DrManah Chandra Changmai MBBS MS
Breast are present bilaterally in
They are modified sweat glands
In male and immature female,breast
After puberty,female breast are fully
horizontally- from lateral border of sternum
To mid-axillary line along fourth rib.
Mammary bed: Rest upon following structures
1.Pectoralis major- In medial two thirds
2.Serratus anterior- lateral one third.
3.External oblique aponeurosis-
In infero-medial quadrant.
Female mammary gland
Intervenes between base of the gland and the deep
Fascia covering the mammary bed.
Axillary tail of spence:
-projection from the upper and outer quadrant
of the gland.
-enters the axilla through an opening in the
axillary fascia(foramen of langer).
Features in the skin overlying the breast
-conical or cylindrical projection below
the centre of the breast.
-usually present at the fourth intercostal
-pierced by 15-20 lactiferous ducts.
-contains circular and longitudinally
disposed smooth muscle.
-pigmented circular area of the skin around
the base of the nipple.
-irreversibly darkened after first pregnancy.
-outer margin contains modified sebaceous
-these galnds enlarged during pregnancy
and lactation(tubercles of montgomery)
Structure of the breast
Made up of three parts.
3.Interlobar fatty tissue.
-15-20 lobes pyramidal in shape drained
by a lactiferous duct.
-All lobes converge towards the areola.
-Near the areola each lactiferous duct dilates
to form lactiferous sinus.
-each duct drain open onto the nipple..
Lactiferous duct and Lobules
-Each lactiferous duct drains a segmental segments
of smaller duct.
-segmental duct divides into small terminal duct
-terminal duct gives rise to numerous sectretory pouches
(alveoli) like cluster of grapes.
-breast parenchyma drain by lactiferous duct is known
-the ducts possess myopeithelial cells.
From birth to pre-pubertal life: lactiferous ducts without alveoli
At puberty: Ducts undergo branching,form solid spherical masses
precusors of alveoli.
In pregnancy: Further proliferation,epithelial growth of terminal duct
increase in the alveoli per lobule.
During lactation: Alveoli are distended by milk secretion,line by single layer
After lactation: Glandular tissue returns to resting condition.
Structural differentiation of mammary gland
Supports lobes and form septa’s
Septa anchor the parenchyma to overlying
These fibrous bands are called ligament of
Interlobar fatty tissue
Makes the organ rounded in contour
Absent beneath areola and nipple.
Branches of the axillary artery, the internal
thoracic artery, and some intercostal
Forms circular venous plexus around the areola
Blood drains in veins which accompany the
corresponding arteries that supply the
breast, i.e. to the axillary, internal thoracic
and intercostal veins.
Innervation of breast
Consists of two sets
Draining the parenchyma of
breast including nipple and
Draining overlying skin excluding
nipple and areola
75% of lymphatics drain into
20% drain into
from both medial and lateral
parts of the gland.
5% from lateral and posterior
part drain into posterior
From parencyma of the breast
From the outer part : Axillary nodes
From the upper part: Supraclavicular group of lymph nodes
From the inner part: Parasternal nodes
From the lower part: communicates with subperitoneal lymphatic
plexus,drains to sub-diaphragmatic lymph
From the overlying skin
Composed of duct system without alveoli.
Breast tissue doesnot extent beyond the margins
Hypertrophi of male breast observed in klinefelter’s
Male breast richly supplied by lymphatics.
Prognosis of breast carcinoma in male worst than
At seventh week of intra uterine life two
ectodermal milk ridges appear
on each side from axillae to inguinal
Amastia : bilateral agenesis of mammary
Polythelia: supernumerary nipples may be
found irregularly over the breast and along milk
Polymastia: accessory breast may occur along
milk ridges,occasionally functional.
Right accessory breast Left accessory breast
Frequency of breast
carcinoma at various sites
Palpation of axillary region
for enlarged nodes
Only 15-20% of studies are abnormal
High % are false positive
To be seen on mammogram, tumor is
usually 8-10 years old
Factors Favoring Breast Conserving
Tumor size and location favorable
Small or no intraductal portion
Patient cannot tolerate general anesthesia
Factors Favoring Mastectomy:
Tumor size and location not favorable
Extensive intraductal component
Inability to observe postop
Inability to ahcieve negative margins
Contraindication for radiotherapy
Cosmetic procedures include breast lifts
(mastopexy), breast augmentation with
implants, and procedures that combine
both elements. Implants containing either
silicone gel or saline are available for
augmentation and reconstructive surgeries
Treatment of carcinoma of breast