Mammary gland

AP Dr G M Kibria
UPNM2
22.4.13
 Learning objectives
At the end of this session you will be able to
1. describe the gross structure of female breast
i. location & extension
ii. areola & nipple
iii. lobes & ducts
iv. connective tissue stroma
v. blood supply
2. explain the lymphatic drainage breast
3. explain the change in the overlying skin in breast
cancer
 Breasts
• A distinguishing feature of mammals
• Modified tubuloalveolar apocrine sweat glands
• Consist of secretory glands, connective tissue
(superficial fascia), overlying skin with nipple &
areola
• A structurally dynamic organ
– In child & man, breast is rudimentary
– In female, after puberty it enlarges to assume
hemispherical shape
– In middle-age multiparous women, the breast may be
large & pendulous
– In old-aged (postmenopausal) women the breast is
smaller, overlying skin wrinkles
 Location & Extension
• Located on the anterior
chest wall (pectoral
region) within the
superficial fascia (external
to deep fascia)
• Superficial to the
pectoralis major, external
oblique and serratus
anterior muscles.
• Extends between the
second rib & the sixth rib,
from the sternum to the
mid-axillary line
• Retromammary Retromammary space
space is a layer of Deep fascia

loose CT that
separates the breast Pectoralis
major
from the deep fascia
(pectoral fascia) &
provides some
degree of Retro-
mammary
movement of the space
breast over the
underlying
structures
• In adult women the nipple
projects from lower half of Nipple & Areola
breast, its position varies
greatly & depends on
development of the gland
• In males & immature females,
the nipples are small & usually
lies over 4th IC space, 10 cm
from midline, just medial to Nipple
mid-clavicular line
• Areola is the circular
pigmented skin (1.5 to 2.5cm) Areola
surrounding the base of nipple
• Montgomery’s follicles are hypertrophied sebaceous
glands in areola
 Nipple: structure
• Nipple contains
– 15-20 openings from
lactiferous ducts
– modified smooth muscle
cells – nipples erect in
response to tactile,
thermal and sexual
stimulation
• Nipples are covered by
wrinkled skin
Smooth muscle &
connective tissue
Breast consists of
Parenchyma:
• 15 to 20 lobes & their lactiferous
ducts (15-20), radiating from the
nipple
• The lactiferous duct from each
lobe opens separately at the
summit of the nipple
• Before termination the duct possesses a dilated ampulla,
the lactiferous sinus, & lies deep to the areola
• Each lobe contains 20-30 lobules
• In the lobule there is cluster of 10-100 secretory alveoli,
& are drained by intralobular ductlactiferous duct
Connective tissue (CT) stroma:
Connective tissue stroma:
• Well-developed CT
stroma surrounds the
ducts, lobule & lobes
• Variable amount of
adipose tissue are
present with this fibrous
stroma
• Intralobular CT are In certain regions, this stroma are
hormonally sensitive- condensed to form well-defined
loose CT that surrounds ligaments, the suspensory or Cooper’s
the alveoli & terminal ligaments, which are fixed to the dermis
ductules of skin & support the breasts (carcinoma
• The intralobular CT of breast creates tension on these
contains less adipose ligaments causing pitting of the skin,
cells Peau d'orange)
 Glandular part vs. adipose cells
• Terminal ductules are present in the inactive gland.
These are the successive branching of lactiferous duct
• During pregnancy, epithelium of terminal ductule
differentiates into fully functionally secretory alveolar
cells producing milk
• In lactating women, the glandular (secretory) tissue is
more abundant
• In non-lactating women, the predominant
component is fat & glandular tissue is less.
• After menopause, most of the glandular alveoli
disappear, leaving behind the ducts. Adipose tissue
may decrease or increase (snell-9:336)
Breast: a dynamic organ
 Axillary tail: Important point to be noted
during evaluation of breast pathology
• Upper & lateral edge of the
breast extends around the
lower border of pectoralis
major & enters the axilla,
where it comes close
relationship with axillary
vessels
• Axillary tail may perforate Axillary
tail
deep fascia & extent as far
as apex of the axilla
Lymphatic drainage of
Subclavian trunk
breast Apical nodes
Central nodes
Pectoral nodes
 Lymphatic drainage of breast (Gray’s ant St)
Importance: Cancer cell often disseminate along the
lymph vessels to the lymph nodes.
• Axillary lymph nodes drain about 75% of lymph from
the breast. Axillary nodes drain into subclavian
lymphatic trunks
• Other lymph nodes are
I. Parasternal (internal thoracic) nodes -->
bronchomediastinal trunks
II. Intercostal nodes (along with head & neck of
ribs -->thoracic duct or bronchomediastinal
trunks
Some lymph vessels communicate with that of
opposite breast & abdominal wall nodes
• Laterally, vessels from the Blood supply of breast
axillary artery; Lateral Thoracoacromial art. Internal thoracic art.
thoracic, superior thoracic
and thoraco-acromial
arteries
• Medially by the perforating
branches from internal
thoracic artery
• Perforating branches from
2nd to 4th intercostal arteries
Veins of the corresponding
arteries drain into axillary,
internal thoracic & intercostal
veins
 Innervation of breast
• Derived from the anterior and lateral
cutaneous branches of the 2th to 6th
intercostal nerves
• The nipple is innervated by 4th intercostal
nerve
 Breast cancer
• The most common malignancy in women
• Constant hormonal exposure & genetic
predisposition are the major risk factors
• Hormonal exposure increases with
– Age
– Early menarche & late menopause
– First full-term pregnancy with older age
• Mutation in autosomal dominant breast cancer
genes contribute about 5% of all breast cancer
 Changes of the skin in breast cancer

• Subcutaneous lymphatic obstruction & tumor-growth

pull on CT ligaments in breast resulting in appearance
of an orange peel texture, Peau d'orange, on the
breast skin
• Further subcutaneous spread of cancer produces a
hard, woody texture to the skin, Cancer en cuirasse
 Development of breast
• Begins early in fetal life and is not complete until after
parturition
• First indications of mammary glands is found in the form of
two epidermal thickenings– the mammary ridges (milk
lines) that extend from axilla to inguinal region at 7th week
• In humans, a major part of the mammary lines disappear
but only one group of mammary ridge cells in the thoracic
region persists and penetrates the underlying mesenchyme
to develop as breast
• It forms 15 to 20 sprouts that give rise to buds
• Buds then canalize to form lactiferous sinus & ducts at the
end of prenatal life
Development of breast
 Developmental anomaly
• Polythelia – a condition where accessory nipples have
formed due to the persistence of fragments of the
mammary line. Accessory nipples may develop
anywhere along the original mammary line but usually
appear in the axillary region
• Polymastia-occurs when a remnant of the mammary line
develops into a complete breast
• Inverted nipple – a condition in which the lactiferous
ducts opens into the original epithelial pit that has failed
to evert (did not become a nipple)
Thank you