating Breast

Capsule of Breast Formed by condensation of superficial

fascia of chest wall, posterior to the breast tissue (Upward continuation of membranous layer of superficial abdominal fascia)

In young females suspensory ligaments help to keep the protuberance of the breast

There is a space between capsule of breast & fascia over the pectoralis major muscle (Retro – mammary space)

Blood Supply of BreastArterial supply

Make anastomosing network within the breast

1. Lateral thoracic artery Main supply of the breast Branch of 2nd part of axillary artery

2. Internal thoracic artery Supply medial part of the breast Branch of a 1st part of subclavian artery

3. Posterior intercostal arteries Branches of descending thoracic aorta

4. Braches of thoracoacromial artery Supply upper part of breast Branch of 2nd part of axillary artery

Venous drainage Circumareolar venous plexus & veins

from glandular tissue draining into the deep veins

Skin & superficial fascia drain to superficial veins

Veins usually run along with arteries Drain to internal thoracic, axillary &

posterior intercostal veins

Lymphatic Drainage Of Upper Limb & Breast

Why we need a lymphatic system?Lymphatic system has lymph vessels & lymph organsGenerally lymphatics run along blood vessels Superficial lymphatic – follow veins Deep lymphatic – follow arteries

They have valves to direct flow towards center

Lymphatic Drainage Of Upper Limb & Breast

Lymphatic Drainage Of Upper Limb & Breast

Lymphatic Drainage of Breast

Lymphatic inside the breast lie between the lobules but communicate with each otherLateral part drains to axillary lymph nodes 75 percent of total lymph drainage

Medial part to parasternal lymph nodesSome lymphatic in upper part of breast drain to supraclavicular lymph nodesFew lymphatics run along the intercostal vessels to intercostal lymph nodes

Axillary Lymph NodesArrange in 5 groups

Anterior group Along lower border of pectoralis major

Posterior group Along subscapular vessels

Lateral group Along axillary vein

Central group Inside the axillary fat

Apical group Posterior to clavicle & along axillary

vein Subclavian lymph trunk begins

Extra axillary lymph nodes Supratrochlear nodes

Proximal to medial epicondyle Infra clavicular lymph nodes

Besides the cephalic vein Usually drains through the clavipectoral

fascia to apical nodes

Right side Drains into subclavian vein or joins

the right jugular trunk

Left side Usually drains to thoracic duct

Nerve supply of breast From 2nd to 6th intercostal nerves

Secretion of milk By milk ejection reflex (read Ganong

18th edition pg 231)

Clinical Importance Of Breast

Developmental abnormalities Supernumery nipples Small or absent breast (Amazia) Retracted nipples

Infection of breast Breast abscess Cellulites of skin

Tumors Benign (harmless)

Fibroadenoma Fibroadenosis

Malignant (cancer) Treatment for breast cancer Detection of breast cancer

Mammogram

Mammogram

Mammogram

Summary

DevelopmentStructureLymphatic DrainageClinical Importance