Upload
nawneet-kumar
View
216
Download
0
Embed Size (px)
Citation preview
7/30/2019 AnatomyThe Breast
1/29
Surgical anatomy of the breast
by
NawneetPG of surgery,
Chalmeda AnandRao Institute ofMedical Sciences, Karimnagar
7/30/2019 AnatomyThe Breast
2/29
Embryologically: belong to integumentFunctionally: part of reproductive
system--- Feeds babies
7/30/2019 AnatomyThe Breast
3/29
C. Modified apocrine sweat glands
- apex of cell becomes part of secretion
and breaks off
D. Present in males and females
7/30/2019 AnatomyThe Breast
4/29
Position and Attachment
1. Lateral aspect of pectoral region
2. Located between 2ed and 6th ribs
3. Extends from lateral border of
sternum to anterior axillary line
4. Surrounded by superficial fascia5. Rests on deep fascia
7/30/2019 AnatomyThe Breast
5/29
Surgical extension
From Midline to edge of latissmus dorsimuscle
Clavicle to 7th or 8th rib
7/30/2019 AnatomyThe Breast
6/29
Breast Anatomy
7/30/2019 AnatomyThe Breast
7/29
7/30/2019 AnatomyThe Breast
8/29
6. Left breast is usually slightly larger
7. Base is circular, either flattened or
concave
8. Separated from pectoralis majormuscle by fascia
7/30/2019 AnatomyThe Breast
9/29
Nipple:
At fourth intercostal space Small conical/cylindrical prominence below
center
Contains smooth muscle fibres arranged
concentrically and longitudinally
Surrounded by thin pigmented skinareola
No hair and sweat glands
7/30/2019 AnatomyThe Breast
10/29
3. Areola: contains dark pigment that
intensifies with pregnancy
a. Circular and radial smooth muscle
fibers
b. Cause nipple erection
c. Contains numerous sweat and sebaceous
glandsenlarge during pregnancyhelps in
lubrication
7/30/2019 AnatomyThe Breast
11/29
4. Each breast consists of 20 lobesof secretory tissue
a. Each lobe has one lactiferous duct
b. Lobes (and ducts) arranged radiallyc. Embedded in connective tissue &
adipose of superficial fascia
d. Lobes composed of lobules
e. Lobules comprise alveoli
7/30/2019 AnatomyThe Breast
12/29
5. lactiferous ducts converge toward
areola and
a. form ampullae--collection siteslactiferous sinuses
b. Ducts become contracted at base ofnipple
7/30/2019 AnatomyThe Breast
13/29
6. Secretory epithelium
a. Changes with hormonal signals
b. Onset of menstruationc. Pregnancy ---glands begin to
enlarge at 2nd month
d. After birth, 1st secretion is
colostrom --contain antibodies
7/30/2019 AnatomyThe Breast
14/29
7. Tail of Spence = axillary tail
a. prolongation of upper, outer
quadrant in axillary direction
b. Passes under axillary fascia
c. May be mistaken for axillary lymph
nodes
7/30/2019 AnatomyThe Breast
15/29
8. Fatty Tissue: surrounds surface, fills
spaces between lobes
a. Determines form & size of breast
b. No fatty deposit under nipple &
areola
7/30/2019 AnatomyThe Breast
16/29
ARTERIAL SUPPLY
ARTERIAL
INTERNAL
MAMMARY
LATERAL BR. OF.INTERCOSTAL
ARTERIES
LATERAL THORACIC
Subclavian a.
External
mammary
(thoracic) a.
.
7/30/2019 AnatomyThe Breast
17/29
2. Veins:a. form a ring around the base of the
nipple --circulus venosusb. Large veins pass from circulus
venosus to circumference of
mammary gland, then to
c. External mammary vto axillary v or
d. Internal mammary vto subclavian v
7/30/2019 AnatomyThe Breast
18/29
3. Innervation: derived from:
a. anterior & lateral cutaneousnerves of thorax
b. spinal segments T3 T6
7/30/2019 AnatomyThe Breast
19/29
LYMPHATIC DRAINAGE
AXILLARY
LATERAL
ANTERIOR
POSTERIOR CENTRAL
INTERPECTORAL
APICAL
INT. MAMMARY
SUPRACLAVICULAR
7/30/2019 AnatomyThe Breast
20/29
7/30/2019 AnatomyThe Breast
21/29
Lymphatic drainage-- clinical
significance
a. Glandular lymphatics drain into
anterior axillary (pectoral) nodescentral axillary nodes apical
nodes
deep cervical nodessubclavicular (subclavian) nodes
7/30/2019 AnatomyThe Breast
22/29
b. Medial quadrants drain into
parasternal nodes
c. Superficial areas , areola and
nipplepectoral nodes
. sentinel lymph node is the first
node draining from tumour bearing
area
7/30/2019 AnatomyThe Breast
23/29
Routes of Metastasis
From medial lymphatics to parasternalnodes--Then to mediastinal nodes
Across the sternum in lymphatics to
opposite side via cross-mammary
pathways--Then to contralateral breast
From subdiaphragmatic lymphatics tonodes in abdomen---Then to liver,
ovaries, peritoneum
7/30/2019 AnatomyThe Breast
24/29
Subdiaphragmatic Lymph Channels
Channels to Contralateral Breast
Axillary Lymph Channels
Major Routes of Metastasis
7/30/2019 AnatomyThe Breast
25/29
D. Anomalies
1. Inverted nipple: congenital or due
to cancer
2. Ectopic nipple:
a. polythelia or hyperthelia
b. additional nipples along milk line
3. Amastia
4. Micromastia
7/30/2019 AnatomyThe Breast
26/29
5. Macromastia
6. Gynecomastia
a. breast development of male in
areolar region
b. noted in males who smokemarijuana at puberty
7. Supernumerary breasts along milk line
7/30/2019 AnatomyThe Breast
27/29
axilla
Pyramidal shape
Apex--Base 4 walls-ant, post. , med., lateral
Containing
Artery and vein
lymph nodes
Long thoracic and intercostobrachial nerves
Fat , fascia
7/30/2019 AnatomyThe Breast
28/29
Axilla-diagram
7/30/2019 AnatomyThe Breast
29/29