6. mammary gland

mammary gland for undergraduates

1. 1
Maj Dr Poonam Singh
Department of Anatomy
NAIHS
MAMMARY GLAND

2. Mammary gland will be studied under..
Introduction, extent
Surfaces
Relations
Structure
Blood supply and nerve supply
Lymphatic supply
applied
2

3. 3
MAMMARY
GLAND
Modified sweat gland in sup fascia
of pectoral region
No connective tissue covering.
Accessory female reproductive org
EXTENT
Vertical : 2-6 ribs in MCL
Hori : lat border sternum – MAL,
level of 4
th
rib
Extends into axilla
Axillary tail of SPENCE
Foramen of LANGER
SHAPE : hemispherical, conical,
pendulous, etc

4. Axillary tail of Spence
Projection from upper
and outer quadrant
Enter axilla thro
opening of Axillary
fascia called
Foramen of Langer
In contact with Ant
group of axillary LN
(d/d – lipoma)
4

5. 5
DEEP RELATIONS – “MAMMARY BED”
Covered by deep fascia
Pectoralis major :
Medial 2/3,
Serratus Anterior :
Upper two digitations
Lat 1/3,
EO aponeurosis
inferomedially –
separate it from rectus
sheath
Base of gland rest upon foll structures:-

6. 6
Mammary Gland : Bed
Pectoralis
Major
Serratus
Anterior
External
Oblique

7. 7
SURFACES
1.Superficial
1.Deep

8. 1.Superficial surface:
Skin, nipple and areola
Under skin, superficial fascia
has nerves/vessels
Nipple and areola - No
subcutaneous fat and hair.
a.Nipple :
4
th
ICS, 4 inch from midline
15 – 20 lactiferous ducts
open
Presence of circular muscle,
longitudinal muscle
Rich nerve supply
8

9. 9
MAMMARY GLAND
b.Areola :
Circular pigmented area.
Pink or brown.
Surrounds the base of nipple
Periphery :
sebaceous glands.
Enlarged as Tubercles of
MONTGOMERY during
pregnancy.
Lubrication of nipple and areola

10. Deep to areola
Lactiferous sinus
 duct dilated to
form sinus
Lymphatic plexus
of Sappey – below
areola
10
Mammary Gland
Subareolar
lymphatic plexus
of Sappey

11. 11
2. Deep surface

LAKE OF MERCILLE
(retro mammary
space or
Chassaignac’s
bursa) - separates
MG from Pect maj
fascia.
Contain areolar
tissue
Retro mammary space
 Helps in mobility of breast
 Space for breast implants
Retro
mammary
space

12. 12
STRUCTURE
1.Parenchyma ( tubulo-alveolar)
2.Stroma
Fibrous tissue
Fatty tissue
Lobules
contain
acini

13. 1. Glandular portion with parenchyma
15 -20 lobes each with multiple
lobules
containing clusters of acini or
alveoli
lactiferous duct-
commence toward nipple from
each lobe
lactiferous sinus –
which open into tip of nipple
Lobes radially arranged, hence
incision radially given
Glandular tissue increase during
preg and lactation
13
Lobes
Lobules
Ducts
Sinus

14. 14
Lobes
Lobules
Ducts
sinuses

15. 15
2. Stroma
Consist of
a.fibrous connective tissue
b.adipose tissue.
Fibrous tissue
Form septa
Run deep surface of gland to skin.
Called Suspensory ligament of
Cooper
Gives firmness to gld.
Elasticity lost during preg –
pendulous.

16. Fatty tissue
Increase during
puberty – smooth
contour
Inter lobar in position
Forms the most of
the bulk of the breast
16

17. 17
Mammary Gland: Structure
Alveoli opening into ductSuspensory ligament running from skin to P Major

18. 18
BLOOD SUPPLY
1.Internal thoracic artery
(subclavian)
perforating br – 2,3,4 ICS
1.Br from Axillary :
Sup thoracic Art
Thoraco acromial – pectoral br
Lat thoracic art
Subscapular art
3.Posterior Intercostal art –
2,3,4th ICS lat br

19. 19
VENOUS DRAINAGE:

Circulus venosus /sub
areolar plexus of vein
Superficial and deep vein
drain into
1.Int mammary V
2.Axillary V
3.Post IC vein –
which drain into Azygous vein

20. 20
Venous drainage of mammary gland
Communication via Post
IC vein, Azygous and
Internal vert plexus
which in turn
communicate with
transverse and sagittal
sinus spreads
malignancy to abdominal
organs, brain, vertebrae,
ribs and skull

