4 pectoral region
DESCRIPTION
Anatomy of pectoral region designed by me is related all anatomical aspect of Pectoral area in an easy wayTRANSCRIPT
PECTORAL REGION
Farrukh ShahzadBSPT, PPDPT
Isra University, Islamabad Campus
2
The pectoralThe pectoral regionregion
The pectoral regionThe pectoral region
Pectoral regionThe pectoral region consists of structures that connect the upper limb to the anterolateral chest wall. surface land marks.Clavicle The jugular notch ( interclavicular notch or suprasternal notch).The sternal angle or angle of Louis.The epigastric fossa.The midclavicular line The infraclavicular fossa or deltopectoral triangle.The tip of the coracoid processThe acromion.The deltoidThe axilla or arm pitThe midaxillary line.
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Cutaneous nerve supply of the pectoral regionCutaneous nerve supply of the pectoral region
The skin skin of the pectoral regionpectoral region
Is divided into 2 parts bya horizontal line passing through
the sternal angle.the sternal angle.
The area above this line is supplied by
the supraclavicular nervessupraclavicular nerves.
The area below the horizontal lineis divided into 2 parts by the midclavicular line :
1- The area medial to the midclavicular line:
is supplied by the anterior cutaneous branches of
the second to 6th intercostal nerves
Each anterior cutaneous nerveEach anterior cutaneous nerve supply the skinthe skin from the midline to
the midclavicular line.
Cutaneous nerve supplyCutaneous nerve supply - The skin skin of the pectoral regionpectoral region is divided into 2 parts by a horizontal line passing through the sternal angle.the sternal angle. - The areaThe area above above this linethis line is supplied by the supraclavicular nervessupraclavicular nerves. These nerves are branches from the cervical plexus (C (C 3, 43, 4 ventral rami). ventral rami).The areaThe area below below the horizontal line is divided into 2 parts by the midclavicular line :
1- The area1- The area medialmedial to to the the midclavicular linemidclavicular line:: It is supplied by the anterior cutaneous branchesanterior cutaneous branches
of the second to 6of the second to 6thth intercostal nervesintercostal nerves
Each anterior cutaneous nerveEach anterior cutaneous nerve divides into a smaller mediala smaller medial and larger lateral brancheslarger lateral branches to supply the skinthe skin from the midlinethe midline to the midclavicular line.the midclavicular line.
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Cutaneous nerve supply of the pectoral regionCutaneous nerve supply of the pectoral region
2- The area2- The area laterallateral to to the midclavicular line:
is supplied by the lateral cutaneous branchesthe lateral cutaneous branches of of
the the third to 9th intercostal nervesthird to 9th intercostal nerves
divides into 2 branches:A- An anterior branchA- An anterior branch:: suppleis the skinthe skin from
the midclavicular line to the midaxillary line
Each lateral cutaneous nerveEach lateral cutaneous nerve
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B- B- A posterior branchA posterior branch::
suppleissuppleis the skinthe skin fromfrom
the the midaxillary linemidaxillary line toto
the the lateral border oflateral border of
Cutaneous nerve supply of the pectoral regionCutaneous nerve supply of the pectoral region
the the erector spinae muscleerector spinae muscle
Muscles of theMuscles of the pectoral regionpectoral region
Bones of the pectoral regionBones of the pectoral region
ClavicleClavicle
ScapulaScapula
HumerusHumerus
SternumSternum
Upper ribs andUpper ribs and their costal cartilagetheir costal cartilage
Bones of the pectoral regionBones of the pectoral regionCoracoid process of the scapulaCoracoid process of the scapula
TipTip
Medial borderMedial border
Upper surfaceUpper surface
ofof
Bones of the pectoral regionBones of the pectoral regionHumerusHumerus
Intertubercular orIntertubercular orBicipital grooveBicipital groove
Lateral lipLateral lip
Medial lipMedial lip
FloorFloor
It hasIt has
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Pectoralis major (6)Pectoralis major (6)1- Sternocostal head:1- Sternocostal head:
From half of the breadth of theFrom half of the breadth of theanterior surface of anterior surface of the sternumthe sternum
And upperAnd upper 6 6 costal cartilages costal cartilages
2- Clavicular head:2- Clavicular head:From the medial half of the From the medial half of the
anterior aspect of the clavicle.anterior aspect of the clavicle.
