BREAST

DR . NIPUN

MBBS, DHAKA

Youngest known

Aleisha
Hunter
survivor
of breast

cancer

You are never too

young for breast cancer
Diagnosed at age of

2 years
Total Mastectomy

Juvenile Secretory
Breast Carcinoma

ANATOMY

Introduction:

Mammary gland.
Present in both sexes.
Rudimentary in male.
Well developed in female after
puberty.
Apocrine gland.

Location:

In the superficial fascia of the pectoral region.

Boundary:

Vertically: 2nd to 6th ribs.

Horizontally: lateral border of sternum to midaxillary line.

Extension:

Above: Clavicle
Below: 7th to 8th ribs
Medially: Midline
Posteriorly : to the edge of latissimus dorsi

nd
2nd
rib

Pectoralis major
major
Pectoralis

Skin

th
6th
rib

Fat

Deep relations:

Axillary tail of Spence:

A small extension of breast
pierces the deep fascia & lies
in the axilla.
Of great surgical importance.
Can be sometimes mistaken as
enlarged lymph nodes or lipoma.
Named after James Spence(1812-1882),
a Scottish surgeon

Structure
Skin:
Nipple
Areola
Parenchyma
Stroma

Skin
Areola
Areola
Nipple
Nipple

Tubercle
Tubercle of
of Montgomery
Montgomery

Parenchyma:

Lobes:
15 20 in number
Composed of minute glandular
structures called lobules
Lobules empty via ductules in
lactiferous ducts

Lactiferous ducts:
Open on to nipple
Contains ampulla near its end
(Reservoir of milk or abnormal discharge)

Stroma:

Partly fibrous & partly fatty

Ligaments of Cooper:

- Anchors the breast with skin

Cancer cells may infiltrate
these ligaments, so the breast
becomes fixed & contraction of
the ligaments can cause retraction
or puckering (folding) of the skin.

HISTOLOGY
Non-lactating

Lactatin
g

Blood Supply:

ArterialExtremely
supply: vascular

1.Internal thoracic artery perforating branches

2.Axillary artery
1. Lateral thoracic artery
2. Superior thoracic artery
3. Acromiothoracic artery
3.Posterior intercostal arteries lateral branches
Arteries are distributed in the anterior surface.
Posterior surface is relatively avascular.

Axillary artery
Superior thoracic
artery
Acromiothoracic
artery
Lateral thoracic
artery

Posterior intercostal
arteries

Internal thoracic
artery

 Venous drainage:

o Veins follow the arteries.

o First converge around the nipple to form an
anastomotic venous circle & then form 02 sets of
veins.
Superficial veins: drain into Internal thoracic
vein & superficial veins of the lower part of
the neck
Deep veins: drain into Internal thoracic ,
Axillary & Posterior intercostal veins

Axillary vein

Anastomotic
venous circle

Internal thoracic vein

Nerve supply:
4th to 6th intercostal nerves
by their Anterior & Lateral
cutaneous branches;
Milk secretion by Prolactin,
not by nerves

LYMPHATIC
DRAINAGE

Lymph nodes:

Axillary (85%) (Sentinel Lymph Node)

Anterior
Central
Apical
Lateral
Posterior
Interpectoral

Internal mammary / Parasternal (10%)

Others (5%)

Supraclavicular
Cephalic / Deltopectoral
Posterior intercostal
Subdiaphragmatic
Subperitoneal

Axillary lymph nodes

Apical
Apical

Lateral
Lateral
Posterior
Posterior

Anterior
Anterior

Central
Central
Interpectoral
Interpectoral

Internal
mammary
lymph
nodes

Lymphatic vessels:
Devoid of valves.

Superficial lymphatics skin over breast except

nipple & areola
Deep lymphatics parenchyma as well as nipple &
areola

Subareolar plexus
Subareolar plexus
(of Sappy)
of Sappy

Development
4

Mammary ridge

Milk line

Age-related changes

Developmental anomalies:

Amastia (Absence of breast)

Polymastia (Supernumerary breasts)
Athelia (Absence of nipple)
Polythelia (Supernumerary nipples)
Gynaecomastia (in Klinefelters syndrome)

Polythelia

Nipple retraction

Athelia

Polymastia
Amastia of right breast

Gynaecomastia

PHYSIOLOGY

Functions:

- Important accessory organ of the female

reproductive system.
- Provides nutrition to the new born in the form of
milk.

Feed Your Faith, Your Fears Will Starve To Death