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6. mammary gland
1. 1
Maj Dr Poonam Singh
Department of Anatomy
NAIHS
MAMMARY GLAND
2. Mammary gland will be studied under..
Introduction, extent
Surfaces
Relations
Structure
Blood supply and nerve supply
Lymphatic supply
applied
2
3. 3
MAMMARY
GLAND
Modified sweat gland in sup fascia
of pectoral region
No connective tissue covering.
Accessory female reproductive org
EXTENT
Vertical : 2-6 ribs in MCL
Hori : lat border sternum – MAL,
level of 4th
rib
Extends into axilla
Axillary tail of SPENCE
Foramen of LANGER
SHAPE : hemispherical, conical,
pendulous, etc
4. Axillary tail of Spence
Projection from upper
and outer quadrant
Enter axilla thro
opening of Axillary
fascia called
Foramen of Langer
In contact with Ant
group of axillary LN
(d/d – lipoma)
4
5. 5
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
Base of gland rest upon foll structures:-
6. 6
Mammary Gland : Bed
Pectoralis
Major
Serratus
Anterior
External
Oblique
8. 1. Superficial surface:
Skin, nipple and areola
Under skin, superficial fascia
has nerves/vessels
Nipple and areola - No
subcutaneous fat and hair.
a. Nipple :
4th
ICS, 4 inch from midline
15 – 20 lactiferous ducts
open
Presence of circular muscle,
longitudinal muscle
Rich nerve supply 8
9. 9
MAMMARY GLAND
b. Areola :
Circular pigmented area.
Pink or brown.
Surrounds the base of nipple
Periphery :
sebaceous glands.
Enlarged as Tubercles of
MONTGOMERY during
pregnancy.
Lubrication of nipple and areola
10. Deep to areola
Lactiferous sinus
duct dilated to
form sinus
Lymphatic plexus
of Sappey – below
areola
10
Mammary Gland
Subareolar
lymphatic plexus
of Sappey
11. 11
2. Deep surface
LAKE OF MERCILLE
(retro mammary
space or
Chassaignac’s
bursa) - separates
MG from Pect maj
fascia.
Contain areolar
tissue
Retro mammary space
Helps in mobility of breast
Space for breast implants
Retro
mammary
space
13. 1. Glandular portion with parenchyma
15 -20 lobes each with multiple
lobules
containing clusters of acini or
alveoli
lactiferous duct-
commence toward nipple from
each lobe
lactiferous sinus –
which open into tip of nipple
Lobes radially arranged, hence
incision radially given
Glandular tissue increase during
preg and lactation
13
Lobes
Lobules
Ducts
Sinus
15. 15
2. Stroma
Consist of
a. fibrous connective tissue
b. adipose tissue.
Fibrous tissue
Form septa
Run deep surface of gland to skin.
Called Suspensory ligament of
Cooper
Gives firmness to gld.
Elasticity lost during preg –
pendulous.
16. Fatty tissue
Increase during
puberty – smooth
contour
Inter lobar in position
Forms the most of
the bulk of the breast
16
18. 18
BLOOD SUPPLY
1. Internal thoracic artery
(subclavian)
perforating br – 2,3,4 ICS
1. Br from Axillary :
Sup thoracic Art
Thoraco acromial – pectoral br
Lat thoracic art
Subscapular art
3. Posterior Intercostal art –
2,3,4th ICS lat br
19. 19
VENOUS DRAINAGE:
Circulus venosus /sub
areolar plexus of vein
Superficial and deep vein
drain into
1. Int mammary V
2. Axillary V
3. Post IC vein –
which drain into Azygous vein
20. 20
Venous drainage of mammary gland
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
21. 21
LYMPHATIC DRAINAGE
Drain into following grp
of lymph nodes
1. Axillary (five sub grp)
2. Internal mammary LN
(along Internal
mammary V)
1. Supraclavicular
2. Posterior IC Lymph
nodes (post parts of
ICS in front of the head
of ribs)
22. 22
Lymphatics divided into two grps :
1. Superficial grp :
drain skin over
breast EXCEPT
nipple and areola
1. Deep grp
Parenchyma of
breast,
Nipple,
Areola
24. 24
DEEP GROUP
1. Parenchyma :
Anterior Axillary LN
(via axillary tail)
1. Nipple and Areola
subareolar lymphatic
plexus of SAPPEY ---
Ant Axillary
3. Medial part of gld :
1. Parasternal
2. Post IC nodes
3. Supraclavicular LN
26. 26
MAMMARY GLAND
4. Deep part of Gland :
solitary lymph channel
pierce pectoral fascia, Pect
major, Clavipectoral
fascia------ Ant Axillary
(BACKDOOR EXIT)
Some lymph from deep
part reach nodes bt Pect
maj and Pect minor. Called
as ROTTER’s NODES
Rotters nodes
27. 27
Summary Lymphatic drainage :
75 % of lymph from the breast = Axillary LN
20 % of lymph from the breast = Internal mammary
LN
5 % of lymph from the breast = Post IC Nodes along
Post IC vein
Nerve supply
4-6th
intercostal nerves (ant & lat br)
Nipple : T4
Secretary activity of gland : Prolactin hormone
28. 28
MAMMARY GLAND - APPLIED
AXILLARY TAIL
Well developed axillary tail mistaken
for enlarged lymph nodes / lipoma
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
30. 30
Nipple
Cracked nipple –
in later pregnancy and lactation.
Nipple to be washed, and lubricated with lanolin
Discharges –
management depends upon presence of lump
31. 31
MAMMARY GLAND - APPLIED
Infections and inflammations – cause mastitis with
abscess
Tumours –
1. Benign – lipoma, fibroadenoma
2. Malignant – carcinoma “more in nulliparous and post
menopausal women”
Arise in epithelia of ducts or lobules
Spread by local, lymphatic and blood stream.
32. 32
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, metastasis to
viscera, bone
Treatment
Surgery (Radical mastectomy)
Hormone therapy
chemotherapy
33. 33
Breast Cancer
Breast cancer
A. skin dimpling
B. nipple retraction
C. Peau d orange 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
34. 34
Formation of Krukenberg’s tumour
• Secondary deposits in
ovaries due to spread from
Ca breast
• reach surface of ovary and
enter through ostia left by
ovulating Graafian follicle
36. Development of the breast
Ectodermal thickening milk ridge /
milk line / line of Schultz
Appears in embryo (4th
week of IUL)
Extends obliquely from axilla to groin
In humans ridge persists only over
pectoral region
36
37. 37
Congenital anomalies
Polythelia
Supernumery nipples over breast
Athelia
No nipple over breast (mainly
accessory breast)
Amastia
No breast development
Amazia
Nipple developed, no breast
development AtheliaAmastia
Amazia
Polythelia