Pectoralis minor (3)Pectoralis minor (3)from the from the 3d , 4th and 53d , 4th and 5thth ribs ribs (3)(3)near their near their costochondral junctionscostochondral junctions
OriginOrigin of theof the pectoral musclespectoral muscles
Subclavius (1)Subclavius (1)from the from the firstfirst costochondral junction costochondral junction (1)(1)
(6, 3, 1)(6, 3, 1)
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Pectoralis major (largest)Pectoralis major (largest)
Pectoralis minor (medium)Pectoralis minor (medium)
InsertionInsertion of theof the pectoral musclespectoral muscles
Subclavius (Smallest)Subclavius (Smallest)
into the medial border & upper surface of the coracoid process of the scapula
into the Subclavius groove.on the lower surface of
the intermediate third of the clavicle
According to sizeAccording to size
into the lateral lipof the Bicipital groove of
the humerus
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The nerve supply of the pectoral muscleThe nerve supply of the pectoral muscle
According to theAccording to the name of the musclename of the muscle
Medial and lateralMedial and lateral pectoral nervespectoral nerves
The pectoralis majorThe pectoralis majorAnd minor musclesAnd minor muscles
Subclavius muscleSubclavius muscle
Nerve to subclaviusNerve to subclavius from thefrom the upper trunk upper trunk of theof the brachial plexus brachial plexus
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The pectoralis major musclesThe pectoralis major muscles
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OriginOrigin
Insertion Insertion
The pectoralis major muscleThe pectoralis major muscle
1- Sternocostal head:1- Sternocostal head:From half of the breadth of theFrom half of the breadth of theanterior surface of anterior surface of the sternumthe sternum
And upper 6 costal cartilagesAnd upper 6 costal cartilages
2- Clavicular head:2- Clavicular head:From the medial half of the From the medial half of the
anterior aspect of the clavicle.anterior aspect of the clavicle.
into the lateral lip of the bicipital groove of the humerus
Nerve supply:Nerve supply: Medial and lateral pectoral nervesMedial and lateral pectoral nerves
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The pectoralis major muscleThe pectoralis major muscle
Action:Action:
medial rotation of the arm with latissimus dorsi and teres major muscles.
2- Approximation of the trunk to the abducted arm as in
climbing a tree, swimming and playing gymnastics.
3 -Flexion of the arm
4 -Helps in deep & forced inspiration.
Shoulder jointShoulder joint
1- Adduction and
The pectoralis major muscleThe pectoralis major muscle
I- Pectoralis major muscle I- Pectoralis major muscle Origin:Origin:
1- Sternocostal head:1- Sternocostal head: From half of the breadth of the
anterior surface of the sternum.And upper 6 costal cartilages.2- Clavicular head:2- Clavicular head: From the medial half of the anterior
aspect of the clavicle.Insertion:Insertion: into the lateral lip of the bicipital
groove of the humerus Nerve supply:Nerve supply:
Medial and lateral pectoral nerves.
Action:Action:1- Adduction and medial rotation of the arm (shoulder) with latissimus dorsi and teres major muscles.
2- Approximation of the trunk to the abducted arm as in climbing a tree, swimming and playing gymnastics.
3- Flexion of the arm.
4- Helps in forced inspiration.
The pectoralis minor muscleThe pectoralis minor muscle
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OriginOrigin
Insertion Insertion
The pectoralis minor muscleThe pectoralis minor muscle
Nerve supply:Nerve supply: Medial and lateral pectoral nervesMedial and lateral pectoral nerves
from the from the 3d , 4th and 53d , 4th and 5thth ribsribs
near their near their costochondral junctionscostochondral junctions
into the medial border & upper surface of the coracoid process of the scapula
Action:Action:1-1- Pulls the scapula forwardsPulls the scapula forwards (protraction of the shoulderprotraction of the shoulder) with the Serratus anterior muscle.
2- Pull the scapula downwards2- Pull the scapula downwards (depression of the shoulder)(depression of the shoulder)
with the lower fibers of the trapezius muscle.
