The breasts

(Mammary glands, Breasts

Summary
The breasts are paired structures located on the ventral thorax. The female breast consists of 10–20
lobes that are surrounded by connective and adipose tissue. Each lobe contains milk-
producing glandular structures and multiple terminal duct lobular units that form the milk duct
system and drain via the major milk ducts and the lactiferous sinuses to the nipple. Lactating lobules
produce the breast milk that nourishes many newborns and protects them from infections (passive
immunity). For more detailed information on lactation, see lactation and breastfeeding. The nipple also
contains multiple nerve endings, which make it particularly sensitive to stimulation.

Adipose tissue

A type of tissue that consists of adipocytes (i.e., fat cells). Stores in the form of triacylglycerols
that can be released when needed. Also serves as insulation and secretes endocrine mediators
(e.g., leptin, estrogens).

Lactiferous sinuses

The expansions of the lactiferous ducts located directly beneath the nipple that act as reservoirs
for milk. The lactiferous ducts and sinuses serve as connections between the breast lobule and the
nipple.

Lactiferous ducts Terminal ducts

15–20 ducts that drain the lobes of the mammary gland.

Breast

The breast parenchyma is made up of 10–20 lobes with interlobar stroma in between.
Each lobe is made up of multiple lobules, which are drained by a single lactiferous duct that opens
onto the surface of the nipple.
The lactiferous sinus is the terminal dilation of the lactiferous duct.

Vasculature and innervation

 Arteries
 o Medial breast: medial mammary branches of the internal thoracic artery from
the subclavian artery
o Lateral breast
 Lateral thoracic and thoracoacromial branches from the axillary artery
 Mammary branches of the posterior intercostal arteries
 Veins
o Intercostal veins → azygos vein (right); vertebral venous complex
 Lymph nodes of the breasts
o Three groups
 Axillary lymph nodes
 Provide 75% of the lymphatic drainage of the breast
 Parasternal (internal thoracic) lymph nodes
 Drain most of the medial parts of the breast
Secretion of milk is not mediated by the nerves but by the hormone prolactin.

A tumor infiltrating the breast tissue can deform, shorten, and retract the Cooper ligaments and

lead to dimpling of the skin. Tumorous infiltration and blockage of the lymphatics manifest
as lymphedema and thickening of the skin, which is known as peau d'orange because of the
resemblance to orange peel. Retraction of the nipple can be a sign of a tumor within the ducts
(Paget disease of the breast).

Carcinomas of the breast metastasize early on through the lymph pathways. As

most carcinomas of the breast develop in the upper lateral quadrant, lymph
node metastases often occur in the axilla of the same side.

Lymph nodes of the breast

Lymphatics of the breast drain into three groups:

1. Axillary group, further divided into three levels

– Level I: lateral to the lateral border of the pectoralis minor
– Level II: behind the pectoralis minor
– Level III: medial to the medial border of the pectoralis minor
2. Parasternal (internal thoracic) group
3. Posterior intercostal group (not shown here)

Efferent lymphatics travel to the supraclavicular nodes and terminate in the thoracic duct (on the left;
not shown here) or the right lymphatic duct.
 Mammary gland

Microscopic images of breast tissue (H&E stain)

Upper image: sections of numerous lobules of the nonlactating mammary gland, which contain acini.
A complete lobule is marked by the green overlay. A lactiferous duct (white outline) drains several
lobules. The interlobular connective tissue stroma is abundant in collagen fibers and irregularly
interspersed with adipocytes (green outline).

Lower image: individual lobular acinus under higher magnification. Lobules are usually lined by two
layers of cells. The inner (luminal) layer comprises cuboidal glandular cells (gray outline), whereas the
outer layer comprises myoepithelial cells (red outline), which rest on the ba

Lactating breasts
 Changes in the mammary gland
o Tubulo-alveolar glands of the lobules initiate lactation
o ↓ Interlobular stroma
 Hormonal regulation of the transition of the glands
o Estrogen: ↑ cell proliferation and hypertrophy of the milk duct system
o Progesterone, estrogen, and prolactin: ↑ cell differentiation and proliferation of
the lobules
o Prolactin: production of milk
Lactating breasts have distinct histological features: very large lobules with tubulo-alveolar ends
and only small amounts of connective tissue between the lobules! Because of the reduced
amount of stroma, histological preparations of lactating breasts can be confused with those of
the prostate or of the parathyroid gland!

Menstrual cycle-dependent and age-dependent changes of the
breasts
 Menstrual cycle
o no changes
o ↑ estrogen and ↑ progesterone → cell proliferation, ↑ number of acini, edema of
interlobular stroma
o desquamation and regression
 Puberty: See “Embryology of the breast“ and “Tanner stages.”
 With age: involution of the breasts