21. 21
LYMPHATIC DRAINAGE
Drain into following grp
of lymph nodes
1.Axillary (five sub grp)
2.Internal mammary LN
(along Internal
mammary V)
1.Supraclavicular
2.Posterior IC Lymph
nodes (post parts of
ICS in front of the head
of ribs)

22. 22
Lymphatics divided into two grps :
1.Superficial grp :
drain skin over
breast EXCEPT
nipple and areola
1.Deep grp
Parenchyma of
breast,
Nipple,
Areola

23. 23
SUPERFICIAL GROUP
UL & LL Quadrant
Axillary LN (Ant –Central
—Apical)
UM quadrant :
parasternal/
supraclavicular
LM quadrant :
Parasternal
Subdiaphragmatic nodes
Subperitoneal lymph
plexus
KRUKENBERGS TUMOUR ??

24. 24
DEEP GROUP
1.Parenchyma :
Anterior Axillary LN
(via axillary tail)
1.Nipple and Areola
subareolar lymphatic
plexus of SAPPEY ---
Ant Axillary
3.Medial part of gld :
1.Parasternal
2.Post IC nodes
3.Supraclavicular LN

25. 25
Post IC nodes
Internal mammary
LN
Deep
lymphatic
drainage

26. 26
MAMMARY GLAND
4.Deep part of Gland :
solitary lymph channel
pierce pectoral fascia, Pect
major, Clavipectoral
fascia------ Ant Axillary
(BACKDOOR EXIT)
Some lymph from deep
part reach nodes bt Pect
maj and Pect minor. Called
as ROTTER’s NODES
Rotters nodes

27. 27
Summary Lymphatic drainage :
75 % of lymph from the breast = Axillary LN
20 % of lymph from the breast = Internal mammary
LN
5 % of lymph from the breast = Post IC Nodes along
Post IC vein
Nerve supply
4-6
th
intercostal nerves (ant & lat br)
Nipple : T4
Secretary activity of gland : Prolactin hormone

28. 28
MAMMARY GLAND - APPLIED
AXILLARY TAIL
Well developed axillary tail mistaken
for enlarged lymph nodes / lipoma
Investigations
Mammography
Soft tissue radiographs of breast.
Cyst (well defined smooth opacity) and
carcinomas (irregular density, distortion
of breast tissue, calcification)
FNAC (fine needle aspiration
cytology)
Used for cell diagnosis

29. 29
MAMMOGRAPHY
Calcification - fibroadenoma
fibroadenoma
Calcified galactocoele
Breast abcess sub areolar
Ca breast with
microcalcification
Fibroadenoma extending
to axilla
Breast cyst
Ca Breast with calcifications
Breast multiple fibroadenomas

30. 30
Nipple
Cracked nipple –
in later pregnancy and lactation.
Nipple to be washed, and lubricated with lanolin
Discharges –
management depends upon presence of lump

31. 31
MAMMARY GLAND - APPLIED
Infections and inflammations – cause mastitis with
abscess
Tumours –
1.Benign – lipoma, fibroadenoma
2.Malignant – carcinoma “more in nulliparous and post
menopausal women”
Arise in epithelia of ducts or lobules
Spread by local, lymphatic and blood stream.

32. 32
Malignant tumours cont,d
Presentation –
Hard lump with retracted nipple
Peau d’ orange (orange like skin) – involvement of skin of
breast due to cutaneous lymphatic oedema
Advanced – ulceration, fixation to chest wall, metastasis to
viscera, bone
Treatment
Surgery (Radical mastectomy)
Hormone therapy
chemotherapy

33. 33
Breast Cancer
Breast cancer
A.skin dimpling
B.nipple retraction
C.Peau d orange A - Dimpling of skin B - Retracted nipple
C - Peau d orange
A – due to pull by lig of cooper
B - due to retraction of milk ducts
C – due to lymphatic obstruction

34. 34
Formation of Krukenberg’s tumour
•Secondary deposits in
ovaries due to spread from
Ca breast
•reach surface of ovary and
enter through ostia left by
ovulating Graafian follicle

35. implants
35

36. Development of the breast
Ectodermal thickening  milk ridge /
milk line / line of Schultz
Appears in embryo (4
th
week of IUL)
Extends obliquely from axilla to groin
In humans  ridge persists only over
pectoral region
36

37. 37
Congenital anomalies
Polythelia
Supernumery nipples over breast
Athelia
No nipple over breast (mainly
accessory breast)
Amastia
No breast development
Amazia
Nipple developed, no breast
development
AtheliaAmastia
Amazia
Polythelia

38. Congenital anomalies
38
Accessory breast along milk ridge

39. 39

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