MAMMARY GLAND

Assoc Prof Dr. Farida Hussan@Khin Pa Pa Hlaing

Human Biology Department
School of Medicine
International Medical University
FaridaHussan@imu.edu.my
Ext: 2829
 Learning outcome
• Briefly describe the location of the mammary glands.

• Explain the structure of the mammary glands

• Describe the changes in the mammary glands in

females from birth until menopause.

• List the blood supply, nerve supply and the lymphatic

drainage of the mammary glands.

• List the relevant clinical correlates

 Mammary glands
• Breasts
– are modified apocrine
sweat glands of skin. Pectoralis
major

Retromammary
– lie in the superficial space

fascia.
 Parts of mammary glands
• Axillary tail of Spence
extends upward and
laterally. Pectoralis major

Areola
Nipple
 Location
• Surface anatomy:
vertically,
extends from the second to
the sixth rib

Horizontally
the lateral margin of the
sternum to the mid-axillary
line.
 Quadrants of the breast
• Main bulk in upper outer
quadrant.

• This quadrant is more often

implicated in breast cancer
and in most benign lesions
of breast tissue.
 Structures of the mammary gland

1. Skin

2. Parenchyma

3. Stroma (connective
tissue)
Structure of the mammary gland- skin
• Nipple - A conical projection of the
skin at the greatest prominence

• has no fat, hair or sweat glands.

• lies at the level of the 4th Lactiferous

intercostal space (not constant) ducts

• Lactiferous ducts open at its tip Nipple

• has rich sensory nerve supply

• contains circularly arranged

smooth muscles which compress
the lactiferous ducts and erect the
nipples.
Areola
• is a disc of skin, which circles the
base of the nipple.

• has modified sebaceous glands Areola

called glands of Montgomery.

• these glands enlarge in

pregnancy and lactation

• The secretion of these glands

keep the nipple and areola
supple for suckling and act as a
lubricant during breast feeding.
Structures of the mammary gland- parenchyma
• Each breast consists of
15-20 lobes.

Lactiferous sinus
• a dilated part of
lactiferous duct just Alveolus
before its termination

Alveolus
Structures of the mammary gland- stroma
Adipose tissue
• The lobes of the
gland are separated
by fibrous septa that
serve as suspensory
ligaments (of
Cooper).
 Embryology of the mammary glands

• develop from invagination of surface

ectoderm

• forms a series of branching ducts along the

mammary ridge.

• just before birth this site of invagination

everts to form the nipple.

• The embryonic milk line (crest) extends

from the axilla to the groin. This is the line
from which the breasts develop in animals
with multiple breasts.
 Developmental abnormalities of the
mammary gland
• The nipple may fail to evert.
1. Retracted nipple- difficult suckling for the
baby, prone to infection.
2. Supernumerary nipples
or even breasts may occur
along a vertical ‘milk line’

• Polythelia

• These have a
rudimentary areola or
nipple.

• The glandular tissue

undergoes proliferation
during pregnancy.
3. Amastia- one or both sides of the breast may be
small or even absent.

• There may be a nipple and areola but no glandular

tissue.
 Changes in female breast
• From birth until puberty, the breast consists
of lactiferous ducts, with no alveoli.

At puberty,
• the ducts start to proliferate, and their
terminations form solid masses of cells—the
future breast lobules.

• Attain hemispherical shape.

• Deposition of fat
 During pregnancy
In Early pregnancy:
• Pigmentation of nipple and areola.

• Increased size of the breast due to

rapid lengthening and branching of
the secretory system.

• Increased vascularity

• Areolar glands or glands of

Montgomery become enlarged and
active.
In late pregnancy:

• Grow slowly but enlarged due to distension of secretory alveoli with

colostrum.

• In the last days of pregnancy, the breasts secrete colostrum, a yellow,

sticky, serous fluid, which is then replaced by true secretion of milk.

• The ratio of glandular to fat tissue rises to 2:1 in the lactating breast,
compared to a 1:1 ratio in non-lactating women.
 Post-weaning
• gland returns to inactive state

• Remaining milk is absorbed

• Secretory alveoli shrink and disappear and

interlobular connective tissue thickens.

