1.ANATOMY OF THE BREAST AND LYMPH NODE STATIONS OF BREASTppt

anatomy of breast

2. INTRODUCTION
Secondary sexual feature of females
 Nutrition for the neonate.
 Rudimentary form in males
1/10 exhibit malignant change
The breast is formed from modified sebaceous
glands. It lies in the superficial fascia.

4. EMBRYOLOGY
5th or 6
th
week - ectodermal mammary ridges
(milk lines) develop
On each side they extend from axilla to groin
49
th
day - invagination of thoracic bud
Remaining mammary line atrophies
15-20 solid ectodermal ingrowths form
lactiferous ducts & alveolar lobes

5. Surrounding somatopleuric mesenchyme forms
connective tissue, fat & vasculature
56
th
day - nipple formation begins
84
th
day - primitive ducts develop
150
th
day - canalization occurs & lactiferous
tubules open into the mammary pit in the last 2
months of gestation.

6. EXTENT
VERTICAL - 2
nd
to 6
th
ribs
HORIZONTAL - midline to the mid –
axillary line
2/3rds rest upon the pectoralis major,
1/3
rd
on the serratus anterior.
AXILLARY TAIL OF SPENCE -is under the deep
fascia ,enters the axilla through FORAMEN OF
LANGER

7. ANATOMY

8. ARCHITECTURE OF THE
GLAND
Composed of acini & fibrous stroma
Acini consists of 8-15 lobes in a spoke like
pattern
Major & minor ducts connect the milk secreting
lobular units to the nipple
Collecting ducts open into the lactiferous sinus at
the base of the nipple

9. Ligaments of Cooper - The breast is anchored to
the overlying skin and underlying pectoralis
fascia by bands of fibrous tissue.
Chest wall includes ribs ,intercostal muscles &
serratus anterior
50% of cancers arise in the upper outer
quadrant- abundant glandular tissue
Invasive cancer develops in the terminal lobular
units

11. BLOOD SUPPLY
The lateral thoracic artery from 2
nd
part of
axillary Artery.
Perforating cutaneous branches of the 2
nd

3
rd
and 4
th
spaces.
Lateral branches of the 2
nd
, 3
rd
and 4
th

intercostal arteries.
Venous drainage are superficial and deep.
Superficial veins are near the skin. Deep
veins drain to axillary, internal mammary
and intercostal vessels.

13. REGIONAL LYMPH NODES
Axillary nodes
Internal mammary
Supraclavicular
Intramammary
Axillary nodal status is the strongest Predictor
of disease free & overall survival

15. AXILLARY LYMPH NODES
 ANTERIOR–SOJIUS GLAND along the
lateral thoracic vein under the anterior axillary
fold.
Posterior : Along the Posterior axillary fold in
relation to the subscapular vessels
Lateral : along the upper part of the Humerus in
relation to the axillary vein
Central : In the fat of the upper part of axilla.
Apical : Also Called infraclavicular glands
bounded below by 1
st
intercostal Space, behind
by axillary vein, in front by costocoracoid
membrane.

16. B – LEVEL I NODE
C – LEVEL II axillary nodes
D – LEVEL III
E – SUPRACLAVICULAR
F – INTERNAL MAMMARY

17. Level 1 (low axilla) lymph nodes lateral to the lateral border of
pectoralis minor
Level 2 (mid axilla) between the medial & lateral borders of
pectoralis minor and the interpectoral (Rotters) nodes
Level 3 (apical axilla) infra clavicular nodes medial to the
medial margin of pectoralis minor & inferior to the clavicle
 
 

18. Lymphatics begin in the interlobular spaces,
Follow the duct
End in the sub areolar plexus of sappey
75% of outer quadrant drain to axillary nodes
50% of lower inner quadrant lesions drain to
internal mammary lymph node chain,lies 3-4cm
lateral to midline & 3 cm deep to the surface

20. Lymphatics of lower inner quadrant form a plexus
over the rectus sheath & pierce the costal margin to
communicate with the sub-peritoneal lymph plexus
(spread to liver)
From this place cancer cells may drop by gravity
into the pelvis(transcoelomic implantation) causing
metastasis in the ovary-krukenburg’s tumour
Some lymphatics pass to posterior intercostal
glands near the heads of ribs .

21. Lymphatics of the skin communicate across the
midline
In cancer secondary invasion of skin appears in
the form of discrete satellite nodules
At the level of 1
st
inter space , lymphatics
connect the right & left internal mammary
chains
So , spread to opposite breast is possible

22. Used for sentinel node imaging
Technetium 99 is injected into the peri tumoral
tissue
Followed by scintillation scanning
Sentinel node +ve - must do axillary dissection
Sentinel node negative –morbidity of axillary
dissection can be spared
90% specific & sensitive
LYMPHOSCINTIGRAPHY

23.  Depending on axillary nodal status
 Node negative - 82.8%
 1-3 positive nodes - 73%
 4-12 positive nodes - 45.7%
 > 13 nodes - 28.4%
SURVIVAL RATE

24. THANK YOU