BREAST (MAMMARY GLAND) DR E.

T GODAM

ANA 211
DEPARTMENT OF HUMAN ANATOMY
RIVERS STATE UNIVERSITY
 THE BREAST
The mammary gland is a modified sweat gland present in the superficial fascia of
the pectoral region. The mammary gland is found in both sexes. However, it remains
rudimentary in male but becomes well-developed in female at puberty. On rare
occasions the breasts of male become enlarged, this condition is called
gynecomastia.
In female, it forms an accessory sex organ of female reproductive system and milk
to the newborn baby. The anatomy of breast is of great surgical importance, and
therefore, needs to be studied in detail.
LOCATION
The breast is located in the superficial fascia of the pectoral region. A small
extension from its superolateral part (axillary tail of Spence) however pierces the
deep fascia and extends into the axilla.
The aperture in the deep fascia through which axillary tail passes into the axilla is
called foramen of Langer.
The axillary tail is the site of high percentage of breast tumor.
SHAPE AND EXTENT
Shape
Hemispherical bulge.
Extent
1. Vertically, it extends from 2nd rib to 6th rib.
2. Horizontally, it extends from lateral border of the sternum to the midaxillary line.
Axillary tail of the breast (of Spence)
passing through the foramen of
Langer
 RELATIONS
The deep aspect of the breast is related to the
following structures from superficial to deep:
The pectoral fascia. Is the deep fascia covering the
anterior aspect of the pectoralis major muscles.
The three muscles. The pectoralis major, Serratus
anterior and external oblique.
The breast is separated from the pectoral fascia by
a space called retro-mammary space which is filled
with loose areolar tissue.
Structure. The breast consist of three structures.
1. Skin
2. Stroma
3. parenchyma/glandular tissue/mammary tissue
proper
Muscles lying deep to the
breast
Structure of the breast: A, parenchyma (lobes of the breast); B, stroma of the breast (suspensory ligaments of
Cooper and fat)
 SKIN
Skin: It is the covering for the breast and presents N/B The sebaceous glands in the areola are enlarged
the following features: during pregnancy and appear as small nodular elevations
called Montgomery’s tubercles.
1. Nipple: It is a conical projection below the center
Stroma: The stroma of breast consists of connective
of the breast, usually at the level of the 4th tissue and fat. It forms the supporting framework of the
intercostal space. It contains smooth muscle fibres, breast.
which can make the nipple stiff and erect or flatten it.
Being richly innervated by sensory nerve endings, The connective tissue condenses to form fibrous strands/
the nipple is the most sensitive part of the breast to septa, called suspensory ligaments of Cooper.
tactile stimulation and become erect during sexual The suspensory ligaments of Cooper are arranged in a
arousal. radial fashion. They connect the dermis of the overlying
skin of the ducts of the breast and pectoral fascia.
2. Areola: It is the circular area of pigmented skin
surrounding the base of the nipple. It contains large The ligaments of the Cooper maintain the protuberance of
the breast. Their atrophy due to ageing makes the breast
number of modified sebaceous glands, particularly pendulous in old age.
at its outer margin. They produce oily secretion,
which lubricates the nipple and areola, and thus The fat forms the most of the bulk of the breast. It is
prevents them from drying and cracking. The color distributed all over the breast except beneath the areola
of the areola and nipple varies with the complexion and the nipple.
of the woman. During pregnancy the areola
becomes darker and enlarged.
 Blood supply:
Parenchyma:
The breast is highly vascular and is supplied by
The parenchyma/glandular tissue of the three arteries.
breast secrete milk to feed the newborn baby.
It consists of about 15–20 lobes arranged in 1. internal thoracic artery: through its
a radial fashion like the spokes of a wheel perforating branches which pierce the 2nd , 3rd
and converge towards the nipple. Each lobe and 4th intercostal spaces.
is divided lobules, which consist of a cluster
of acini. Each lobe is drained by a lactiferous 2. axillary artery: through its lateral thoracic,
duct. superior thoracic, and acromiothoracic
branches
The duct from different lobes converge
towards the nipple and opens at its submit. 3. posterior intercostal artery through their
lateral branches.
Near its termination each duct expands into a
lactiferous sinus which serves as a reservoir VENOUS DRAINAGE
of milk during lactation. 1. axillary vein
2. internal thoracic vein
3. posterior intercostal vein
The veins follows the arteries.
Structure of the lobes of the mammary gland
ARTERIAL AND LYMPH NODE
DRAINAGE OF THE BREAST
Mode of lymphatic drainage of the breast (UL = upper lateral quadrant, LL = lower lateral quadrant, UM =
upper
medial quadrant, LM = lower medial quadrant).
 NERVE SUPPLY AND LYMPHATIC
DRAINAGE OF THE BREAST
Nerve supply: primary nerve supply is somatosensory. It
LYPHAYTICS DRAINING THE BREAST.
is derived from 2 to 6 intercostal nerve through their
nd th

anterior and lateral cutaneous branches.

