BREAST & AXILLARY LYMPH NODES PPT. SK.ppt

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1. ANATOMY OF
THE BREAST

2. •The female reproductive
organ that provides
essential nourishment to
the new born and infant.
•Each breast is a rounded
elevation on the front of
upper part of thorax, over
the pectoral region
•Consists of mass of
glandular tissue embedded
in connective tissue and fat.
Areola
Nipple
Introduction / General Information
A.Embryologically: belong to integument [ECTODERM]
B.Functionally: part of reproductive system.
C.It is a modified apocrine sweat gland
D.Present in males and females

3. POSITION OF BREASTIt lies deep to the skin
in the superficial fascia &
upon the deep pectoral
fascia over pectoral
region.
Ir extends from 2
nd
to 6
th

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.

4. “TAIL OF SPENCE” =
AXILLARY TAIL
A prolongation of upper,
outer quadrant in axillary
direction
It Passes under axillary
fascia
It May be mistaken for
axillary lymph node

5. -Breast shape and size depend upon genetic, racial and dietary factors, and the age,

parity and menopausal status of the individual.
-Breasts may be hemispherical, conical, variably pendulous, piriform or thin and
flattened.
-The main bulk of the breast tissue is usually localized to its upper outer
quadrant. This quadrant is more often implicated in breast cancer and in most
benign lesions of breast tissue.
-It is fixed to skin & underlying fascia by fibrous connective tissue bands Known as
Cooper’s (Suspensory) Ligaments.
Ligaments may retract when breast tumors are present.
-Left breast is usually slightly larger.
-Base is circular, either flattened or concave.
-It is separated from pectoralis major muscle by deep fascia

6. Retromammary Space
Retromammary
Space

7. Outer surface:-
It is convex.
It shows a small conical,
cylindrical prominence called
Nipple which lies at fourth
intercostal space
The nipple is surrounded by a dark pigmented ring

of skin called areola. It is thin skinned region
which
is lacking from hairs & sweat glands, but
contains
areolar glands
Areola contains dark pigment that intensifies in
pregnancy.
Areola has circular and radial smooth muscle fibers,
contraction of which cause erection of nipple.
Gross features of the the Breast

8. Nipple & aerola location
4
th
intercostal space

9. Internal structure of the Breast
The breast contains:
•epithelial glandular tissue
of the tubulo-alveolar type
•fibrous connective tissue
(stroma) surrounding the
glandular tissue
•interlobar adipose tissue

11. Internal structure of
the Breast
Each breast consists of 15-20 lobes
of secretory tissue
-Each lobe has one lactiferous duct
-Lobes (and ducts) arranged radially
-Lobes are embedded in connective
tissue & adipose of superficial
fascia of pectoral region
-Lobes composed of lobules
-Lobules comprise of alveoli
-Fatty Tissue surrounds surface, fills
spaces between lobes. The fatty
tissue also determines the form,
shape & size of the breast.
- Theie is No fatty deposit under
nipple & areola

12. Internal structure of the Breast LOBES AND LOBULES

13. Internal structure of the
Breast
A. GLANDULAR TISSUE
•This consists of branching ducts and
terminal secretory lobules.
•In the mature breast 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
•Each lactiferous duct is therefore
connected to a tree-like system of
ducts and lobules, enclosed and
intermingled with connective tissue
stroma, collectively forming a lobe of
the mammary gland
•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.

14. Internal structure of the Breast
Excretory (lactiferous) ducts

15. Internal structure of
the Breast
Stroma of the Breast
B.The stroma penetrates between and
encloses the lobules, where it has a
loose texture, allowing the rapid
expansion of secretory tissue during
pregnancy).
• Fibrous condensations of stromal
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. Elsewhere in the normal
breast, fibrous tissue surrounding the
glandular components extends to the
skin and nipple, assisting in the
mechanical coherence of the gland.

16. •Highly variable in amount,
this is typically present in
the interlobar stroma, and
not amongst the lobules.
•Fatty Tissue: surrounds
surface, fills spaces
between lobes.
•Determines form & size of
breast.
•No fatty deposit under
nipple & areola
Internal structure of the Breast
C.-ADIPOSE / FATTY TISSUE

17. ARTERIAL SUPPLY OF BREASTSupplying 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
supreme thoracic, the pectoral
branches of the thoraco-acromial
artery, the lateral thoracic and the
subscapular artery;
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. The second perforating
artery is usually the largest,
supplying the upper region of the
breast, and the nipple, areola and
adjacent breast tissue

18. VENOUS DRAINAGE
OF BREAST
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.
Individual variation may occur, and
the axillary vein may be bifid.
A. Medial drainage through internal
thoracic vein to the right heart.
B. Posterior drainage to vertebral
veins.
C. Lateral drainage to intercostal,
superior epigastric veins, and
liver.
D. Lateral superior drainage through
axillary vein to the right heart.