3-3- Medial (downward) rotationMedial (downward) rotation of the of the scapula:scapula: with the levator scapulae muscle44 - -Helps in deep & forced inspirationHelps in deep & forced inspiration
scapulascapula
RibsRibs
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The pectoralis minor muscleThe pectoralis minor muscle
II- Pectoralis minor muscle II- Pectoralis minor muscle Origin:Origin:
from the from the 3d, 43d, 4th th and 5and 5thth ribs ribs near their near their costochondral costochondral
junctionsjunctions
Insertion:Insertion:
into the medial border & upper surface of
the coracoid process of the scapula
Nerve supply: Nerve supply: Medial and lateral pectoral Medial and lateral pectoral
nerves.nerves.
Action:Action:1-1- Pulls the scapula forwardsPulls the scapula forwards (protraction of the shoulderprotraction of the shoulder) with the Serratus anterior muscle.2- Pull the scapula downwards2- Pull the scapula downwards
(depression of the shoulder)(depression of the shoulder) with the lower fibers of the trapezius muscle.
3-3- Medial (downward) rotationMedial (downward) rotation of the of the scapula:scapula:
with the levator scapulae muscle.
4- 4- Helps in forced inspirationHelps in forced inspiration. .
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The subclavius muscleThe subclavius muscle
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OriginOrigin
Insertion Insertion
The subclaviusThe subclavius musclemuscle
Nerve supplyNerve supply Nerve to subclavius from theNerve to subclavius from the upper trunk of the brachial plexusupper trunk of the brachial plexus
from the from the firstfirst costochondral junctioncostochondral junction
into the Subclavius groove. on the lower surface of
the intermediate third of the clavicle
Action:Action: 1- Fixation of the clavicle1- Fixation of the clavicle during movements of the shoulder.movements of the shoulder.
2- Helps in inspiration.2- Helps in inspiration.
ClavicleClavicle
RibRib
III- Subclavius muscleIII- Subclavius muscle Origin:Origin:
from the from the firstfirst costochondral junction.costochondral junction.Insertion:Insertion: into the Subclavius groove. on the lower surface of the intermediate third of the clavicle Nerve supply:Nerve supply:
Nerve to subclavius.Nerve to subclavius.
Action:Action: 1- Fixation of the clavicle 1- Fixation of the clavicle during movements of the shoulder.movements of the shoulder. 2- Helps in inspiration. 2- Helps in inspiration.
The The clavipectoral clavipectoral
fasciafascia
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The clavipectoral fasciaThe clavipectoral fascia
It It is a strong sheet of
- ItIt lies between
the subclavius musclethe subclavius muscle and
pectoralis minor muscle pectoralis minor muscle
fibrous tissue.fibrous tissue.
The The clavipectoral fascia clavipectoral fascia (anterior view)(anterior view)
The clavipectoral fasciaThe clavipectoral fascia - It It is a strong sheet of fibrous tissuefibrous tissue deep to the clavicular headclavicular head of the pectoralis major musclepectoralis major muscle. - ItIt lies between the subclaviusthe subclavius and pectoralis minor musclespectoralis minor muscles. - Its Its upper partupper part splits into 2 layers to enclose the subclavius musclethe subclavius muscle and attaches to the margin of the subclavius groovethe subclavius groove.
- Its Its lower partlower part splits to enclose the pectoralis minor musclethe pectoralis minor muscle and then extends from its its lower borderlower border to attach to the axillary fasciathe axillary fascia forming what is called the suspensory ligamentsuspensory ligament of the axillaof the axilla. - Its - Its medial partmedial part is attached to the 1the 1stst and 2 and 2ndnd costal costal
cartilagescartilages and its its lateral partlateral part is attached to the coracoid process.the coracoid process.
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The costocoracoid membraneThe costocoracoid membrane
is pierced by:
1- The cephalic vein.1- The cephalic vein.
2- The lymphatics2- The lymphatics along along the cephalic veinthe cephalic vein,,
3- The thoracoacromial artery.3- The thoracoacromial artery.
4- The lateral pectoral nerve.4- The lateral pectoral nerve.
The clavipectoral fasciaThe clavipectoral fascia. - The clavipectoral fascia - The clavipectoral fascia is pierced by: 1- The cephalic vein.1- The cephalic vein. 2- The lymphatics2- The lymphatics along along the cephalic veinthe cephalic vein,, 3- The thoracoacromial artery.3- The thoracoacromial artery. 4- The lateral pectoral nerve.4- The lateral pectoral nerve.