They are divided into 2 groups.
Lymphatic drainage:
SUPERFICIAL AND DEEP.
Lymph node draining the breast.
1. Superficial lymphatics drain the skin of the breast
The lymph from the breast is drained into the following
lymph node: except that of nipple and areola.
1. Axillary lymph nodes. They are divided into four 2. Deep lymphatics drain the parenchyma of the
groups. a. anterior/ pectoral b. posterior c. central and breast, and skin of the nipple and areola. A plexus of
lateral. lymph vessels deep to the areola is called subareolar
2. internal mammary nodes lying along the internal plexus of Sappey .
thoracic vessels
The subareolar plexus and most of the lymph from
3. supraclavicular node lying above the clavicle the breast drain into the anterior group of axillary
4. posterior intercostal node: lying in the posterior part lymph nodes.
of the intercostal spaces in front of the head of the ribs.
The superficial lymphatics of the breast of one side
5. Cephalic (deltopectoral) node lying in the communicate with those of the opposite side.
deltopectoral groove. Consequently the unilateral malignancy may
N/B. The lymph from breast also drained into become bilateral.
subdiaphragmatic and subperitoneal lymph plexuses
 LYMPHATICS DRAINAGE FROM THE
BREAST
They occur as follows communicate with subdiaphragmatic and subperitoneal lymph
plexuses.
1. The lymph from lateral quadrants of the breast is
5. The lymph vessels from the deep surface of the breast pierce
drained into anterior axillary or pectoral group of lymph pectoralis major and clavipectoral fascia to drain into the apical
nodes. These lymph nodes are situated deep to the group of axillary lymph nodes.
lower N.B. About 75% of the lymph from the breast is drained into axillary
border of pectoralis minor. nodes, 20% into internal mammary lymph nodes, and 5% into the
posterior intercostal lymph nodes.
2. The lymph from medial quadrants is drained into
internal mammary lymph nodes situated along the
internal mammary artery. Some lymphatics may go to
the internal mammary lymph nodes of the opposite side.
3. A few lymph vessels from the lower lateral quadrant of
the breast follow the posterior intercostal arteries and
drain into posterior intercostal nodes located along the
course of these arteries.
4. The few lymph vessels from the lower medial
quadrant
of the breast pierce the anterior abdominal wall and
CLINICAL The knowledge of lymphatic drainage of the breast is of

CORRELATION
METASTASIS OF CANCER TO THE BRAIN occurs
great clinical importance due to high percentage of
occurrence of cancer in the breast and its subsequent
dissemination of cancer cells (metastasis) along the lymph
through the various venous routes.
Cancer cells from the breast – posterior intercostal vein vessels to the regional lymph nodes.
– vertebral venous plexus – intracranial Dural venous In classical operation of radical mastectomy, whole of
sinuses – Brain.
Breast cancer (carcinoma of the breast): It is one of the breast is removed along with axillary lymph nodes, and
most common cancers in the females. It arises from the
epithelial cells of the lactiferous ducts. In about 60% pectoralis major and minor muscles.
cases, it occurs in the upper lateral quadrant and • Some lymph vessels from the inferomedial quadrant of
commonly affects females between 40–60 years of age.
Clinically it presents as: the breast communicate with the subperitoneal lymph
(a) Presence of a painless hard lump.
plexus and carry cancer cells to it. From here cancer
(b) Breast becomes fixed and immobile, due to
infiltration cells migrate transcoelomically and deposit on the ovary
of suspensory ligaments.
producing a secondary tumor in ovary called Krukenberg’s
(c) Retraction of skin, due to infiltration of suspensory
tumor.
ligaments.
(d) Retraction of nipple due to infiltration and fibrosis of
lactiferous ducts.
(e) peau d’orange’ appearance of the skin (i.e., skin
giving
rise to appearance like that of the skin of the orange)
due to obstruction of superficial lymphatics.
 CLINICAL CORRELATION
Developmental anomalies of the breast: The following
developmental anomalies of the breasts are
encountered
during clinical practice:
• Polythelia/supernumerary nipples, which appear
along
the milk ridge and is often mistaken for moles.
• Retracted nipple/inserted nipple, which occurs if
nipple
fails to develop from ectodermal pit. In this condition
suckling of infant cannot take place and nipple is
prone to
infection.
• Polymastia, the development more than one breast
along
Mammogram Depicting Carcinoma
the milk line.