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SURGICAL ANATOMY
OF THE BREAST
DR. MOHAMED HABIB
LECTURER OF SURGERY
OUTLINE
• Situation and deep relations.
• Structure and development.
• Blood supply.
• Nerve supply.
• Lymphatic drainage.
• Applied anatomical points.
LEARNING OBJECTIVES
• Appropriate knowledge of anatomical landmarks of Breast.
• Interpretation of your knowledge into clinical and
operative data.
INTRODUCTION
• Pectoral region ? Includes:
1. Skin.
2. Superficial fascia which contains the mammary gland.
3. Deep fascia (also called pectoral fascia).
4. Muscles: Include pectoralis major, pectoralis minor and
subclavius
THE MAMMARY GLAND
•lies in the superficial fascia of the pectoral
region
•Hemispherical in shape and has a circular
base, apex and axillary tail
•4 quadrants?
BASE .. APEX ..
AXILLARY TAIL
STRUCTURE
1. Skin and subcutaneous tissue
2. Parenchyma including lobes and ducts
3. Stroma
ARTERIAL SUPPLY
• Lateral 1/2 & tail are supplied mainly by lateral thoracic
artery (branch of 2nd part of axillary artery)
• Medial ½ is supplied mainly by perforating branches of
internal thoracic artery.
• Pectoral branch of acromiothoracic artery of the second
part of axillary artery
LYMPHATIC DRAINAGE
• 75% of lymph vessels pass laterally to axillary lymph nodes
,
• From the medial part of the breast, 20% of lymphatic
drainage of the breast pass to para-sternal (internal
thoracic ) lymph nodes.
LYMPHATIC DRAINAGE CONT.
• 5% of lymphatic drainage of the breast to the followings:
• Subscapular group drains axillary tail of the breast.
• Infra-clavicular & supra-clavicular lymph nodes.
• Some lymph vessels pass medially to other breast & axilla .
• Posterior intercostal lymph nodes then to para-aortic lymph
nodes.
• Some lymphatics from lower part of breast communicates with
the lymphatics in the rectus sheath and subdiaphragmatic lymphatics
.
APPLIED ANATOMY
• Breast abscess should be drained by a radial
incision in the breast substance to minimize the
damage of the radially arranged ducts.
APPLIED ANATOMY
• If the malignant tumor invades the Cooper’s
ligaments and pull on the overlying skin leading to
dimpling of skin.
• If the malignant tumor invades the lactiferous
ducts and may pull on the nipple leading to
retracted nipple .
APPLIED ANATOMY
• Obstruction of the skin lymphatics caused oedema
& swelling of the skin except the hair follicles and
the skin appears as an orange peel a condition
called peau d'orange.
• Breast cancer produce lymphatic spread mainly to
anterior → central → apical groups of axillary
lymph nodes.
THANK YOU

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Surgical anatomy of the breast.pptx

  • 1. SURGICAL ANATOMY OF THE BREAST DR. MOHAMED HABIB LECTURER OF SURGERY
  • 2. OUTLINE • Situation and deep relations. • Structure and development. • Blood supply. • Nerve supply. • Lymphatic drainage. • Applied anatomical points.
  • 3. LEARNING OBJECTIVES • Appropriate knowledge of anatomical landmarks of Breast. • Interpretation of your knowledge into clinical and operative data.
  • 4. INTRODUCTION • Pectoral region ? Includes: 1. Skin. 2. Superficial fascia which contains the mammary gland. 3. Deep fascia (also called pectoral fascia). 4. Muscles: Include pectoralis major, pectoralis minor and subclavius
  • 5.
  • 6. THE MAMMARY GLAND •lies in the superficial fascia of the pectoral region •Hemispherical in shape and has a circular base, apex and axillary tail •4 quadrants?
  • 7.
  • 8. BASE .. APEX .. AXILLARY TAIL
  • 9.
  • 10.
  • 11. STRUCTURE 1. Skin and subcutaneous tissue 2. Parenchyma including lobes and ducts 3. Stroma
  • 12.
  • 13.
  • 14.
  • 15. ARTERIAL SUPPLY • Lateral 1/2 & tail are supplied mainly by lateral thoracic artery (branch of 2nd part of axillary artery) • Medial ½ is supplied mainly by perforating branches of internal thoracic artery. • Pectoral branch of acromiothoracic artery of the second part of axillary artery
  • 16.
  • 17.
  • 18. LYMPHATIC DRAINAGE • 75% of lymph vessels pass laterally to axillary lymph nodes , • From the medial part of the breast, 20% of lymphatic drainage of the breast pass to para-sternal (internal thoracic ) lymph nodes.
  • 19. LYMPHATIC DRAINAGE CONT. • 5% of lymphatic drainage of the breast to the followings: • Subscapular group drains axillary tail of the breast. • Infra-clavicular & supra-clavicular lymph nodes. • Some lymph vessels pass medially to other breast & axilla . • Posterior intercostal lymph nodes then to para-aortic lymph nodes. • Some lymphatics from lower part of breast communicates with the lymphatics in the rectus sheath and subdiaphragmatic lymphatics .
  • 20.
  • 21.
  • 22.
  • 23. APPLIED ANATOMY • Breast abscess should be drained by a radial incision in the breast substance to minimize the damage of the radially arranged ducts.
  • 24.
  • 25. APPLIED ANATOMY • If the malignant tumor invades the Cooper’s ligaments and pull on the overlying skin leading to dimpling of skin. • If the malignant tumor invades the lactiferous ducts and may pull on the nipple leading to retracted nipple .
  • 26.
  • 27. APPLIED ANATOMY • Obstruction of the skin lymphatics caused oedema & swelling of the skin except the hair follicles and the skin appears as an orange peel a condition called peau d'orange. • Breast cancer produce lymphatic spread mainly to anterior → central → apical groups of axillary lymph nodes.
  • 28.