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AP Dr G M Kibria
UPNM2
22.4.13
Learning objectives
At the end of this session you will be able to
1. describe the gross structure of female breast
i. location & extension
ii. areola & nipple
iii. lobes & ducts
iv. connective tissue stroma
v. blood supply
2. explain the lymphatic drainage breast
3. explain the change in the overlying skin in breast
cancer
Breasts
• A distinguishing feature of mammals
• Modified tubuloalveolar apocrine sweat glands
• Consist of secretory glands, connective tissue
(superficial fascia), overlying skin with nipple &
areola
• A structurally dynamic organ
– In child & man, breast is rudimentary
– In female, after puberty it enlarges to assume
hemispherical shape
– In middle-age multiparous women, the breast may be
large & pendulous
– In old-aged (postmenopausal) women the breast is
smaller, overlying skin wrinkles
Location & Extension
• Located on the anterior
chest wall (pectoral
region) within the
superficial fascia (external
to deep fascia)
• Superficial to the
pectoralis major, external
oblique and serratus
anterior muscles.
• Extends between the
second rib & the sixth rib,
from the sternum to the
mid-axillary line
• Retromammary Retromammary space
space is a layer of Deep fascia
loose CT that
separates the breast Pectoralis
major
from the deep fascia
(pectoral fascia) &
provides some
degree of Retro-
mammary
movement of the space
breast over the
underlying
structures
• In adult women the nipple
projects from lower half of Nipple & Areola
breast, its position varies
greatly & depends on
development of the gland
• In males & immature females,
the nipples are small & usually
lies over 4th IC space, 10 cm
from midline, just medial to Nipple
mid-clavicular line
• Areola is the circular
pigmented skin (1.5 to 2.5cm) Areola
surrounding the base of nipple
• Montgomery’s follicles are hypertrophied sebaceous
glands in areola
Nipple: structure
• Nipple contains
– 15-20 openings from
lactiferous ducts
– modified smooth muscle
cells – nipples erect in
response to tactile,
thermal and sexual
stimulation
• Nipples are covered by
wrinkled skin
Smooth muscle &
connective tissue
Breast consists of
Parenchyma:
• 15 to 20 lobes & their lactiferous
ducts (15-20), radiating from the
nipple
• The lactiferous duct from each
lobe opens separately at the
summit of the nipple
• Before termination the duct possesses a dilated ampulla,
the lactiferous sinus, & lies deep to the areola
• Each lobe contains 20-30 lobules
• In the lobule there is cluster of 10-100 secretory alveoli,
& are drained by intralobular ductlactiferous duct
Connective tissue (CT) stroma:
Connective tissue stroma:
• Well-developed CT
stroma surrounds the
ducts, lobule & lobes
• Variable amount of
adipose tissue are
present with this fibrous
stroma
• Intralobular CT are In certain regions, this stroma are
hormonally sensitive- condensed to form well-defined
loose CT that surrounds ligaments, the suspensory or Cooper’s
the alveoli & terminal ligaments, which are fixed to the dermis
ductules of skin & support the breasts (carcinoma
• The intralobular CT of breast creates tension on these
contains less adipose ligaments causing pitting of the skin,
cells Peau d'orange)
Glandular part vs. adipose cells
• Terminal ductules are present in the inactive gland.
These are the successive branching of lactiferous duct
• During pregnancy, epithelium of terminal ductule
differentiates into fully functionally secretory alveolar
cells producing milk
• In lactating women, the glandular (secretory) tissue is
more abundant
• In non-lactating women, the predominant
component is fat & glandular tissue is less.
• After menopause, most of the glandular alveoli
disappear, leaving behind the ducts. Adipose tissue
may decrease or increase (snell-9:336)
Breast: a dynamic organ
Axillary tail: Important point to be noted
during evaluation of breast pathology
• Upper & lateral edge of the
breast extends around the
lower border of pectoralis
major & enters the axilla,
where it comes close
relationship with axillary
vessels
• Axillary tail may perforate Axillary
tail
deep fascia & extent as far
as apex of the axilla
Lymphatic drainage of
Subclavian trunk
breast Apical nodes
Central nodes
Pectoral nodes
Lymphatic drainage of breast (Gray’s ant St)
Importance: Cancer cell often disseminate along the
lymph vessels to the lymph nodes.
• Axillary lymph nodes drain about 75% of lymph from
the breast. Axillary nodes drain into subclavian
lymphatic trunks
• Other lymph nodes are
I. Parasternal (internal thoracic) nodes -->
bronchomediastinal trunks
II. Intercostal nodes (along with head & neck of
ribs -->thoracic duct or bronchomediastinal
trunks
Some lymph vessels communicate with that of
opposite breast & abdominal wall nodes
• Laterally, vessels from the Blood supply of breast
axillary artery; Lateral Thoracoacromial art. Internal thoracic art.
thoracic, superior thoracic
and thoraco-acromial
arteries
• Medially by the perforating
branches from internal
thoracic artery
• Perforating branches from
2nd to 4th intercostal arteries
Veins of the corresponding
arteries drain into axillary,
internal thoracic & intercostal
veins
Innervation of breast
• Derived from the anterior and lateral
cutaneous branches of the 2th to 6th
intercostal nerves
• The nipple is innervated by 4th intercostal
nerve
Breast cancer
• The most common malignancy in women
• Constant hormonal exposure & genetic
predisposition are the major risk factors
• Hormonal exposure increases with
– Age
– Early menarche & late menopause
– First full-term pregnancy with older age
• Mutation in autosomal dominant breast cancer
genes contribute about 5% of all breast cancer
Changes of the skin in breast cancer