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FEMALE REPRODUCTIVE SYSTEM
Maj Rishi Pokhrel
NAIHS
rongon28us@yahoo.com
www.slideshare.net
Mammary Gland
OVARY
4
MAMMARY GLAND
– Modified sweat gland in
sup fascia
– No connective tissue
covering.
– Accessory female
reproductive org
Mammary Gland
EXTENT
• Vertical : 2-6 ribs in mid-clavicular line
• Hori : lat border sternum – mid
axillary line at level...
MAMMARY GLAND
– Superficial & deep surface
– Superficial surface
• Skin, nipple & areola
• Under skin, superficial fascia
...
Nipple
• 4th ICS, 4 inch from
midline
• 15 – 20 lactiferous
ducts open
• Presence of circular
muscle, longitudinal
muscle
...
8
Areola
– Circular pigmented area, pink
or brown.
– Periphery : sebaceous glands
– Enlarged as Tubercles of
MONTGOMERY du...
9
Deep surface
Retro mammary space
– Separates mam gland
from Pectoralis major
fascia
– Contains areolar tissue
– Helps in...
10
DEEP RELATIONS – MAMMARY BED
• Covered by deep fascia
– Pectoralis major :
• Medial 2/3,
– Serratus Anterior :
• Upper ...
11
STRUCTURE
• Glandular portion with
parenchyma
• Connective tissue i.e
stroma
 Fibrous tissue
 Fatty tissue
 Suspenso...
Glandular portion
– 15 -20 lobes each with multiple
lobules containing acini or alveoli
– lactiferous duct- commence
towar...
13
Lobes
Lobules
Ducts
sinuses
14
Mammary Gland: Structure
Alveoli opening into ductSuspensory ligament running from skin to P Major
15
BLOOD SUPPLY
1. Internal thoracic artery
(subclavian)
– perforating br – 2,3,4 ICS
2. Br from Axillary :
– Sup thoracic...
16
Mammary Gland : Blood Supply
Branches of Axillary
1. Sup thoracic Art
2. Thoraco-acromial
pectoral br
3. Lat thoracic a...
17
Communication via Post IC
vein, Azygous and Internal
vert plexus which in turn
communicate with transverse
and sagittal...
18
Venous drainage of mammary gland
19
LYMPHATIC DRAINAGE
– Axillary (five sub group)
– Internal mammary LN
• along Internal
mammary V
– Supraclavicular
– Pos...
20
Summary Lymphatic drainage
– 75 % Parenchyma = Axillary LN
– 20 % Parenchyma = Internal mammary LN
– 5 % parenchyma = P...
21
• Investigations
– Mammography
• Soft tissue radiographs of breast.
• Cyst (well defined smooth opacity) and carcinomas...
22
• AXILLARY TAIL
– Well developed axillary tail mistaken for enlarged
lymph nodes/Lipoma
• Nipple
– Cracked nipple
• in ...
23
– Infections and inflammations – cause mastitis with
abscess
– Cysts
– Tumors
• Benign – Lipoma, fibro adenoma
• Malign...
24
– Malignant tumours cont,d
• Presentation –
– Hard lump with retracted nipple
– Peau d’ orange (orange like skin) –
inv...
25
Breast Cancer
• Breast cancer
– Peau d orange
– nipple retraction,
– skin dimpling
– Metastasis :
• skull and brain
(Ba...
26
27
KRUKENBERGS TUMOUR
Secondary deposits in ovaries due to
spread from Ca breast :
• Lymph inferomedial part
• communicate...
28
Formation of
Krukenberg’s
tumour
29
Congenital anomalies
– Polythelia
• Supernumery nipples
over breast
– Athelia
• No nipple over breast
(mainly accessory...
30
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Mammary glands