The female breastThe female breast
The female breastThe female breastThe basic anatomybasic anatomy of the breastthe breast is of considerable clinical importanceconsiderable clinical importance
because of the frequent developmentfrequent development of cancer cancer in the glands glands and the subsequent migration of the malignant cellsmigration of the malignant cells along the lymph vesselsthe lymph vessels to
the lymph nodeslymph nodes in the armpitthe armpit.
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The female breastThe female breastconsists of :
1- The mammary gland.1- The mammary gland.
2- The superficial fascia2- The superficial fascia )the stromathe stroma of the glandthe gland
3- The overlying skin.3- The overlying skin.and the surrounding fatthe surrounding fat.(
The female breastThe female breast
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* Shape and position:* Shape and position:- The breastThe breast is
conical in shape.
Its baseIts base is circular and has
a constant positiona constant position.
ItIt extends from the sternumthe sternum
to the midaxillary linethe midaxillary line at the level of the 4th ribthe 4th rib.
Vertically, it it extends from the 2nd ribthe 2nd rib to the 6th ribthe 6th rib
the midclavicular linethe midclavicular lineat the level of The female breastThe female breast
Structure of the breastStructure of the breast ** The female breast The female breast consists of :1- The mammary gland.1- The mammary gland.2- The superficial fascia2- The superficial fascia (the stromathe stroma of the glandthe gland and the surrounding fatthe surrounding fat).3- The overlying skin.3- The overlying skin.
* Shape and position:* Shape and position:- The breastThe breast is conical in shape.- Its baseIts base is circular and has a constant positiona constant position.- ItIt extends from the sternumthe sternum to the midaxillary linethe midaxillary line at the level of the 4the 4thth rib rib.- Vertically, it it extends from the 2the 2ndnd rib rib to the 6the 6thth rib rib at the midclavicular linethe midclavicular line.
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The nippleThe nipple of the breastthe breast
is a conical or cylindrical prominence prominence.
ItIt lies belowthe center of the breastcenter of the breast
opposite the
4th intercostal space4th intercostal space
1010 CmCm from
the midlinethe midline
The female breastThe female breast
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Structure of the breastStructure of the breast- A processA process of the glandthe gland extends from the upper lateral partupper lateral part along the lower border of the pectoralis major musclethe pectoralis major muscle. This processThis process is called the axillary tailthe axillary tail of the breastthe breast. The axillary tailThe axillary tail may pierce the axillary fasciathe axillary fascia and enter the axillathe axilla and becomes in close relation to the axillary vesselsthe axillary vessels.
The nippleThe nipple of the breastthe breast - It It is a conical or cylindrical prominence prominence. - ItIt lies below the center of the breastcenter of the breast opposite the 44thth intercostal space intercostal space 10 Cm10 Cm from the midlinethe midline. Its summitIts summit carries the openings openings of the lactiferous ductslactiferous ducts of the mammary glandmammary gland.
Structure of the breastStructure of the breast - The nippleThe nipple contains many smooth myocytessmooth myocytes, whichwhich are arranged in 2 directions. Most myocytesMost myocytes are circularly arranged and their stimulationtheir stimulation (e.g. by suckling suckling) leads to erection of the nipplethe nipple. Other myocytesOther myocytes are longitudinally arranged and retract the nipplethe nipple.
The areolaThe areola: - The nippleThe nipple is surrounded by a circular patcha circular patch of pigmented skin
called the areolathe areola. The areolaThe areola contains many sebaceous glandssebaceous glands.
- The areolaThe areola undergoes the following changesfollowing changes with pregnancypregnancy:1- Its colorIts color becomes darkerdarker: This changeThis change is permanentpermanent and can be used as a diagnostic signa diagnostic sign of the first pregnancythe first pregnancy. After labourAfter labour, the colorthe color lightens but never returns to its original stateits original state. 2- The sebaceous glandsThe sebaceous glands enlarge and their secretionstheir secretions are useful for lubrication of the nipplethe nipple during lactationduring lactation. 3- Some small mammary glandsSome small mammary glands within the areolathe areola increase in size and appear as tuberclestubercles known as Montgomery’s tuberclesMontgomery’s tubercles. These tuberclesThese tubercles are considered as a sign ofa sign of pregnancy pregnancy.
