Breast Lymphatic Drainage of Upper Limb

Development Structure Lymphatic Drainage Clinical 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 structure Structure of the female breast depends on the

age of the female parity of female stage of pregnancy & lactation Stage of the menstrual cycle
Very few glands & fat No alveoli

Before puberty

Puberty

Increase in size due to the increase in fatty tissue Areola & nipple are formed Breast lobules are formed Fibrous tissue separates breast lobules
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

Pregnancy & lactation

Stages of breast development

During menstrual cycle

Increase in size in mid cycle due to increase in blood flow Involution of glandular tissue replaced by fatty tissue Decrease in size Decrease in elasticity of connective tissue

After menopause

Structure Of The Breast

Structure Of The Breast

Structure Of The Breast

Macroscopic structure of Breast

Size & shape may vary greatly Extent of base of the breast is usually constant Base

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) 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

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 lobes Each lobe is drained by an individual lactiferous duct, arranged in radial direction Ducts drain on to the flat surface of the nipple Lobes 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 Breast

Arterial supply
Make anastomosing network within the breast
1.

Lateral thoracic artery

Main supply of the breast Branch of 2nd part of axillary artery Supply medial part of the breast Branch of a 1st part of subclavian artery Branches of descending thoracic aorta

2.

Internal thoracic artery

3.

Posterior intercostal arteries

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 organs Generally 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 other Lateral part drains to axillary lymph nodes

75 percent of total lymph drainage

Medial part to parasternal lymph nodes Some lymphatic in upper part of breast drain to supraclavicular lymph nodes Few lymphatics run along the intercostal vessels to intercostal lymph nodes

Axillary Lymph Nodes

Arrange in 5 groups

Anterior group
Along lower border of pectoralis major

Posterior group

Along subscapular vessels Along axillary vein

Lateral group

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 Usually drains to thoracic duct

Left side

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 Breast abscess Cellulites of skin

Infection of breast

Tumors

Benign (harmless)
Fibroadenoma
Fibroadenosis

Malignant (cancer)
Treatment for breast cancer
Detection of breast cancer

Mammogram

Mammogram

Mammogram

Summary
Development Structure Lymphatic Drainage Clinical Importance