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ANATOMY: PECTORAL REGION AND THE AXILLA

Petoral Region
SUPERFICIAL STRUCTURES

Superficial cutaneous nerves

o Anterior and lateral cutaneous terminal
branches of the intercostals nerves
Superficial blood vessels
o Perforating branches of the intercostals
arteries
o External mammary artery
Platysma muscle
Mammary gland

Lateral Cutaneous Nerve:

Terminal branch of the intercostal nerve

Found in each corresponding intercostal space
Lateral Cutaneous Nerve
o Emerges from the 2nd itnercostal space
(sometimes the 3rd)
o Extends to the medial surface of the arm

Perforating branches from the Intercostal Artery:

Seen emerging with the anterior cutaneous nerves

in each intercostal space
Lies near the sternal border

External Mammary Artery

Branch of the lateral thoracic artery

Courses medially
Supplies the lateral quadrants of the mammary
gland

Mammary Gland:

Relations:
o Superiorly: 2nd rib
o Inferiorly: 6th rib
o Medially: parasternal or midsternal line
o Laterally: midaxillary line
o Anteriorly: skin
o Posteriorly: deep pectoral fascia
4 quadrants:
o Upper outer quadrant
o Upper inner quadrant
o Lower outer quadrant
o Lower inner quadrant
Nipple lies at the level of the 4th ICS or T4
o Perforated by the individual openings of
the 15-20 lactiferous ducts
o Areola is usually pigmented depending on
ethnicity and genetic factors
o Sebaceous Glands (of Montgomery) dot
the skin of the areola
Axillary Tail of Spence
o glandular extension
o lies between the angle of the anterior
axillary fold and upper arm
Internal Anatomy
o Mammary bed
! Where the breasts are attached
Deep Pectoral fascia
which serves as the floor

Common site of pus and

mass accumulation
o Suspensory Ligaments of Cooper
! Fibrous septa which divides the
gland into 15-20 lobes
! Anchors the breast to the pectoral
wall
! Extension of connective tissue
from the mammary bed to the
skin
Glandular Structures
o Mammary gland lobules
! Compound branched tubular or
tubule acinar gland
o Lactiferous Sinus
o Lactiferous Ducts
! Glandular units converges to form
the nipple
Blood supply
o Medial Part:
! Perforating branches of the
internal thoracic artery
! Intercostal arteries
o Lateral Part:
! Axillary artery via the:
Thoracoacromial artery
Lateral Thoracic artery
via
the
External
Mammary Artery
Lymphatic Drainage
o Lateral quadrant
! Anterior axillary or pectoral group
of nodes
o Medial quadrant
! Drain by means of vessels that
pierce the intercostals spaces
and enter the internal thoracic
group of nodes
Innervation
o 4th 6th Intercostal nerves
! The anterior cutaneous branch
and the lateral cutaneous branch
forms the anterior rami and gives
off sensory branches to the
breasts
o Sympathetic fibers from the intercostals
nerves are distributed to the:
! Myoepithelial cells
! Glandular alveoli
! Lactiferous ducts
! Smooth muscle fibers around the
nipple, areola and blood vessels

DEEP PECTORAL FASCIA

Attached superiorly to the clavicle and extends to

the axilla where it blends with the axillary fascia
Forms a sheath for the pectoralis major muscle
Clavi-pectoral fascia fascial covering of the
pectoralis minor

Pectoralis Muscle:

Large, fan-shaped muscle

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Contributes to the formation of
the delto-pectoral groove which
lodges the cephalic vein
o The lower sterno-costal and aponeurotic
fibers twist upwards forming a bilaminar
tendon which inserts proximally to the
lateral ridge of the greater tubercle of the
humerus
Innervation
o Lateral Pectoral Nerve
! Branch of the lateral cord of the
brachial plexus
! Pierces the clavi- pectoral fascia
close to the superior border of the
pectoralis minor
o Medial Pectoral Nerve
! Branch of the medial cord of the
brachial plexus
! Pierces the middle of the
pectoralis minor muscle
Actions
o Powerful adductor and medial rotator of
the arm
o Assists in flexing the humerus
! Sternocostal fibers help bring
down the arm
!

Helps in expanding the thoracic cavity in

response to extreme need for oxygen

Pectoralis Minor

Origin: 3rd 5th ribs and corresponding cartilages

Insertion: coracoids process of the scapula
Innervation: Medial Pectoral Nerve
Action: pulls the scapula forward; rotates it
medially

Subclavius

Small thin muscle beneath the clavicle

Ensheathed by the clavipectoral fascia
o Costocoracoid Membrane thickening of
the fascia after covering the pectoralis
minor

Serratus Anterior

Attached to the lateral thoracic wall

Paralysis of this muscle will cause winged scapula
o Winged scapula backward displacement
of the scapula on its vertebral border

ORIGIN

INSERTION

ACTION

INNERVATION

Medial half of the

clavicle; anterior
surfaces of the
sternum and upper 6
costal cartilages;
aponeurosis of the
anterior abdominal wall

Lateral lip of the

bicipital groove

Adducts the arm and

rotates it medially
(clavicular fibers also
help in flexing the arm)

Lateral Pectoral Nerve

3rd 5th rib and

corresponding costal
cartilages

Coracoids process of
the scapula

Pulls scapula forward

and rotates it medially

Medial Pectoral Nerve

Subclavius

Costal cartilage and

medial ends of first rib

Inferior surface of the

lateral third of the
clavicle

Helps to stabilize the

sterno-clavicular joint
and lift 1st rib

C5 and C6

Serratus Anterior

Muscular slips from the

lateral surfaces of the
upper 8 ribs; lower 4
slips interdigitate with
the external obliques