• Pigmentation of areola fades but never returns to

normal.
 Post menopause
• Atropic glandular tissue due to absence of
hormonal influence of oestrogen and
progesterone.

• The connective tissue becomes less

cellular, and the amount of collagen
decreases resulting in pendulous breasts.

• In some women, marked fatty

infiltration of the breast occurs at this
stage;

• in others, the breasts shrink considerably.

 Stages of development
1. Female before
puberty.
2
2. Female at 3
puberty. 1.
3. Male, adult.
4. Female, first half
of menstrual 4 5 6
cycle.
5. Female, second
half of menstrual
cycle. 7
6. Female, pregnant.
7. Female, lactating. 8
9
8. Female, post-
weaning.
9. Female,
menopause.
 Non-pregnant
Inactive duct
system

During
Alveoli pregnancy
proliferates
at the end of
the ducts

Lactating

Milk secretion
and • Inactive glands are
accumulation compound tubular,
in
the alveoli • Active glands (in pregnancy
lumen and lactation) are compound
tubuloalveolar.
Prepubertal
(inactive)
mammary gland

Gland in late
pregnancy
Gland in
pregnancy

Rudimentary ducts embedded in

a loose connective tissue stroma
(Infant)

Lactation
• Lumens are filled with a
proteinaceous fluid with
clear lipid vacuoles.

• The epithelium is
attenuated, simple
squamous.
1. Lobules
2. Precursors of alveoli
3. Intralobular connective
tissue
4. Interlobular duct
5. Interlobular connective
tissue
Lactating mammary glands:

• Lactating mammary glands show little intralobular connective tissue and

much glandular tissue (1:2).

• Active alveoli- show dilated lumen with low simple cuboidal epithelial lining.

• Resting alveoli- show a narrow lumen with tall epithelial lining.

• Cells of the alveoli enlarge with well-developed RER, and Golgi apparatus.

• Protein packaged into secretory vesicles which undergo exocytosis.

• Lipids are secreted by apocrine secretion into the lumen.

 Blood supply
Arterial supply
Subclavian A.

Axillary A.
Internal thoracic
A.
Lateral thoracic
A.

Posterior
Intercostal A.
 Blood supply
Venous drainage

Internal thoracic
Axillary Vein Vein

Lateral thoracic Vein

 Lymphatic drainage
parenchyma, nipple and areola Infra- and supraclavicular LN

Subareolar plexus
lateral medial

Axillary Parasternal
nodes (75%) nodes

Pectoral (ant:)
Broncho-
mediastinal
lymph trunk
Central group
Thoracic or Rt
Apical group lymphatic duct Inferior phrenic nodes
 Clinical correlation
Breast abscess
• Commonly occurs in a lactating
mammary gland

• spread from a cracked nipple

• may form an abscess

• treated with antibiotics and surgically

drained by a radial incision to minimize
spread and damage to radially
arranged ducts.
 Breast cancer
• usually adenocarcinoma from the epithelial cells of the
lactiferous ducts.

• Lymphogenic metastasis: Metasatic cells pass through 3

sets of lymphnodes before entering the venous system.

• Venous metastasis can spread to vertebrae, cranium and

brain.

• Contiguity spread may occur to the retromammary space

and chest wall.
 Breast cancer
• Nipple deviation- interference of
the lymphatic drainage by the
cancer causes lymphedema which
deviates the nipple.
• Nipple retraction- sub-areolar
cancer may involve the
lactiferous ducts and cause
fibrous degeneration
(Desmoplasia may occur around
a neoplasm, causing dense
fibrosis around the tumor) and
retract the nipple.
 Breast cancer
• Peau d’orange

-Due to lymphedema, it cause thickened,

leather like appearance of skin.

-“orange-peel” appearance.

• Skin tethering-

-due to cancerous invasion to

glandular tissue and fibrosis
(fibrous degeneration).

-This results in shortening of the

suspensory ligaments.
 Breast cancer
Axillary lymph node
enlargement-

due to primarily lymphogenic

spread, axillary lymphadenopathy
almost always accompanies breast
cancer.

But absence of this sign does not

rule out spread to infra/supra-
clavicular nodes.
THANK YOU.