ANATOMY OF MAMMARY GLAND WITH CLINICAL ANATOMY

mammary gland or breast is a modified sebaceous gland that secretes and stores milk to provide nutrition to new born.it is rudimentary in male and well developed in female .This ppt deals with anatomy of mammary gland in detail ,blood supply nerve supply ,lymphatic drainage. clinical anatomy is also explained in this ppt.

1. MAMMARY GLAND BY- DR ROOPA TEGGI 2 ND YEAR PG SCHOLAR DEPT OF RACHANA SHAREERA SDMCAH HASSAN

2. INTRODUCTION- Breast or Mammary gland is the most important structure present in pectoral region. It is found in both sexes, but rudimentary in male and well developed in female after puberty. The breast is modified sweat gland. It forms important accessory organ of female reproductive system ,and provides nutrition to newborn in the form of milk. Shape - Hemispherical

3. SITUATION- It lies in superficial fascia of the pectoral region. It is divided into four quadrants, 1)Upper medial 2)Upper lateral 3)Lower medial 4)Lower lateral A small extension of the upper lateral quadrant called the axillary tail of spence , passes through opening in the deep fascia and lies in the axilla. The opening is called Foramen of Langer.

4. EXTENT- Vertically –extends from second to sixth rib Horizontally extends from lateral border of sternum to midaxillary line.

5. DEEP RELATIONS- Breast lies on deep fascia(Pectoral fascia)covering the Pectoralis major. Still deeper there are parts of three muscles , namely Pectoralis major, Serratus anterior, External oblique muscle of abdomen. The breast is separated from Pectoral fascia by loose areolar tissue called Retro-mammary space . Because of presence of this loose areolar tissue, the normal breast can be moved freely over Pectoralis major.

6. STRUCTURE OF BREAST- Structure of breast can be studied by dividing it into 1)skin 2)parenchyma 3)stroma

7. 1) Skin- Nipple- a conical projection ,which is present just below the centre of breast at level of 4 th intercostal space It is pierced by 15-20 lactiferous ducts It has few modified sweat and sebaceous glands ,rich in nerve supply and has many sensory end organs at termination of nerve fibres. Areola- Skin surrounding the base of nipple is pigmented and forms a circular area called Areola This region is rich in modified sebaceous glands, particularly at its outer margin. These become enlarged during pregnancy and lactation to form raised Tubercles of Montgomerry . Oily secretions of these glands lubricate the nipple and areola,and prevent them from cracking during lactation. The skin of Areola is devoid of hair and there is no fat beneath it. Below areola lie the lactiferous sinus where stored milk is seen

8. PARENCHYMA- Breast is a compound tubulo-alveolar gland which secretes milk. The gland consist of 15-20 lobes. Each lobe is cluster of alveoli , and is drained by lactiferous duct. Lactiferous duct converge and open on it. Near its termination each duct has a dilatation called lactiferous sinus.

9. STROMA- It forms the supporting framework of the gland. It is partly fibrous and partly fatty. The fibrous stroma forms septa, known as Suspensory ligaments of Cooper, which anchor the skin and gland to Pectoral fascia The fatty stroma forms the main bulk of the gland.it is distributed all over the breast ,except beneath areola and nipple.

10. Blood supply- Arterial supply- Internal thoracic artery branch of subclavian artery Lateral thoracic and superior thoracic and acromiothoracic branches of axillary artery Posterior intercostal arteries Venous drainage- Superficial veins drain into internal thoracic vein Deep veins drain into axillary and posterior intercostal veins

11. Nerve supply and Lymphatic drainage- Nerve supply- 4-6 intercostal nerves Lymphatic drainage- There are 5 group of lymph nodes into which the lymph of breast is drained .They are- 1)Axillary lymph nodes-anterior ,posterior ,lateral ,central ,apical groups of nodes-about 75% 2)Internal mammary nodes-about 20% 3)other lymphatic nodes include-Supraclavicular lymph nodes, Cephalic nodes, Posterior intercostal and Subdiaphragmatic, Subperitoneal lymph plexus-about 5%

12. CLINICAL ANATOMY- Upper and outer quadrant of breast is frequent site of carcinoma. because of communication of superficial lymphatics of breast across the midline ,the cancer may spread to other breast and also to other organs of abdomen Breast abscess -a painful ,pus filled lump that forms in the breast tissue due to an infection Amastia -a rare birth defect causes complete absence of breast tissue, nipple, areola on one or both sides of body. Polymastia -a rare condition where person has more than two breast Athelia -congenital absence of one or both nipple Amazia- rare condition where one or both breast are absent ,but nipple and areola are present.

13. PEAU D”ORANGE APPEARANCE- Obstruction of superficial lymph vessels by cancer cells may produce oedema of skin giving raise to an appearance like that of skin of orange

14. Self E xamination of Breast- Inspect -symmetry of breasts and nipples Change in colour of skin Retraction of nipple is sign of cancer Discharge from nipple on squeezing it Palpate all four quadrants with palm of hand. Note any palpable lump. Raise the arm to feel lymph nodes in axilla Investigations- Mammogram Fine needle aspiration cytology(FNAC)