Vertebral (medial)
border of the scapula

Stabilizes the scapula

during movement of
the shoulder joint

Long Thoracic Nerve

(C5, C6, C7)

Pectoralis Major

Pectoralis Minor

(prevents the medial

winging of the scapula)

Axilla

o
Regarded as a 4-sided pyramidal space
Relations:
o Anteriorly: pectoral and subclavius
muscles and clavicle
o Medially: upper 5 ribs and attached
serratus anterior
o Posteriorly: latissimus dorsi, teres major
and lateral border of the subscapularis
muscle
o Laterally: surgical neck of the humerus
o Base: skin

Medial Pectoral Nerve

Anterior Axillary fold formed by the

pectoralis major and pectoralis minor
Posterior Axillary fold formed by the
subscapularis, teres major, latissimus
dorsi and scapula

CONTENTS OF THE AXILLA

Cords and Branches of the brachial plexus

Axillary artery
Axillary Vein

Brachial Plexus

Roots C5, C6, C7, C8 and T1

Formed by the union of the anterior divisions of the

upper and middle trunks
Found supero-lateral to the axillary artery
Branches:
o Lateral pectoral nerve
! Supplies the pectoralis minor and
pectoralis major (with the medial
pectoral nerve)
o Musculocutaneous Nerve
! Supplies
the
anterior
compartment of the arm
! Cutaneous
branches
are
distributed to the forearm
o Lateral Head of the Median Nerve
! Short trunk which joins the medial
head of the median nerve,
forming the median nerve
! The median nerve lies anteromedial to the axillary artery

Medial Cord:

C8 and T1
Prolongation of the anterior division of the lower
trunk
Lies infero-medial to the axillary artery
Branches:
o Ulnar Nerve
! Largest branch
! Positioned medial to the axillary
artery
! Proceeds
to
the
posterior
compartment of the arm; behind
the medial epicondyle into the
forearm where it dristributes its
branches
o Medial head of the Median Nerve
! Joins the lateral head of the
median nerve to form the median
nerve
o Medial Pectoral Nerve
! Pierces the middle of the
pectoralis minor

With the lateral pectoral nerve, it

supplies the pectoralis major
Medial Cutaneous Nerves
! Cutaneous nerve of the arm
! Cutaneous nerve of the forearm
!

Posterior Cord:

C5, C6, C7, C8 and T1

Formed by the union of the posterior divisions of
the 3 trunks
Located deep and posterior to the axillary artery
Branches
o Axillary/ Circumflex Nerve
! Moderately large
! Lies
deep
in
the
axilla,
penetrating the gap between the
subscapularis and teres major
muscles
! Supplies the deltoids and teres
minor muscles
o Radial Nerve
! Larger branch of the posterior
cord
o Thoracodorsal nerve
! Descends along the psoterolateral surface of the chest wall
! Innervates the latissimus dorsi
! Similar course with that of the
long thoracic nerve but it lies
deeper and more posterior
o Upper and Lower Subscapular Nerve
! Course through the anterior
surface of the subscapular
muscle
! Lower subscapular nerve also
supplies the teres major

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AXILLARY ARTERY

Direct continuation of the subclavian artery

Origin: subclavian artery
Commencement: outer border of the 1st rib
Course: Proceeds laterally in the infraclavicular
fossa to the axilla where it is surrounded by the
cords of the brachial plexus. After coursing the
medial aspect of the upper part of the arm, its
passes in front of the teres major muscle. At the
lower border of the teres major muscle, it will
change its name into brachial artery
Termination: lower border of the teres major
The axillary artery is divided into 3 parts by the
pectoralis minor muscle
o First part
! from the outer border of the 1st
rib to the upper border (medial
border) of the pectoralis minor
! gives off 1 branch
o Second part
! Covered by the width of the
pectoralis minor muscle
! Gives off 2 branches
o Third part
! Extends between the lateral
border of the pectoralis minor
muscle to the lower border of the
teres major muscle
! Gives off 3 branches (highly
variable)
Branches of the Axillary artery
o Highest Thoracic Artery
! Branching off from the 1st part of
the axillary artery
! Distributed to the tissues in the
1st and 2nd intercostal spaces
o Thoracoacromial artery
! Branching off from the 2nd part of
the axillary artery
! Further branches of into:
Clavicular branch
Deltoid branch
Acromial branch
Descending
pectoral
branch
o Lateral Thoracic Artery
! Branching off from the 2nd part of
the axillary artery
! Descends along the lateral border
of the pectoralis major muscle to
continue at the lateral surface if
the chest wall
! Gives off an external mammary
branch which supplies the lateral
quadrants of the breast
o Subscapular artery
! Largest branch of the axillary
artery which branches off from
the 3rd part
! Descends along the lateral border
of the scapula diving into 2
terminal branches
o Circumflex Scapular artery
! Winds around the lateral border

o
o

Two anterior circumflex humeral arteries

! Winds around the surgical neck of
the humerus
Posterior circumflex artery
! Stouter
than
the
anterior
counterpart
! Branches off from the 2rd part of
the axillary artery
! Passes through the quadrangular
space accompanied by the
axillary nerve to wind around the
surgical neck and reach the deep
surface of the deltoid

AXILLARY VEIN

Formed by the union of the basilic vein and two

vena comites of the brachial artery
o Vena comites " brachial bein
Commencement: lower border of the teres major
muscle
The axillary vein lies more superficial to the axillary
artery along its course
Termination: outer border of the 1st rib