This document provides an anatomical overview of the female breast. It describes the breast's position and structure, including the skin, glandular tissue, stroma, blood and lymphatic supply. Development from the embryonic stage through puberty is addressed. Clinical correlations are discussed, such as breast cancer development and spread, as well as other common breast conditions like mastitis and cysts. Early detection of breast cancer through examination and mammography is emphasized for improved prognosis.

1. Cynthia Nixon Sheryl Crow
Christina Applegate
Olivia Newton John
What
important
fact is
common
with these
females?

2. Anatomy of Breast
Dr.B.B.Gosai

3. Introduction
Breast found in both sexes but well
developed in female after puberty.
Accessory organ of female reproductive
system.
Modified sweat gland
Hemispherical in adult and pendulous in old
age

4. Position and Extent
Lies deep to skin in the
superficial fascia over
pectoral region.
Extent: from 2nd to 6th rib
vertically and from lateral
margin of sternum to
midaxillary line horzontally.
Superolateral part called
axillary tail of spence
pierces the deep fascia
(Foramen of langer) and
extends in the axilla.

5. Deep relations of breast
Retromammary
space: loose
areolar tissue
Pectoral fascia
Pectoralis major,
serratus anterior
and external
oblique

6. Structure of the Breast
The breast contains:
 Skin
 Parenchyma: epithelial glandular tissue
of the tubulo-alveolar type
 fibrous connective tissue and fat (stroma)
surrounding the glandular tissue


7. Skin
 Nipple: Conical projection
just below the centre of
breast, pierced by 15-20
lactiferous ducts and contain
smooth muscles and sensory
end organs
 Areola: Pigmented area
surrounding the base of nipple
contain modified sebaceous
glands which enlarge during
pregnancy, These enlarged
glands are known as Tubercles
of Montgomery for secretion to
prevent cracking of nipple
Nipple
Tubercles of Montgomery

8. Glandular Tissue (Parenchyma)
 This consists of branching ducts and
terminal secretory lobules.
 In the mature breast 15-20 lobules. Each
lobule consists of several blind-ending
branches or expansions, the alveoli
(acini), converging on an alveolar duct
 The ducts converge on to the 15–20
larger lactiferous ducts which open on
to the apex of the nipple.
 Breast cancers arise at the junction of
the lobules and ducts, and as they
increase in size they lead to fibrous
tissue formation so that they are hard
and irregular.

9. Stroma of the Breast
 Formed by fibrous tissue and fat
 Fibrous tissue extend from the ducts to
the dermis, and these are often well
developed in the upper part of the breast
as the suspensory ligaments (of Astley
Cooper), which assist in the support of
the breast tissue.
 Pathologically, these may be contracted
by fibrosis in carcinoma, causing
retraction or pitting of the overlying skin.
Peau de orange

10. Arterial supply
 Supplying the female breasts are branches of the axillary
artery, the internal thoracic artery, and some intercostal
arteries, as follows:
 the axillary artery supplies blood to the breast via several
branches: the superior thoracic, the pectoral branches of
the thoraco-acromial artery, the lateral thoracic
 the internal thoracic artery gives perforating branches to
the anteromedial part of the breast;
 the second to fourth intercostal arteries give
perforating branches more laterally in the anterior thorax.

11. Arteries

12. Venous drainage
Around the areola there is a circular venous
plexus.
From this and from the glandular tissue,
blood drains in veins accompanying the
arterial blood supply, i.e. to the axillary,
internal thoracic and intercostal veins.
Great individual variation may occur

13. Nerve supply
 The nerve supply of the breast is derived from the
branches of the fourth to sixth intercostal nerves
 They carry sensory and sympathetic efferent fibres.
 The nipple supply is from the T4;
 this forms an extensive nerve plexus within the
nipple, its sensory fibres terminating close to the
epithelium as free endings, Meissner corpuscles and
Merkel disc endings.
 These are essential in signalling suckling to the
central nervous system; however, secretory
activities of the gland are largely controlled by
ovarian and hypophyseal hormones (Prolactin)
rather than by efferent motor fibres.