- The nippleThe nipple and areola areola are devoid of fat.fat.
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Relations of the base of the breastRelations of the base of the breast
The upper medial 2/3 The upper medial 2/3 Of the base of the breastthe breast
lie on
the pectoralis major musclethe pectoralis major muscle
ItsIts lower lateral 1/3lower lateral 1/3
lies on the serratus anterior musclethe serratus anterior muscle
and external oblique muscleexternal oblique muscle.
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ClavicleClavicle
Upper 7 ribsUpper 7 ribsIntercostal musclesIntercostal muscles
Pectoralis majorPectoralis major
Pectoralis minor Pectoralis minor
Subclavius Subclavius
deep fasciadeep fascia of the pectoral regionthe pectoral region
breastbreastSkin of the breastSkin of the breastNipple and areolaNipple and areola
deep membranous layerdeep membranous layer of superficial fasciasuperficial fascia
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is separated from
The pectoral muscles byThe pectoral muscles by
by a layer ofa layer of loose connective tissueloose connective tissue
called
the submammarythe submammary or
retromammary spaceretromammary space
This spaceThis space lies between
deep membranous layerdeep membranous layer of superficial fasciasuperficial fascia
and
deep fasciadeep fascia of the pectoral regionthe pectoral region
The breastThe breast
Relations of the breastRelations of the breastRelations:Relations: - The upper medial 2/3 The upper medial 2/3 of the breastthe breast lie on the pectoralis major musclethe pectoralis major muscle. ItsIts lower lateral 1/3 lower lateral 1/3 lies on the serratus anterior musclethe serratus anterior muscle and external oblique muscleexternal oblique muscle.
The breastThe breast is separated from these musclesthese muscles by a layer of a layer of loose connective tissueloose connective tissue called the submammarythe submammary or retromammary space. retromammary space. This spaceThis space lies between the deep membranous layerdeep membranous layer of superficial fasciasuperficial fascia and deep fasciadeep fascia of the pectoral regionthe pectoral region. The retromammary spaceThe retromammary space is relatively avascular but traversed by lymph vesselslymph vessels and some blood vesselssome blood vessels.
Relations of the breastRelations of the breastThe retromammary space The retromammary space is important important because: 1- ItIt may be the site of an abscessan abscess. 2- The breast prosthesesThe breast prostheses are usually inserted into this spacethis space. 3- ItIt permits free movements of the breastthe breast over the musclesthe muscles.
4- ItIt is the spacethe space (line of cleavageline of cleavage) where the breastthe breast is separated from the underlying musclesthe underlying muscles during simple mastectomysimple mastectomy. 5- ItIt is the site of the deep lymphatic plexus deep lymphatic plexus of the breastthe breast.
Structure of the mammary glandStructure of the mammary gland- The glandThe gland is a modified sweat glanda modified sweat gland. - It It consists of parenchymaparenchyma and stromastroma.- The parenchymaThe parenchyma consists of 15 – 20 lobes. 15 – 20 lobes. Each lobeEach lobe consists of several lobulesseveral lobules.
- Each lobuleEach lobule has a ductulea ductule. The ductulesThe ductules within each lobeeach lobe
unite with each othereach other to form a single duct a single duct for the lobethe lobe. This ductThis duct is called the lactiferous ductthe lactiferous duct. - The lactiferous ducts The lactiferous ducts (15 - 20)(15 - 20) converge towards the nipplethe nipple. Each ductEach duct dilates under the areolathe areola to form lactiferous sinuslactiferous sinus which narrows again and open separately on the summit of the nipplesummit of the nipple.
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Arterial supply of the breastArterial supply of the breast
The breastThe breast is supplied by1- Perforating branches1- Perforating branches of
the internal mammary arterythe internal mammary artery
in the 2nd, 3d and 4th intercostal spacesthe 2nd, 3d and 4th intercostal spaces
)main arterial supplymain arterial supply.(
22 - -Mammary branchesMammary branches of
the lateral thoracic arterythe lateral thoracic artery
and pectoral branchpectoral branch of
the thoraco-acromial arterythe thoraco-acromial artery
3- Perforating branches3- Perforating branches from
the 2nd, 3d and 4th posterior intercostal arteriesthe 2nd, 3d and 4th posterior intercostal arteries..
