![• Peau d’ orange skin-
obstruction of superficial
lymphatics by cancer cells
produce oedema of skin.
• May spread from one
breast to other
• Abdominal seeding
[Krukenberg tumor ]
• Spread through veins-
communicate with
vertebral venous plexus-
spread to vertebrae &
brain
APPLIED ANATOMY cont…
© Prof.Dr.N.Mugunthan](https://image.slidesharecdn.com/mammarygland-prof-251217095657-a8190d40/75/MAMMARY-GLAND-Prof-Dr-N-Mugunthan-Professor-of-Anatomy-KMMC-Medical-College-Muttom-33-2048.jpg)
MAMMARY GLAND -Prof.Dr.N.Mugunthan.Professor of Anatomy, KMMC Medical College, Muttom.
Anatomy of the Breast 1. **External Anatomy:** * **Nipple**: The central protruding part of the breast, where milk is ejected. It contains several openings for lactiferous ducts. * **Areola**: The pigmented area surrounding the nipple, typically darker in color. It contains small glands (Montgomery's glands) that secrete oils to lubricate the nipple during breastfeeding. #### 2. **Internal Anatomy:** * **Mammary Glands**: Modified sweat glands responsible for milk production. These glands are arranged in lobes. * **Lobes**: The breast is divided into 15-20 lobes, each containing smaller lobules that produce milk. * **Lobules**: The smallest units within the lobes that contain alveoli (milk-producing sacs). * **Alveoli**: Small structures that produce milk in response to hormonal signals. * **Lactiferous Ducts**: Tubes that carry milk from the alveoli to the nipple. They converge to form larger ducts near the nipple. * **Lactiferous Sinuses**: Enlarged areas of the lactiferous ducts just beneath the areola where milk is temporarily stored before being expelled. * **Connective Tissue**: The stroma, or supportive tissue, made up of adipose (fat) tissue and fibrous tissue, which gives the breast its shape and firmness. #### 3. **Vascular and Lymphatic System:** * **Blood Supply**: The breast is primarily supplied by branches of the internal mammary artery and the lateral thoracic artery. * **Lymphatic Drainage**: Lymphatic vessels drain into axillary (armpit) lymph nodes, as well as nodes in the clavicular (collarbone) and supraclavicular regions. Lymphatic drainage is essential for immunity. #### 4. **Supportive Structures:** * **Suspensory Ligaments (Cooper's Ligaments)**: These fibrous bands of tissue support the breast and help maintain its shape by connecting the breast tissue to the overlying skin. * **Fatty Tissue**: The amount of fat varies with age, hormonal changes, and genetics, influencing breast size and density.
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MAMMARY GLAND -Prof.Dr.N.Mugunthan.Professor of Anatomy, KMMC Medical College, Muttom.
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- 2. Competency Topic: Pectoral region Domain LevelCore AN 9.2 Describe the location, extent, deep relations, structure, age changes, blood supply, lymphatic drainage, microanatomy and applied anatomy of breast. K KH Y AN 9.3 Describe development of breast. K KH N © Prof.Dr.N.Mugunthan
- 3. Specific Learning Objectives Essayquestion : 10 marks/30 minutes • 42 years old Mrs.Kamatchi came to surgical OPD with c/o pain and swelling in the left breast for last 6months.O/E. Breast fixed to chest wall,nipple retracted, skin shows peau d’ orange and enlarged anterior axillary node. a) Name the clinical condition. (1 mark) b) Give the reason why breast fixed to chest wall,retraction of nipple and peau d’ orange appearance of skin. (3marks) c) Describe gross features and lymphatic drainage of breast with suitable diagram. (6 marks) At the end of this Theory class the students should be able to answer the following © Prof.Dr.N.Mugunthan
