Breast

Breast.

“The breasts from their prominence,the colour of their skin ,and the red colour of the nipples,by which they are surmounted,add great beauty to the female form” Sir Astley Cooper, on the anatomy of breast,1840.

The breast is formed from modified sebacious glands. it lies therefore in the superficial fascia.

extent. Breast extends from above downwards second to sixth ribs ( vertical extent) And extending transversely from the lateral margin of the sternum to anterior axillary line ( horizontal extent) 2/3 rd of the breast lies on the pectoralis major and 1/3 rd lies on the serratus anterior.

Short head Of biceps brachii m. Deltoideus m. brachialis m. major Subscapularis m. Serratus anterior m. Latissimus dorsi m. Obliquus externus m. Copyright 0 2(D4, Elsevier. minor m..

Architecture of gland. Lobule is the basic structural unit of the mammary gland Number varies from 10-100 They more in young women acini lobules lobes.

Extralobular stroma o Intralobular terminal d Lobular acinus Terminal duct Intralobular stroma Copyright 0 Elsevier..

Nipple-areolar complex Lactiferous sinus Breast duct Fat Cooper's ligament Breast lobules Epidermis Lymphatics Dermis COopees ligament Breast lobules Breast Lymphatics Retromammary space / Deep fascia ——„„„—Pectoralis major m. Copyfight 0 Elsevier..

Foramen Langer is a opening in the axillary fascia through which breast tissue gets in to axilla.

Ligaments of cooper. Breast is anchored to the overlying skin and underlying pectoral fascia by bands of fibrous tissue called ligaments of cooper.

nipple. It lies in the 4 th intercostal space from the midline Near its apex lies the orifices of lactiferous ducts . Normally nipple projects forwards and outwards.

A number of small swelling or Montgomery’s tubercles are visible around the areola,and these are overly enlarged sebacious glands.

Areolar epithelium. Contains 3 types 0f epithelium 1.Sweat glands 2.Sebacious glands( Montogmery ) 3.Accessary mammary glands.

Arterial blood supply. 1.lateral thoracic artery from the 2 nd part of axillary A 2.perforating cutaneous br of the internal mammary A ( subclavian A) 3.lateral br of the 2 nd ,3 rd and 4 th intercostal arteries(aorta).

Venous Drainage. Superficial veins radiate from the breast and are characterised by their proximity to the skin. They are accompanied by lymphatics Deep veins drains in to axillary internal mammary and intercostal vessels.

Nerve supply. The secreting tissue is supplied by sympathetic nerves which reach via the 2 nd to the 6 th intercostal nerves. Overlying skin is supplied by the anterior and lateral branches of the 4 th ,5 th ,6 th intercostal nerves.

Lymphatic drainage. Breast drains mainly to six sets axillary glands 1.anterior set 2.posterior set 3.lateral set 4.central set 5.apical set 6.interpectoral set.

Cephalic v. Axillary v. group group Ext. mammary group Central axillary group Subclavicu group Int. jug. vein Pect. minor m. Pect. major m. Internal Copyright 0 Elsevier..

Number of axillary lymph nodes around 30 -60.

Internal mammary lymph nodes fewer in number and lie along the internal mammary vessels deep to the plane of the costal cartilage..

Anterior set. Main lymph gland of breast ( Sojius ) situated along the lateral thoracic vein under anterior axillary fold near 3 rd rib axillary tail of breast is in contact with gland.

Posterior set. Lies along the posterior axillary fold in relation to the subscapular vessels.

Lateral set. Along the upper part of humerus in relation to the axillary vein.

Central set. Situated in the fat of the upper part of the axilla.the intercostobrachial nerve passes outwards amongst these glands.

Apical set. These are also called the infraclavicular glands They lies in the apex of axilla.

Interpectoral set. Few nodes lying between pect.major and minor muscles.

Lymphatic drainage. Drained by two sets of lymphatics 1.lymphatics of the skin over the breast. 2.lymphatics of the parenchyma of the breast.

Lymphatics of the overlying skin. These drain the skin over the breast except the skin of the areola and nipple. They pass in the radial direction and in the surrounding glands. It is of great surgical moment to observe that the lymphatics of the skin over the breast communicate across the middle line,and that A unilateral disease may become bilateral by this route..

Lymphatic of parenchyma of breast. Subareolar lymph plexus of Sappey is a collection large lymph vessels situated under the areola Axillary glands receive about 75 to 85% of lymph draining the breast tissue.

The role of internal mammary glands pathway is important in the spread of breast cancer When lymph channels are blocked , tumour cell may spread in a retrograde direction.

AXILLARY FASCIAL ‘TENT’. Axillary nodes are enclosed by layers of fascia which resemble A tent lying on its side. The tent have anterior wall posterio -inferior wall anterosuperior wall apex base.

ANY OPERATION DESIGNED FOR A BLOCK DISSECTION OF AXILLARY LYMPH NODES SHOULD EXCISE THE TENT INTACT ,AND SHOULD NOT ENTER THE TENT WHICH MAY RESULT IN THE LIBERATION OF MALIGNANT CELLS.

Diseases of breast. Diseases of breast congenital Amazia,polands syndrome polymazia acquired Infection Inflammation Traumatic Benign diseases malignancy.

Acquired types. 1.Infection 2.Inflammation 3.Traumatic 4.Benign 5.malignancy.

infections. Acute bacterial mastitis Mastitis from milk engorgement Mastitis of mumps Chronic intramamary abscess Chronic subareolar abscess Tuberculosis actinomycosis.

Chronic infection. Hidradenitis suppurativa.

inflammation. Mondor’s diseases.

traumatic. Traumatic fat necrosis haematoma.

Benign breast diseases. 1.ANDI 2.duct ectasia 3.galctocele 4.benign tumours.

Benign tumours. Epithelial duct papilloma pure adenoma Connective tissue nuerofibroma lipoma Mixed fibroadenoma.

Fibroadenoma is the commonest tumour of the breast below the age of 35.

What is ANDI ?. It is Aberrations of Normal Development and Involution Normal breast changes throughout life.

Alternate terms used for ANDI. 1.mammary dysplasia 2.fibrocystic diseases 3.fibroadenosis 4.chronic mastitis.

Breast is a dynamic structure which undergoes changes throughout woman’s reproductive life and superimposed upon ,this cyclical changes throughout the menstrual cycle..

Normal breast changes throughtout life. Lobule development Cyclical changes involution.

pathology. Cyst formation Fibrosis Hyperplasia papillomatosis.

Clinical features. mastalgia … Lumpiness(seldom discrete) ….

Lumpiness may be bilateral Changes may be cyclical Increase in lumpiness and mastalgia before mensus.

treatment. 1.firm reassurance 2.exclude cancer 3.pain chart 4.evening primrose oil(1000mg daily for 3 months 5.danazol ( prolactin inhibitor)200 -800mg daily up to 6 months 6.tamoxifen( antioestrogen ).