Blood supply of the breastBlood supply of the breast I- Arterial supply of the breast :I- Arterial supply of the breast :The breastThe breast is supplied by the following arteriesthe following arteries: 1- Perforating branches1- Perforating branches of the internal mammary artery the internal mammary artery in the 2the 2ndnd, 3d and 4, 3d and 4thth intercostal spaces intercostal spaces (main arterial supplymain arterial supply). 2- Mammary branches2- Mammary branches of the lateral thoracic arterythe lateral thoracic artery and pectoral branchpectoral branch of the thoraco-acromial arterythe thoraco-acromial artery (branchbranch from the 2the 2ndnd part part of the axillary arterythe axillary artery). 3- Perforating branches3- Perforating branches from the 2the 2ndnd, 3d and 4, 3d and 4thth posterior intercostal arteries. posterior intercostal arteries.
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The breastThe breast
adjacent veinsadjacent veins
1- The internal mammary vein1- The internal mammary vein
22 - -Axillary veinAxillary veinthroughthrough
the lateral thoracic veinthe lateral thoracic vein
33 - -The posterior intercostal veinsThe posterior intercostal veins
The venous blood of the
Venous drainage of the breastVenous drainage of the breast
Is drained into
This is the mainmain venous drainagevenous drainage
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the intercostal nervesintercostal nerves
Nerve supply of the breastNerve supply of the breast
The breastThe breastis supplied by
the anterior cutaneous branchesanterior cutaneous branches and
the laterallateral cutaneous branchescutaneous branches ofthe 4th, 5th and 6th 4th, 5th and 6th intercostal nervesintercostal nerves
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Nerve supply of the breastNerve supply of the breastThe breastThe breast is supplied by the anterior and lateralanterior and lateral cutaneous branchescutaneous branches of the 44thth, 5, 5thth and 6 and 6thth intercostal nervesintercostal nerves.
Lymphatic drainage of breast
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TheThe lymphaticslymphatics from the breastthe breast
radiate into many directions
1 -The central and lateralThe central and lateral partsparts of the glandthe gland
drain intothe anterior (pectoral) groupthe anterior (pectoral) group
of axillary lymph nodesof axillary lymph nodes..
2 -The tail of the breastThe tail of the breast
the subscapular groupthe subscapular group
3 -The upper partThe upper part of the glandthe gland
drains into
the apical group of axillary lymph nodesthe apical group of axillary lymph nodes and lower deep cervical lymph nodeslower deep cervical lymph nodes
drain into
4 -The medial partThe medial part of the glandthe gland the parasternal lymph nodesthe parasternal lymph nodesdrains into
Lymphatic drainage of the breastLymphatic drainage of the breast
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5 -The lymphaticslymphatics from the skinthe skin of
the medial partthe medial part of the breastthe breast
cross the midline and
anastomose with
the lymphaticsthe lymphatics of
the other breastthe other breast
Lymphatic drainage of the breastLymphatic drainage of the breast
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6- The lymphaticslymphatics from the skinthe skin of
the infero-medial partthe infero-medial part of the breastthe breast
anastomose with the lymphaticsthe lymphatics of
the anterior wall of the rectus sheaththe anterior wall of the rectus sheath
Lymphatic drainage of the breastLymphatic drainage of the breast
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Lymphatic drainage of the breastLymphatic drainage of the breast
7- The lymphaticslymphatics from
anastomose with
the subdiaphragmatic plexussubdiaphragmatic plexus
the inferomedial partthe inferomedial part of the glandthe gland
and then through the diaphragmthe diaphragm
to the medistinal lymph nodesthe medistinal lymph nodes
Lymphatic drainage of the breastLymphatic drainage of the breast - Through the lymphaticsthe lymphatics, cancer breastcancer breast may spread to: 1- The axillary lymph nodesThe axillary lymph nodes. 2- The other breastThe other breast and parasternal lymph nodesparasternal lymph nodes. 3- TheThe lower deep cervical lymph nodeslower deep cervical lymph nodes. 4- The rectus sheathThe rectus sheath and then to the liverthe liver through the the
falciform ligamentfalciform ligament. 5- The subdiaphragmatic plexusThe subdiaphragmatic plexus and then through the the
diaphragmdiaphragm to the mediastinal lymph nodesthe mediastinal lymph nodes.
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