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Mammary glands

  1. 1. FEMALE REPRODUCTIVE SYSTEM Maj Rishi Pokhrel NAIHS rongon28us@yahoo.com www.slideshare.net
  2. 2. Mammary Gland
  3. 3. OVARY
  4. 4. 4 MAMMARY GLAND – Modified sweat gland in sup fascia – No connective tissue covering. – Accessory female reproductive org
  5. 5. Mammary Gland EXTENT • Vertical : 2-6 ribs in mid-clavicular line • Hori : lat border sternum – mid axillary line at level of 4th rib • Extends into axilla – Axillary tail of SPENCE – Foramen of LANGER SHAPE • hemispherical, conical, pendulous, etc
  6. 6. MAMMARY GLAND – Superficial & deep surface – Superficial surface • Skin, nipple & areola • Under skin, superficial fascia has nerves/vessels • Nipple and areola - No subcutaneous fat and hair. 6
  7. 7. Nipple • 4th ICS, 4 inch from midline • 15 – 20 lactiferous ducts open • Presence of circular muscle, longitudinal muscle • Rich nerve supply
  8. 8. 8 Areola – Circular pigmented area, pink or brown. – Periphery : sebaceous glands – Enlarged as Tubercles of MONTGOMERY during pregnancy – Lubrication of nipple and areola – Lactiferous sinus
  9. 9. 9 Deep surface Retro mammary space – Separates mam gland from Pectoralis major fascia – Contains areolar tissue – Helps in mobility of breast – Space for breast implants
  10. 10. 10 DEEP RELATIONS – MAMMARY BED • Covered by deep fascia – Pectoralis major : • Medial 2/3, – Serratus Anterior : • Upper two digitations • Lat 1/3, – EO aponeurosis • Inferomedially – separate it from rectus sheath
  11. 11. 11 STRUCTURE • Glandular portion with parenchyma • Connective tissue i.e stroma  Fibrous tissue  Fatty tissue  Suspensory lig of cooper
  12. 12. Glandular portion – 15 -20 lobes each with multiple lobules containing acini or alveoli – lactiferous duct- commence toward nipple from each lobe – lactiferous sinus opens into tip of nipple – Lobes radially arranged, hence incision radially given – Glandular tissue increase during pregnancy and lactation 12
  13. 13. 13 Lobes Lobules Ducts sinuses
  14. 14. 14 Mammary Gland: Structure Alveoli opening into ductSuspensory ligament running from skin to P Major
  15. 15. 15 BLOOD SUPPLY 1. Internal thoracic artery (subclavian) – perforating br – 2,3,4 ICS 2. Br from Axillary : – Sup thoracic Art – Thoraco acromial – pectoral br – Lat thoracic art – Subscapular art 3. Intercostal art – – 2,3,4th ICS lat br – 2nd IC Art largest br – • supply upper breast, Nipple and areola)
  16. 16. 16 Mammary Gland : Blood Supply Branches of Axillary 1. Sup thoracic Art 2. Thoraco-acromial pectoral br 3. Lat thoracic art 4. Subscapular art
  17. 17. 17 Communication via Post IC vein, Azygous and Internal vert plexus which in turn communicate with transverse and sagittal sinus spreads malignancy to abdominal organs, brain, vertebrae, ribs and skull VENOUS DRAINAGE – Superficial and deep veins – Circulus venosus (part of superficial vein): sub areolar plexus of vein – Superficial and deep vein drain into • Int mammary V • Axillary V • Post IC vein – which drain into Azygous vein
  18. 18. 18 Venous drainage of mammary gland
  19. 19. 19 LYMPHATIC DRAINAGE – Axillary (five sub group) – Internal mammary LN • along Internal mammary V – Supraclavicular – Posterior IC Lymph nodes
  20. 20. 20 Summary Lymphatic drainage – 75 % Parenchyma = Axillary LN – 20 % Parenchyma = Internal mammary LN – 5 % parenchyma = Post IC Nodes along Post IC vein
  21. 21. 21 • Investigations – Mammography • Soft tissue radiographs of breast. • Cyst (well defined smooth opacity) and carcinomas (irregular density, distortion of breast tissue, calcification) – FNAC (fine needle aspiration cytology) • Used for cell diagnosis APPLIED ANATOMY
  22. 22. 22 • AXILLARY TAIL – Well developed axillary tail mistaken for enlarged lymph nodes/Lipoma • Nipple – Cracked nipple • in later pregnancy and lactation. • Nipple to be washed, and lubricated with lanolin – Discharges • management depends upon presence of lump
  23. 23. 23 – Infections and inflammations – cause mastitis with abscess – Cysts – Tumors • Benign – Lipoma, fibro adenoma • Malignant – carcinoma “more in nulliparous and bearing child protective” – Spread by local, lymphatic and blood stream. – LN involvement shows metastatic potential. – Advanced disease – involve supraclavicular
  24. 24. 24 – Malignant tumours cont,d • Presentation – – Hard lump with retracted nipple – Peau d’ orange (orange like skin) – involvement of skin of breast due to cutaneous lymphatic oedema – Advanced – ulceration, fixation to chest wall, metastatsis to viscera, bone • Treatment – Mastectomy – Radiotherapy – Harmone therapy – chemotherapy
  25. 25. 25 Breast Cancer • Breast cancer – Peau d orange – nipple retraction, – skin dimpling – Metastasis : • skull and brain (Batsons plexus of veins) A - Dimpling of skin B - Retracted nipple C - Peau d orange A – due to pull by lig of cooper B - due to retraction of milk ducts C – due to lymphatic obstruction
  26. 26. 26
  27. 27. 27 KRUKENBERGS TUMOUR Secondary deposits in ovaries due to spread from Ca breast : • Lymph inferomedial part • communicate with rectus sheath – • pierce Linea alba – forms Sub peritoneal plexus – drain into subdiaphragmatic LN – • pass through Falciform lig – • reach hepatic node – – Cause obstructive jaundice • Tumor cells drop from sub peritoneal plexus into general cavity – • reach surface of ovary and enter through Ostia left by ovulating Graafian follicle – KRUKENBERGS (secondary deposits on surface of ovary)
  28. 28. 28 Formation of Krukenberg’s tumour
  29. 29. 29 Congenital anomalies – Polythelia • Supernumery nipples over breast – Athelia • No nipple over breast (mainly accessory breast) – Polymastia • Accessory breast along milk ridge – Amastia • No breast development – Amazia • Nipple developed, no breast development
  30. 30. 30

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