Lecture notes for medical students

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2. Introduction

3. Introduction
• We are members of the class Mammals
identified by presence of breasts in females
which secrete milk for their young.
• Modified sweat gland- modified apocrine
gland.

4. Embryology

5. Embryology
• Begins to develop as early as the 4th week
as a downgrowth from a thickened
mammary ridge (milk line) of ectoderm
along a line from the axilla to the inguinal
region.
• Nipples or even glands proper may form at
lower levels on this line.

6. Parts

7. Parts
• For the sake of description only divided into
four quadrants.

8. Arterial Supply

9. Arterial Supply
• Axillary artery →
–Lateral thoracic -main
–Acromiothoracic branches.
• Internal mammary artery →
perforating branches.
• Intercostal arteries → lateral
perforating branches- relatively
unimportant source.

10. Venous Drainage

11. Venous Drainage
Sub areolar venous plexus
• Axillary vein.
• Internal Mammary veins
• Posterior intercostal veins

12. Lymphatic Drainage

13. Lymphatic Drainage
Follows the pathway of its blood supply
along tributaries of the
• Axillary vessels axillary lymph nodes 75%
• Internal thoracic vessels 15%
• upper can go to supraclavicular
• Lower 2 quadrants can go to
subdiapragmatic or abdominal nodes

14. Lymphatic Drainage
Axillary Lymph nodes described in two
ways-
• Groups
• Levels

15. Lymphatic Drainage
Axillary Lymph nodes Groups :
• Anterior -Pectoral
• Posterior-Subscapular
• Lateral- Brachial
• Medial - central
• Apical
• Infraclavicular
• Supraclavicular

16. Lymphatic Drainage
Axillary Lymph nodes Levels:
• Level I- Lateral to Pect. Minor
• Level II- Deep to Pect. Minor
• Level III –Medial to Pect. Minor

17. Nerve Supply

18. Nerve Supply
• Sensory innervation of the breast is
dermatomal in nature.
• It is mainly derived from the anterolateral
and anteromedial branches of thoracic
intercostal nerves T3-T5.
• Supraclavicular nerves from the lower
fibers of the cervical plexus also provide
innervation to the upper and lateral portions
of the breast.
• Researchers believe sensation to the nipple
derives largely from the lateral cutaneous
branch of T4.

19. Extent
• The base of the adult female breast
consistently overlies the 2nd to 6th ribs,
from the sternal edge to the midaxillary
line.
• The upper outer quadrant extends towards
axilla as the axillary tail

20. Relations
• 2/3 rests on pectoralis major,
• 1/3 on serratus anterior,
• lower medial edge overlaps the upper
part of the rectus sheath.
• The retro-mammary space is located
between the posterior capsule of the breast
and the fascia over pectoralis major.
• This space is commonly exploited in the
placement of implants

21. Attachments/Supports
• The lobules are separated by fibrous septa
running from the subcutaneous tissues to the
fascia of the chest wall (the ligaments of
Cooper/ Astley Cooper fibers/ suspensory
ligaments)

22. Microscopic Anatomy

23. Microscopic Anatomy
• Made up of 15–20 lobules of glandular
tissue embedded in fat.
• Lobule formation occurs only in the female
• breast & does so after puberty.
• Each lobule drains by its lactiferous duct on
to the nipple, which is surrounded by the
pigmented areola.
• At the summit of the arborizing ductal
system, the subareolar ducts widen to form
the lactiferous sinuses,

24. Microscopic Anatomy
• The ducts are surrounded by myoepithelial
cells.
• This area is lubricated by the areolar glands
of Montgomery which are modified
sebaceous glands

25. Physiology

26. Physiology
The female breast passes through 5phases
during lifetime
1. Prepubertal
2. Post pubertal
3. Pregnancy
4. Lactational
5. Menopausal

27. Physiology
• The resting (non-lactating) breast, consists
mostly of fibrous & fatty tissue
• During phases of the menstrual cycle the
breast epithelium and lobular stroma
undergo cyclic stimulation.
• Dominant process is hypertrophy and
alteration of morphology rather than
hyperplasia.
• In the late luteal (premenstrual) phase, there
is an accumulation of fluid and intralobular
edema.

28. Physiology
• With pregnancy, there is diminution of the
fibrous stroma to accommodate the
hyperplasia of the lobular units.
• Growth is influenced by high circulating
levels of estrogen and progesterone and by
high levels of prolactin .
• Estrogen and progesterone inhibit the
stimulatory effects of prolactin on milk
production.

29. Physiology
• After childbirth, there is a sudden loss of the
placental hormones.
• A continued high level of prolactin is the
principal trigger for lactation.
• The actual expulsion of milk is under
hormonal control and is caused by the
contraction of the myoepithelial cells by
hormone Oxytocin.
• Stimulation of the nipple is the physiologic
signal for both the continued pituitary
secretion of prolactin and for the acute
release of oxytocin.

30. Physiology
• When breast-feeding ceases, there is a fall
in prolactin and no stimulus for release of
oxytocin. The breast then returns to a
resting state and to the cyclic changes
induced when menstruation begins again.

31. Physiology
• After menopause progressive atrophy of
lobes & ducts takes place – Involution.
• These changes include increased fat
deposition, diminished connective tissue,
and the disappearance of lobular units.

32. The male breast

33. The male breast
• Resembles the rudimentary female breast
• has NO lobules or alveoli.
• The small nipple and areola lie over
the 4th intercostal space.

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