19. NERVE SUPPLY OF BREAST
•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 rather than by efferent motor
fibres.

20. LYMPHATIC DRAINAGE OF BREAST
This is of considerable importance in the spread of breast
tumours.
The lymph drainage of the breast, as with any other organ,
follows the pathway of its blood supply and therefore
travels:
–along tributaries of the axillary vessels to axillary
lymph nodes;
–along the tributaries of the internal thoracic vessels
to the internal mammary chain
– Along the intercostal vessels to the posterior
intercostal lymph nodes.

21. THE AXILLARY
LYMPH NODES
The axillary lymph nodes are 20–30 in
number. They drain
Breast
Pectoral region
Upper abdominal wall
Upper limb
They are arranged in five groups :
Anterior :lying deep to pectoralis major
along the lower border of pectoralis
minor;
Posterior-along the subscapular vessels;
Lateral—along the axillary vein;
Central—in the axillary fat;
Apical (through which all the other
axillary nodes drain) at the apex of the
axilla above pectoralis minor and along
the medial side of the axillary vein.

22. Axillary Lymph Nodes
Subgroups:
Anterior
Posterior
Lateral
Central
Apical

23. LYMPHATIC DRAINAGE
OF BREAST
The lymphatic drainage of the
breast can be very variable
A.From the subareolar plexus (of
Sappey) there are efferent
vessels draining to the
following:
-To the contralateral breast
-To the internal mammary
lymph node chain,
and thence via:
1. The mediastinal lymph nodes
to the para-aortic lymph
nodes, bronchomediastinal
trunks, thoracic duct and right
thoracic duct
2.Inferiorly, the superior and
inferior epigastric lymphatic
routes to the groin

24. B. PARANCHYMA (Glandular
Tissue) of breast drain into
1- Anterior axillary (pectoral) nodes
 central axillary nodes apical
nodes  deep cervical nodes 
subclavicular (subclavian) group of
lymph nodes.
2- Medial quadrants drain into
parasternal group of nodes
3- Superficial regions of skin, areola,
nipples: -Form large channels &
drain into pectoral group of nodes.
There is a tendency for the lateral
part of the breast to drain towards
the axilla and the medial part to
the internal mammary group of lymph
nodes.
LYMPHATIC DRAINAGE
OF BREAST

25. LYMPHATIC DRAINAGE OF BREAST

26. Routes of Metastasis
•From medial lymphatics to parasternal nodes
–Then to mediastinal nodes
•Across the sternum in lymphatics to
opposite side via cross-mammary pathways
–Then to contralateral breast
•From subdiaphragmatic lymphatics to nodes in
abdomen
–Then to liver, ovaries, peritoneum

27. 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
 Shortly before birth this site of
invagination everts to form the
nipple, ducts develop and get
canalized.
DEVELOPMENT OF BREAST

28. Stages of development
•From birth until puberty, the breast consists of lactiferous
ducts, with no alveoli.
• At puberty, the ducts start to proliferate, and their
terminations form solid masses of cells—the future breast lobules.
•During pregnancy, secreting alveoli appear. During the early
weeks, ductal sprouting and lobular proliferation occur, with
increased nipple and areolar pigmentation.
The alveoli now display a lumen surrounded by the secretory cells.
•In the last days of pregnancy, the breasts secrete colostrum, a
yellow, sticky, serous fluid, which is then replaced by true secre-
tion of milk. When lactation ceases, the glandular tissue returns
to its resting state.
•After the menopause, the glandular tissue of the breast atrophies,
the connective tissue becomes less cellular, and the amount of
collagen decreases. In some women, marked fatty infiltration of
the breast occurs at this stage; in others, the breasts shrink
considerably.

29. 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)
or small breast micromastia or large breast macromastia
The nipple may fail to evert. It may be congenital or due to
cancer.There may be nipple development but no breast tissue
(amazia). Also there may be ectopic nipple: (additional nipples
along milk line
 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'.
Gynecomastia
a. breast development of male in areolar region
b. noted in males who smoke marijuana at puberty
DEVELOPMENT ANOMALIES OF BREAST

30. Mammogram