Lymphatic Drainage Of Breast and Its Applied

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1. contents BREAST/MAMMARY GLAND: A BRIEF INTRODUCTION FEATURES EXTENT LYMPHATICS LYMPH NODES AXILLARY LYMPH NODES LYMPHATIC DRAINAGE SOME SPECIAL POINTS SENTINEL LYMPH NODES APPLIED

2. BREAST/ MAMMARY GLAND Present in the superficial fascia of the pectoral region The breast is found in both sexes,but is rudimentary in the male Modified sweat gland Constitutes an important accessory organ of female reproductive system

3. Features Divided into four quadrants-UL,UM,LL,LM Axillary tail of spence -A small part of the mammary gland may extend along the inferolateral edgeof the pectoralis major towards the axillary fossa (armpit)forming axillary tail of spence .

4. EXTENT Vertically from 2 nd to 6 th rib Horizontally From lateral border of sternum to mid axillary line

5. LYMPHATICS Lymphatics resemble veins in structure. Elastic in nature. Have valves which prevents backflow. Along their length ,lymph nodes are present. In Breast ,two types- 1)Superficial Lymphatics -Drains skin over the Breast except nipple and areola 2)Deep Lymphatics - a) Drains the Parenchyma of Breast . b) Also drains the nipple and areola.

6. LYMPH NODES/GLANDS Present along the length of lymphatics . Have several lymphatics leading towards them(afferent) and one or two leading away(efferent). Lymph From the breast drains into: 1) Axillary Lymph Nodes 2)The internal mammary lymph Nodes 3)some lymph also reaches supraclavicular,cephalic , posterior, intercoastal , subdiaphgrametic and subperitoneal lymph nodes.

7. THE AXILLARY LYMPH NODES The axillary lymph nodes (some 20–30 in number) drain lymphatics of the breast pectoral region Upper abdominal wall upper limb 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.

8. ARRANGEMENT OF PRINCIPAL AXILLARY LYMPH NODES

9. A) Pectoralis Major Muscle. B) Axillary Lymph Nodes (posterior) C) Axillary Lymph Nodes (lateral) D) Axillary Lymph Nodes (central) E) Supraclavicular Lymph Nodes F)Internal Mammary Lymph Nodes P R I C I P A L L Y M P H N O D E S O F B R E A S T

10. Lymphatic drainage Lymphatic spread of a growth of the breast may occur further afield when these normal pathways have become interrupted by malignant deposits, surgery or radiotherapy. Secondaries may then be found in the lymphatics of the opposite breast or in the opposite axillary lymph nodes the groin lymph nodes (via lymph vessels in the trunk wall) the cervical nodes in peritoneal lymphatics spreading there in a retrograde manner from the lower internal mammary nodes

11. SOME SPECIAL POINTS Lymph of the breast drains as: About 75% into axillary nodes(anterior group) 20% ---- internal mammary nodes 5% ---- posterior intercostal nodes Internal mammary nodes drain the lymph not only from the inner half of the breast,but from the outer half as well there is a tendency for the lateral part of the breast to drain towards the axilla and the medial part to the internal mammary chain

12. SOME SPECIAL POINTS CONTD. Subareolar plexus of Sappey – plexus of lymph vessel present deep to the areola Lymphatics from deep surface of the breast pass through the pectoralis major muscle and the clavipectoral fascia to reach the apical node,and also to the internal mammary nodes Lymphatics from lower and inner quadrants of the breast may communicate with the subdiaphragmatic and subperitoneal lymph

13. SENTINEL LYMPH NODES These are the hypothetical First Lymph Nodes draining a cancer. The Concept Of sentinel Lymph Node is important because Of the advent oF the Sentinel Lymoph Node Biopsy technique. This Concept Helps in reducing the removal of non tumourers lymph nodes thus preventing lymphedema .

14. APPLIED Lymph Vessels Of breast comunicates with those of abdomen. Cancer of breast can spread to liver. Cancer cells may drop to pelvis producing secondary cancers there.(KRUKENBERG’S SYNDROME) Upper ,Outer Quadrant contains large number of glandular tissues and is site of 60% of Breast Carcinomas.

15. Peau d’orange Interference with the lymphatic drainageby cancer may cause lymphedema,which in turn may result in deviation of the nipple and a thickened,leather like appearance of the skin.Prominent or ‘puffy’ skin between dimpled pores give it an orange peel like appearance.

16. Nipple retraction Retraction of nipples: Infilteration of Lactiferous Ducts and their consequent fibrosis results in nipple retraction or subareolar breast cancer result in nipple retraction.

17. SKIN TETHERING Larger Dimples Result from cancerous invasion of the glandular tissue and fibrosiswhich causes shortening or place traction of the suspensory ligaments .

18. Mammography Radiographic Examination of the breasts - mammography - is one of the techniques used to detect breast masses. A Carcinoma Appears as a large jugged density in the mammogram. Generally,the skin is thickened over the tumour and the nipple is depressed.

19. MAMMOGRAPHY AND MAMMOGRAM

20. SURGICAL INCISIONS OF BREAST Given in the inferior breast quadrants when possible because of less vascular supply. Incisions That must be made near the areola or on the breast itself are usually directed radially to either side of the nipple(Langer Tension Lines) or circumferentially.

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