- 4. OVERVIEW Case scenario Gross features Structureof breast Blood supply Nerve supply Lymphatic drainage Microanatomy (histology) Development Applied anatomy Summary © Prof.Dr.N.Mugunthan
- 5. HOW TO DESCRIBETHE MAMMARY GLAND Introduction Gross features • Situation • Extent • Shape Relations Structure of breast Blood supply • Arterial supply • Venous drainage Nerve supply Lymphatic drainage Applied anatomy © Prof.Dr.N.Mugunthan
- 6. INTRODUCTION / DEFINITION Modifiedsweat gland Present in both sexes Rudimentary in male Well developed in female after puberty Accessory organ of female reproductive system © Prof.Dr.N.Mugunthan
- 7. GROSS FEATURES Situation: • Liesin the superficial fascia of pectoral region • Axillary tail of Spence – pierces deep fascia (foramen of Langer) and lies in axilla © Prof.Dr.N.Mugunthan
- 8. Extent: Vertical -2 to6 rib Horizontal- lat.border of sternum to midaxillary line GROSS FEATURES © Prof.Dr.N.Mugunthan
- 9. Shape: Varies Hemispherical or conical Dividedinto 4 quadrants Superomedial & superolateral Inferomedial & inferolateral Axillary tail –extension from superolateral quadrant GROSS FEATURES © Prof.Dr.N.Mugunthan
- 10. RELATIONS 1. Superficial: skin 2.Deep : • Loose areolar tissue (retro mammary space - lake of Marcelli)-breast move freely • Deep fascia (pectoral fascia) • Pectoralis major & minor • Serratus anterior • External oblique © Prof.Dr.N.Mugunthan
- 11. STRUCTURE OF BREAST 1.Skin 2. Parenchyma 3. Stroma © Prof.Dr.N.Mugunthan
- 12. 1. Skin: a. Nipple–conical projection • Below the centre of breast- 4th intercostal space • Pierced by 18-20 lactiferous ducts • Has modified sweat & sebaceous glands • Rich nerve supply STRUCTURE OF BREAST cont… © Prof.Dr.N.Mugunthan
- 13. b. Areola: • Circulararea surround the nipple • Deeply pigmented • Modified sebaceous glands- Montgomery tubercle • Devoid of hair & fat STRUCTURE OF BREAST cont… © Prof.Dr.N.Mugunthan
- 14. 2.Parenchyma: • Glandular tissue–secretes milk • 18-20 lobes • Tail of Spencer (Axillary tail) pierces deep fascia (foramen of Langer) & enter into axilla • Each lobe- cluster of alveoli and drained by lactiferous ducts • lactiferous ducts open into the nipple • Lactiferous sinus- dilatation near its termination STRUCTURE OF BREAST cont… © Prof.Dr.N.Mugunthan
- 15. 3. Stroma: • Supportingframe work • Fibrous & fatty • Fibrous stroma forms septa –suspensory ligaments of Cooper • Extends from the skin to pectoral fascia • Fatty stroma forms main bulk of gland STRUCTURE OF BREAST cont… © Prof.Dr.N.Mugunthan
- 16. AGE CHANGES • Birthto pre pubertal life – ducts without alveoli • At puberty – 18 to 20 ducts branching, alveoli formed • In pregnancy – alveoli enlarge • During lactation – distended alveoli cuboidal – resting phase columnar – active phase • After lactation - alveoli shrink • After menopause – glandular tissue is replaced by fibrous tissue © Prof.Dr.N.Mugunthan
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- 18. BLOOD SUPPLY a. Arterialsupply: Branches from – a) Internal thoracic artery b) Lateral thoracic artery c) Superior thoracic artery d) Acromio thoracic artery e) Lateral branches of post.intercostal arteries © Prof.Dr.N.Mugunthan
- 19. b.Venous drainage: • Anastomoticvenous circle around the base of nipple • Vein follow the arteries and drain into a) Internal thoracic vein b) Axillary vein c) Post.intercostal veins BLOOD SUPPLY cont…. © Prof.Dr.N.Mugunthan
- 20. NERVE SUPPLY • Anterior& lateral cutaneous branches of 4th,5th and 6th intercostal nerves © Prof.Dr.N.Mugunthan
