Uncle Snell’s Notes in Gross Anatomy
The Breasts
− Not anatomically part of the upper limb
− Situated in the pectoral region and their blood
supply and lymphatic drainage is largely into the
armpit
Location and Description
− Specialized accessory glands of the skin that
secrete milk
− They are present in both sexes
− In males and immature females, they are similar in
structure
− Nipples
o Small and surrounded by a colored area of
the skin called the areola
− The breast tissue consists of a system of ducts
embedded in connective tissue that does not
extend beyond the margin of the areola
Puberty
− The breasts gradually enlarge and assume their
hemispherical shape under the influence of ovarian
hormones
− The ducts elongate, but the increased size of the
glands is mainly from the deposition of fats
− The base of the breast extends from the 2nd to 6th
rib and from the lateral margin of the sternum to
midaxillary line
− The greater part of the gland lies in the superficial
fascia
− Axillary tail
o A small part that extends upward and
laterally, pierces the deep fascia at the
lower border of the pectoralis major
muscle, and enters the axilla
− Each breast consists of 15-20 lobes, which radiate
out from the nipple
− The main duct from each nipple and possesses a
dilated ampulla just before its termination
− The base of the nipple is surrounded by the areola
− Tiny tubercles on the areola are produced by the
underlying areolar glands
− The lobes of the glands are separated by fibrous
septa that serves as suspensory ligaments
− Behind the breast is a space filled by loose
connective tissue called the retromammary space
Young Women
− The breasts tend to protrude forward from a circular
base
Early Pregnancy
− There is a rapid increase in length and branching in
the duct system
− The secretory alveoli develop at the ends of the
smaller ducts, and the connective tissue becomes
filled with expanding and budding secretory alveoli
− The vascularity of the connective tissue also
increases to provide adequate nourishment for the
developing gland
− The nipples enlarge, and the areola becomes
darker and more extensive as a result of increased
deposits of melanin pigment in the epidermis
− The areolar glands enlarge and become more
active
Late Pregnancy
− During the second half of pregnancy, the growth
process slows
− The breasts continue to enlarge mostly because of
the distention of secretory alveoli with the fluid
secretion called colostrum
Postweaning
− Once the baby has been weaned, the breast return
to their inactive state
− The remaining milk is absorbed, the secretory
alveoli shrink, and most of them disappear
− The interlobular connective tissue thickens
− The breast and the nipples shrink and return to their
original size
− The pigmentation of the areola fades, but the area
never lightens to its original color
Post menopause
− The breast atrophies
− Most of the secretory alveoli disappear, leaving
behind the ducts
− The amount of adipose tissue may increase or
decrease
− The breasts tend to shrink in size and become
more pendulous
− The atrophy after menopause is caused by the
absence of ovarian estrogen and progesterone
Blood Supply
− Perforating branches of the internal thoracic
artery
− Intercostal arteries
− Axillary artery
o Also supplies the gland via its lateral
thoracic and thoracoacromial branches
Venous Drainage
− Veins correspond to the arteries
Lymph Drainage
− Anterior axillary or pectoral group of nodes
o Lateral quadrants of the breast
o Situated just posterior to the lower border
of the pectoralis major muscle
− Vessels that pierce the intercostal spaces and
enter the internal thoracic group of nodes
o Medial quadrants of the breast
o Situated within the thoracic cavity along the
course of the internal thoracic artery
− A few lymph vessels follow the posterior
intercostal arteries and drain posteriorly into
the posterior intercostal nodes
o Situated along the course of the posterior
intercostal arteries
− Some vessels communicate with the lymph vessels
of the opposite breast and with those of the anterior
abdominal wall
− Lymph drainage of the mammary gland is of great
clinical importance because of the frequent
development of cancer in the gland and the
subsequent dissemination of the malignant cells
along the lymph vessels the lymph nodes