contents BREAST/MAMMARY GLAND: A BRIEF

INTRODUCTION FEATURES

EXTENT

LYMPHATICS

LYMPH NODES AXILLARY LYMPH NODES

LYMPHATIC DRAINAGE

SOME SPECIAL POINTS

SENTINEL LYMPH NODES

APPLIED

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

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 edgeofthe pectoralis major towards the axillaryfossa(armpit)forming axillary tail of spence.

EXTENT

Verticallyfrom 2nd to 6th rib

HorizontallyFrom lateral border of

sternum to mid

axillary line

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.

LYMPH NODES/GLANDS Present along the length of

lymphatics.

Have several lymphaticsleading 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.

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 pectoralisminor;

posterior—along the subscapularvessels;

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.

ARRANGEMENT OF PRINCIPAL AXILLARY

LYMPH NODES

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

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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

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

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

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.

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.

Peau d’orangeInterference 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.

Nipple retractionRetraction of nipples: Infilteration of Lactiferous Ducts

and their consequent fibrosis results in nipple retraction or

subareolar breast cancer result in nipple retraction.

SKIN TETHERING

Larger Dimples Result from cancerous

invasion of the glandular tissue and

fibrosiswhich causes shortening or place

traction of the suspensory ligaments .

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.

MAMMOGRAPHY AND

MAMMOGRAM

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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