upper limb breast
TRANSCRIPT
BreastLymphatic Drainage of Upper
Limb
DevelopmentStructure
Lymphatic DrainageClinical Importance
Breast
Development of breast
Before birth Develop from a invagination of
ectoderm during 4th week of development along mammary ridge (Milk line)
Milk line runs from axilla to mid inguinal region
Breast is a modified sweat gland
Development of breast
Development of breast
After birth Lobule formation occurs in female
breast after puberty Development of female breast is
divided into five phases
Structure of the Breast
Male breast is a rudimentary structureStructure of the female breast depends on the age of the female parity of female stage of pregnancy & lactation Stage of the menstrual cycle
Before puberty Very few glands & fat No alveoli
Puberty Increase in size due to the increase in
fatty tissue Areola & nipple are formed Breast lobules are formed Fibrous tissue separates breast lobules
Pregnancy & lactation Alveoli bud off from smaller ducts
within a lobule Breast enlarge in size (400g) Secretary fat globules are present
inside alveoli When lactation ceases atrophy of
lobules and glands, replaced with fatty tissue
Stages of breast development
During menstrual cycle Increase in size in mid cycle due to
increase in blood flow
After menopause Involution of glandular tissue replaced
by fatty tissue Decrease in size Decrease in elasticity of connective
tissue
Structure Of The Breast
Structure Of The Breast
Structure Of The Breast
Macroscopic structure of Breast
Size & shape may vary greatlyExtent of base of the breast is usually constantBase Extends from sternal edge to mid
axillary line Extends from 2nd to 6th ribs Over lies pectoralis major, seratus
anterior, rectus sheath & external oblique muscle
Axillary tail Smaller projection of upper outer quadrant
of the breast Usually lies in subcutaneous fat of the axilla Rarely it penetrates the deep fascia of
axillary floor & lie with the axillary lymph nodes (frequently mistaken for axillary lump)
Nipple Pigmented projection of skin 15 – 20 lactiferous ducts drain each lobe of
breast drains to the surface Smooth muscles of the nipple cause
erection to sexual stimuli Terminal part of the lactiferous ducts are
dilated to form sinuses
Nipple
Areola Pigmented skin surrounding the
nipple Large sebaceous glands & areolar
glands form small projection on the skin (Tubercles of Montgomery)
Longitudinal section of breast
Section of breast
Glandular Arrangement Of The Breast
Glands are arranged as 15 – 20 lobesEach lobe is drained by an individual lactiferous duct, arranged in radial directionDucts drain on to the flat surface of the nippleLobes are separated from each other by fibrous bands connecting overlying skin & the capsule of the breast (Suspensory ligament of cooper)
Glands of the Breast
Non Lactating/ Lactating Breast
Non Lactating Breast
Lactating Breast
Capsule of Breast Formed by condensation of superficial
fascia of chest wall, posterior to the breast tissue (Upward continuation of membranous layer of superficial abdominal fascia)
In young females suspensory ligaments help to keep the protuberance of the breast
There is a space between capsule of breast & fascia over the pectoralis major muscle (Retro – mammary space)
Blood Supply of BreastArterial supply
Make anastomosing network within the breast
1. Lateral thoracic artery Main supply of the breast Branch of 2nd part of axillary artery
2. Internal thoracic artery Supply medial part of the breast Branch of a 1st part of subclavian artery
3. Posterior intercostal arteries Branches of descending thoracic aorta
4. Braches of thoracoacromial artery Supply upper part of breast Branch of 2nd part of axillary artery
Venous drainage Circumareolar venous plexus & veins
from glandular tissue draining into the deep veins
Skin & superficial fascia drain to superficial veins
Veins usually run along with arteries Drain to internal thoracic, axillary &
posterior intercostal veins
Lymphatic Drainage Of Upper Limb & Breast
Why we need a lymphatic system?Lymphatic system has lymph vessels & lymph organsGenerally lymphatics run along blood vessels Superficial lymphatic – follow veins Deep lymphatic – follow arteries
They have valves to direct flow towards center
Lymphatic Drainage Of Upper Limb & Breast
Lymphatic Drainage Of Upper Limb & Breast
Lymphatic Drainage of Breast
Lymphatic inside the breast lie between the lobules but communicate with each otherLateral part drains to axillary lymph nodes 75 percent of total lymph drainage
Medial part to parasternal lymph nodesSome lymphatic in upper part of breast drain to supraclavicular lymph nodesFew lymphatics run along the intercostal vessels to intercostal lymph nodes
Axillary Lymph NodesArrange in 5 groups
Anterior group Along lower border of pectoralis major
Posterior group Along subscapular vessels
Lateral group Along axillary vein
Central group Inside the axillary fat
Apical group Posterior to clavicle & along axillary
vein Subclavian lymph trunk begins
Extra axillary lymph nodes Supratrochlear nodes
Proximal to medial epicondyle Infra clavicular lymph nodes
Besides the cephalic vein Usually drains through the clavipectoral
fascia to apical nodes
Right side Drains into subclavian vein or joins
the right jugular trunk
Left side Usually drains to thoracic duct
Nerve supply of breast From 2nd to 6th intercostal nerves
Secretion of milk By milk ejection reflex (read Ganong
18th edition pg 231)
Clinical Importance Of Breast
Developmental abnormalities Supernumery nipples Small or absent breast (Amazia) Retracted nipples
Infection of breast Breast abscess Cellulites of skin
Tumors Benign (harmless)
Fibroadenoma Fibroadenosis
Malignant (cancer) Treatment for breast cancer Detection of breast cancer
Mammogram
Mammogram
Mammogram
Summary
DevelopmentStructureLymphatic DrainageClinical Importance