Lecture notes for UG MBBS

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7. See notes for bibliography.

2. Learning Objectives
• Embryology
• Parts
• Size and Weight
• Surfaces
• Borders
• Relations
• Arterial Supply
• Venous Drainage
• Lymphatic Drainage
• Nerve Supply
• Attachments/Supports
• Surface Marking
• Microscopic Anatomy
• Applied Anatomy
• Physiology
• Congenital Anomalies

3. Introduction & History.
•

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

5. Embryology
•

6. 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 breast proper may form at
lower levels on this line.

7. Parts
•

8. Parts
• For the sake of description only divided into
four quadrants and a central part.
• 50% of breast tissue lies in upper outer
quadrant and 20% in central part.

9. Extent
•

10. Extent
• The base of the adult female breast overlies
the 2nd to 6th ribs, from the sternal edge to
the midaxillary line.
• Nipple lies at 4rth IC space.
• The upper outer quadrant extends into
axilla as the axillary tail .

11. Relations
•

12. 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

13. Attachments/Supports
•

14. Attachments/Supports
• Cooper ligaments -The lobules are
separated by fibrous septa running from the
breast skin to thefascia of the chest wall
(Astley Cooper fibres/ suspensory
ligaments)

15. Arterial Supply
•

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

17. Venous Drainage

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

19. Lymphatic Drainage

20. Lymphatic Drainage
• Lymph from the breast lobules, nipple ,
and areola
• → subareolar lymphatic plexus:
– 75% → pectoral lymph nodes →axillary lymph
nodes → subclavian lymphatic trunks;
important pathway for metastatic spread of
breast carcinomas
– 20% → parasternal nodes →
bronchomediastinal trunks
– 5% → intercostal nodes → thoracic or
bronchomediastinal lymph trunks

21. Lymphatic Drainage
Axillary Lymph nodes Groups :
• Anterior -Pectoral
• Posterior-Subscapular
• Lateral- Brachial
• Medial - central
• Apical
• Rotter’s ( interpectoral ) nodes
• Infraclavicular
• Supraclavicular

22. Lymphatic Drainage
Axillary Lymph nodes Levels:
1. Level I- Lateral to Pect. Minor
2. Level II- Deep to Pect. Minor
including Rotter’s nodes
3. Level III –Medial to Pect. Minor
• Level I and II are removed in MRM
• All three are removed in Patey’s MRM and
Radical Mastectomy.

23. Nerve Supply

24. 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
fibres 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.

25. •

26. Microscopic Anatomy

27. Microscopic Anatomy
• Made up of 15–20 lobules of glandular
tissue embedded in fat. Terminal Ductal
Lobular Unit- TDLU
• 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,

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

29. Physiology

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

31. 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.

32. 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.

33. 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.

34. 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.

35. 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.

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

37. Congenital Anomalies

38. Congenital Anomalies
1. Polythelia supernumerary nipple and
areola.
2. Polymastia supernumerary breast.
3. Athelia absence of the nipple, areola.
4. Amastia absence of breast tissue.
5. Poland syndrome is a combination of chest
wall deformity and absent or hypoplastic
pectoralis muscle and breast associated
with shortening and brachysyndactyly of
the upper limb.

39. MCQs
• 75% Lymph from breast goes to - (CET
JULY 2015 PATTERN)
• a) Axillary L.N.
• b) Subclavicular L.N.
• c) Internal mammary L.N.
• d) Cephalic L.N.

40. MCQs
• 75% Lymph from breast goes to - (CET
JULY 2015 PATTERN)
• a) Axillary L.N.
• b) Subclavicular L.N.
• c) Internal mammary L.N.
• d) Cephalic L.N.

41. MCQs
• Peau d' orange appearance of breast is due
to? (DNB 2008)
• (A) Infiltration of cooper ligament
• (B) Infiltration of lactiferoeus ducts
• (C) Obstruction of dermal lymphatics
• (D) Involvement of skin

42. MCQs
• Peau d' orange appearance of breast is due
to? (DNB 2008)
• (A) Infiltration of cooper ligament
• (B) Infiltration of lactiferoeus ducts
• (C) Obstruction of dermal lymphatics
• (D) Involvement of skin

43. MCQs
• The most frequent site of accessory breasts
is
• (a) Groin
• (b) Thigh
• (c) Axilla
• (d) Buttock

44. MCQs
• The most frequent site of accessory breasts
is
• (a) Groin
• (b) Thigh
• (c) Axilla
• (d) Buttock

45. MCQs
• Congenital absence of breast may
sometimes be associated with the absence
of a portion of
• (a) Pectoralis major
• (b) Pectoralis minor
• (c) Teres major
• (d) Latissimus dorsi

46. MCQs
• Congenital absence of breast may
sometimes be associated with the absence
of a portion of
• (a) Pectoralis major
• (b) Pectoralis minor
• (c) Teres major
• (d) Latissimus dorsi

47. MCQs
• The breast develops from
• (a) Ectoderm
• (b) Endoderm
• (c) Mesoderm
• (d) All of the above

48. MCQs
• The breast develops from
• (a) Ectoderm
• (b) Endoderm
• (c) Mesoderm
• (d) All of the above

49. MCQs
Witch's milk refers to
• (a) Infected milk
• (b) Secretions during pregnancy
• (c) Secretions of Infant breast
• (d) Secretions of male breast

50. MCQs
Witch's milk refers to
• (a) Infected milk
• (b) Secretions during pregnancy
• (c) Secretions of Infant breast
• (d) Secretions of male breast

51. MCQs
• Abnormality of breast development is a
feature of which syndrome?
• (a) Triple X Syndrome
• (b) Turners syndrome
• (c) Poland syndrome
• (d) Cri-du-chat syndrome

52. MCQs
• Abnormality of breast development is a
feature of which syndrome?
• (a) Triple X Syndrome
• (b) Turners syndrome
• (c) Poland syndrome
• (d) Cri-du-chat syndrome

53. MCQs
• Number of lobes in each breast is
• (a) 2-3
• (b) 4-8
• (c) 15-20
• (d) 50-100

54. MCQs
• Number of lobes in each breast is
• (a) 2-3
• (b) 4-8
• (c) 15-20
• (d) 50-100

55. MCQs
Rotter's nodes are present in
• (a) Apical group
• (b) Deltopectoral groove
• (c) Interpectoral groove
• (d) Supraclavicular fossa

56. MCQs
Rotter's nodes are present in
• (a) Apical group
• (b) Deltopectoral groove
• (c) Interpectoral groove
• (d) Supraclavicular fossa

57. MCQs
Axillary nodes which are located posterior to
pectoralis minor tendon are referred to as
• (a) Level I
• (b) Level II
• (c) Level III
• (d) apical nodes

58. MCQs
Axillary nodes which are located posterior to
pectoralis minor tendon are referred to as
• (a) Level I
• (b) Level II
• (c) Level III
• (d) apical nodes

59. MCQs
• Which of the following hormone is
responsible for milk let down?
• (a) Estrogen
• (b) Progesterone
• (c) Prolactin
• (d) Oxytocin

60. MCQs
• Which of the following hormone is
responsible for milk let down?
• (a) Estrogen
• (b) Progesterone
• (c) Prolactin
• (d) Oxytocin

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