Surgical Anatomy of the Breast

Dr Adeoso A A Dept. Of Histopathology Uduth

SYNOPSIS
INTRODUCTION EMBRYOLOGY ANATOMY ARTERIAL SUPPLY VENOUS SUPPLY LYMPHATIC SUPPLY

Introduction
The breast is said to be a modified sweat gland and present in all mammals Develops as early as the fouth week usually protuberant in females as a hallmark of pubertal development Provides nutrition to the infant via lactation Consist of a glandular epithelial part and lactiferous duct. After menopause there is progressive atrophy of the ducts and lobes. It is a rudimentary gland in males

Embryology
Starts as a thickening in the epidermis in a bandlike manner forming a mammary line or ridge

Majority of the line do disappear,that of the thoracic region persist and penetrate the underlying mesenchyme
Forms 15-24 sprouts,small buds these canalise to form lactiferous ducts. The lactiferous ducts open into epithelial pit,shortly after birth the epithelial pit transforms into the nipple

ANATOMY
Located in the superficial facia of the anterior thoracic wall. The base is between the 2nd rib and 6th rib and the sternal edge to the mid axillary line,overlies the pectoralis major overlapping into the serrantus ant.rectus sheath and a small part into external oblique muscle. In 95% of women there is an extension towards the axilla,may rarely penetrate the deep facia lie adjacent to lymph nodes

Cont.
Each breast is composed of 15-20 lactiferous ducts,each draining a lobe of the breast . The lobes converge on the tip of the nipple,the projection at the center of the breast Surrounding the nipple is an area of pigmentation called the areola

 SKIN-The areola in the female at puberty is pigmented and at each pregnancy there is an increase in melanin deposit. Some large sebaceous glands under the areola may enlarge to form small elevations especially during pregnancy The dermis of the skin merges with the superficial facia which envelopes the parenchyma of the breast . The superficial facia enveloping the breast is continous with the superficial abdominal facia(of Camper)below and the superficial cervical facia above

Cont.
Behind the breast, the upward continuation of the deep facia (Scarpas) is condensed to form a posterior capsule. Strands of fibrous tissue (suspensory ligament of Cooper) connect the dermis of the overlying skin to the ducts of the breast ,this helps to maintain the protuberance of the young breast.

Cont.
The fibrous strands may undergo fibrosis when associated with certain cancers of the breast leading to dimpling of the breast. Between the capsule and the deep facia over the pectoralis major is a space known as the retromammary space which is rich in lymphatics

Lateral thoracic artery, Internal thoracic artery and Intercostal arteries. Internal thoracic arteries and its perforating branches supply a medial part of the breast. Lateral thoracic artery supplies a lateral part of the breast. Most of the lateral part is supplied by intercostal arteries and their branches.

Arterial supply

Venous Drainage
describe an anastomotic circle round the base of the nipple, called Haller circulus venosus. From this, large branches transmit the blood from medial part of the breast into internal thoracic veins and from the lateral part of the breast into lateral thoracic vein and intercostal veins this communicates with the vertebral venous system

Lymphatic drainage
In general the lymphatic drainage follows the blood supply. 75% of the the lymphatic drainage passes to the axillary group of lymph nodes,mainly to the anterior group,posterior group and rest. Much of the medial part of the breast is drained by the parasternal group of lymph nodes. The liver via rectus abdominis mucle Opposite breast and axilla

 Axillary lymph nodes- there are about 30 to 40 of these are supplied by lymph vessels that pass to them. They are divided into few groups: apical lymph nodes, central lymph nodes, lateral lymph nodes, pectoral lymph nodes and subscapular lymph nodes

Innervations
Intercostal nerves innervate the breast. Branches of the supraclavicular nerves also innervate superior part of the breast

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