14. Lymphatic drainage
 The lymphatic drainage of the breast is
very important as these is the route of
spread of infection and cancer.
 Superficial lymphatics from skin of
breast except nipple and areola
 Deep lymphatics from parenchyma and
nipple and areola form subareolar plexus
of sappy.
 Lymph nodes of breast:
 Axillary nodes: Anterior, posterior,
central and apical
 Internal mammary nodes
 Subdiaphragmatic nodes
 Supraclavicular nodes
 Posterior intercostal nodes

15. Lymph
Vessels

16. Lymphatic drainage by quadrant of breast
Supraclavicular Nodes

17. Lymphatic drainage by quadrants
 From superolateral quadrant:
– Anterior, posterior axillary nodes
– Supraclavicular nodes
 From superomedial quadrant:
– Internal mammary nodes
– Supraclavicular nodes
 From inferomedial quadrant:
– Intenal mammary nodes
– Subdiaphragmatic nodes
 From infrolateral quadrant:
– Posterior intercostal nodes
– Subdiaphragmatic nodes

18. Important characteristics of
lymphatic drainage
 the axillary lymph nodes, the predominant site of drainage from the
breast. (70 %).
 Internal mammary nodes communicate by lymphatics crossing
midline and hence one side cancer can spread to opposite breast
 Route of spread of cancer is according to route of lymphatics
 Secondary spread of cancer involve axillary nodes, (Axilla)
supraclavicular nodes (Neck), internal mammary nodes (Opposite
breast) and subdiaphragmatic nodes (Abdomen-liver, ovary).
 Nowadays, a simpler nomenclature is generally adopted, based on the relation of
the nodes to pectoralis minor.
 Those lying below pectoralis minor are the low nodes (level 1),
 those behind the muscle are the middle group (level 2),
 while the nodes between the upper border of pectoralis minor and the lower
border of the clavicle are the upper or apical nodes (level 3).
 In addition, between pectoralis minor and major there may be one or two other
nodes (Rotter's nodes).

19. Breast Development
Prenatal Development
 Epithelial mammary bud
appearing at a gestational age of
35 days; by day 37 this has
become a mammary line
extending from the axilla through
to the inguinal region
 The thoracic mammary bud
invaginates into the mesenchyme,
with involution of the remaining
mammary line
 Then Nipple is formed , ducts
develop and get canalized.

20. •Developmental anomalies of breast
 Accessory breast tissue may be present in adults
anywhere along the milk line (polythelia)
 Accessory breast develop usually in the thoracic region
(90%) but also occasionally in the axillary (5%) or
abdominal (5%).
 In either sex, there may be no breast development
(amastia)
 Rarely, the nipple may not develop (athelia) although
this occurs more commonly in accessory breast tissue.
 At birth the combination of fetal prolactin and maternal
oestrogen may give rise to transient hyperplasia and
secretion of 'witch's milk'.

21. Polymastia
Amastia

22. Normal non-lactating lobule with
terminal duct.
1.The duct can be seen
leading to the lobule
which is composed of
multiple, small acini set
within a loose intralobular
stroma.
2. The denser, interlobular
stroma can be seen
surrounding the lobule
and duct.
3. A small amount of
adipose tissue is also
present

23. Normal non-lactating terminal
duct lobular unit
1. The terminal
duct can just be
seen to the left of
the picture.
2. The lobule is
composed of
numerous acini.

24. High power view of a non-lactating
lobule
 . The two cell type lining
of the acini can be clearly
seen with the inner
luminal epithelium and
outer myoepithelial layer.
 The eosinophilic basement
membrane can also be
discerned.
 The loose intralobular
stroma contrasts with the
denser, interlobular stroma
surrounding the lobule.

25. Lactating breast
 . The lobules are greatly
expanded. Many more
acini are present
 lined by cells showing
evidence of secretory
activity.
 The intralobular stroma
has largely been
displaced.

26. High power view of lactating
breast
 . The enlarged lobule,
composed of multiple
distended acini, can be
seen.
 The vacuolated cytoplasm
of the secretory epithelium
is clearly visible.
 Myoepithelium is
difficult to see.

27. Clinical Anatomy of breast
Cancer of breast: second common cancer in
female
Retraction of skin (Peau de orange)
Retraction of nipple
Stony hard swelling in breast
Spread of cancer to nodes of breast
Distant metastasis
Early detection can be treated and gives better
prognosis

29. Fungating Fulminant cancer
Surgical removal of
breast: Mastectomy

30. Artificial breast for
cancer patients
Breast implants for
cosmetic surgery
Sarah Jessica Parker

31. Early detection
Breast examination
Mammogram

32. Other clincal conditions
Mastitis: Infection of
breast
Breast abscess: Incision
for drainage should be
radial to avoid injury to
ducts

33. Cystic swelling in breast
due to blockage of ducts
Gynecomastia: Female like
breast in male

34. Learning never ends !!!!