- 21. Lymphatic Drainage of breast 1.Drainagefrom skin excluding areola and nipple 2.Drainage from parenchyma including areola and nipple © Prof.Dr.N.Mugunthan
- 22. 1. Lymphatic Drainagefrom skin excluding nipple & areola: Outer part Axillary nodes Upper part 1.Supra clavicular nodes 2.Infra clavicular nodes Apical group of axillary nodes Inner part Parasternal nodes ( ipsilateral and contalateral) Lower part 1. Sub diaphragmatic nodes 2.Hepatic nodes © Prof.Dr.N.Mugunthan
- 23. I. Lymphatic drainageof skin except nipple & areola (superficial) a) Axillary nodes b) Internal mammary nodes (parasternal) c) Supra/infra clavicular nodes d) Hepatic and subdiaphragmatic nodes © Prof.Dr.N.Mugunthan
- 24. 2. Drainage fromparenchyma including nipple & areola: 75% Axillary nodes 20% Parasternal nodes 5% Posterior intercostal nodes © Prof.Dr.N.Mugunthan
- 25. II.Lymphatic drainage of parenchymaincluding nipple & areola (deep) a) Subareolar plexus of Sappy’s b) Ant. Group of axillary nodes (75%) c) Internal mammary nodes (parasternal) (20%) d) Intercostal nodes (5%) © Prof.Dr.N.Mugunthan
- 26. MICROANATOMY Inactive mammary gland ©Prof.Dr.N.Mugunthan
- 27. MICROANATOMY Active mammary gland ©Prof.Dr.N.Mugunthan
- 28. DEVELOPMENT OF BREAST Milk line / mammary ridge Axilla to groin Human- persist only in pectoral region Mammary pit Secondary buds grows from the floor of pit © Prof.Dr.N.Mugunthan
- 29. DEVELOPMENTAL ANOMALIES OFBREAST • Amastia – absence of breast • Athelia - absence of nipple • Polymastia – supernumerary breasts • Polythelia –supernumerary nipples • Gynaecomastia- development of breast in male (Klinefelter’s syndrome) © Prof.Dr.N.Mugunthan
- 30. APPLIED ANATOMY a) Breastabscess: • should be drained by radial incision • (avoid cutting lactiferous ducts) b) Mastitis : • Inflammation of breast © Prof.Dr.N.Mugunthan
- 31. Fibroadenoma of breast/ breast mouse / breast lump (benign tumour): Freely mobile Painless swelling SBE –Self Breast Examination Excision of lump APPLIED ANATOMY cont… © Prof.Dr.N.Mugunthan
- 32. Carcinoma breast: Breast isfixed –Infiltration of the tumor into retromammary space Tumor fixed to underlying pectoral fascia Retraction or puckering of skin – contraction of suspensory ligament Retraction of nipple – infiltration of cancer cells into lactiferous duct and fibrosis APPLIED ANATOMY cont… © Prof.Dr.N.Mugunthan
- 33. • Peau d’orange skin- obstruction of superficial lymphatics by cancer cells produce oedema of skin. • May spread from one breast to other • Abdominal seeding [Krukenberg tumor ] • Spread through veins- communicate with vertebral venous plexus- spread to vertebrae & brain APPLIED ANATOMY cont… © Prof.Dr.N.Mugunthan
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- 35. SUMMARY Gross features Situation Extent Shape Relations Structure of breast Blood supply Arterial supply Venous drainage Nerve supply Lymphatic drainage Histology Development Applied anatomy © Prof.Dr.N.Mugunthan
- 36. YOUR ANSWER TOCASE SCENARIO Essay question : 10 marks/30 -45 minutes • 42 years old Mrs.Kamatchi came to surgical OPD with c/o pain and swelling in the left breast for last 6months.O/E. Breast fixed to chest wall,nipple retracted, skin shows peau d’ orange and enlarged anterior axillary node. a) Name the clinical condition. (1 mark) b) Give the reason why breast fixed to chest wall,retraction of nipple and peau d’ orange appearance of skin. (3marks) c) Descrie the gross features and lymphatic drainage of breast with suitable diagram. (6 marks) © Prof.Dr.N.Mugunthan
- 37. For more detailsjust click @ https://sites.google.com/view /dr-n-mugunthan-online- learning/home © Prof.Dr.N.Mugunthan
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