Chapter 17: BREAST Notes pendulous configuration with

decreased volume
Embryology
 5th to 6th week : 2 ventral bands of thickened Nipple-areola complex
ectoderm (mammary ridges, milk lines)  Epidermis is pigmented and variably corrugated
 Primary bud  15 to 20 secondary buds  Puberty: pigments becomes darker and nipple
 Witch’s milk: transitory event that occur in assumes an elevated configuration
response to maternal hormones that cross the  Pregnancy: areola enlarges and pigmentation is
placenta further enhanced
 Montgomery’s Tubercles are small elevations on the
Anomalies surface of the areola which contain sebaceous,
Inverted congenital (4%), failure of nipple to sweat, and accessory glands
nipple elevate above the skin level  Smooth muscle fibers lie circumferentially in the
Polymastia  supernumerary breasts may occur in dense connective tissue and longitudinally along
Accessory any configuration along the the major ducts and extend upward into the nipple
breasts mammary milk line but most  nipple erection
frequently occur between the normal  Dermal papilla (tip of nipple): sensory nerve
nipple location and symphysis pubis endings and Meissner’s corpuscles
 Turners, Fleischers
 accessory axillary is uncommon and Inactive and Active Breast
usually bilateral
 Lobes terminate in major (lactiferous) duct (2 – 4
Polythelia  accessory nipples (<1%)
mm in diameter)  open into the ampullar of the
 may be associated with
abnormalities of urinary and CV nipple (constricted orifice, 0.4 – 0.7 mm in
systems diameter)  lactiferous sinus (dilated portion)
Amastia arrest in mammary ridge development o Major ducts: lined with two layers of
Absence of that occurs during the 6th fetal week cuboidal cells
breasts Poland o Minor ducts: lined with single layer of
Symmastia webbing between the breasts across the columnar to cuboidal cells
midline
Inactive breast
Functional Anatomy  Epithelium is sparse
 15 to 29 lobes  Primarily of ductal epithelium
 Cooper’s suspensory ligament: fibrous band of  Minor ducts are cord-like with small lumina 
connective tissue that insert perpendicularly into estrogen stimulation alveolar epithelium
the dermis and provide structural support increases in height, duct lumina become prominent
 Axillary Tail of Spence extends laterally across the and some secretions accumulate
anterior axillary fold  Decrease hormonal stimulation  alveolar
epithelium regresses
Ducts are lined by squamous cell epithelium and cancers
usually arise from the ducts (the usual cancer of breast is Pregnancy
infiltrating ductal carcinoma)  Proliferative and developmental maturation
 Hormonal stimulation  enlargement 
Anatomical borders of the breast lymphocytes, plasma cells, and eosinophils
accumulate within the connective tissues
Superior 2nd or 3rd rib
Inferior Inframammary fold at 6th or 7th rib  Minor ducts branch and alveoli develop 
Medial Lateral border of the sternum asymmetric, and variations in the degree of
Lateral Anterior axillary line development may occur within a single lobule
Deep/ Fascia of pectoralis major, serratus  Parturition : enlargement occurs via hypertrophy
Posterior anterior, external oblique abdominal of the alveolar epithelium and accumulation of
Surface muscles and the upper extent of the rectus secretory products
sheath  Alveolar epithelium secretes:
(a) Protein component of milk: synthesized in the
 Upper Outer Quadrant of the breast contains a ER (merocrine secretion)
greater volume of tissue (b) Lipid component of milk: forms as free lipid
 Protuberant conical form, the base is roughly droplet in the cytoplasm (apocrine secretion)
circular measuring 10 – 12 cms in diameter  Colostrum
o Milk released in the first few days of
Characteristics of the breast thru age parturition
Nulliparous Hemispheric configuration with o Low lipid but contains considerable
distinct flattening of the nipple quantities of antibodies (source:
Pregnant Becomes larger and increases in lymphocytes and plasma cells that
Lactating volume and density accumulate within CT)
Senescence Assumes a flattened, flaccid and more

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Types of Exocrine Glands
Merocrine Cells secrete via exocytosis
Salivary glands, Eccrine sweat glands,
Apocrine Sweat Glands
Apocrine Cells secrete via membrane-bound
vesicles
Mammary glands
Holocrine Cell lysis releases entire contents of the
cytoplasm and cell membrane
Sebaceous glands

Blood Supply, Innervation and Lymphatics

Arterial Supply
 Principal blood supply:
(a) Perforating branches of internal mammary artery
(b) Lateral branches of the posterior intercostal
arteries
(c) Branches from the axillary artery (highest thoracic,
lateral thoracic, and pectoral branches of the
thoracoacromial artery)
 Lateral Thoracic Artery
o Gives branches to serratus anterior,
pectoralis major and minor, subscapularis
o Also gives rise to lateral mammary
branches

Venous Supply
 Principal groups:
(a) Internal Thoracic Vein
(b) Posterior Intercostal Vein
(c) Tributaries from Axillary Vein
 Batson’s vertebral venous plexus
o Valveless, provide route of metastases to
the vertebrae, skull, pelvic bones, and CNS
o Extends from the base of the skull to the
sacrum

Innervation
 Lateral cutaneous branches of the 3 rd through the
6th intercostal nerves
o Sensory innervation of the breast (lateral
mammary branches) and of the
anterolateral chest wall
 Cutaneous branches that arise from the cervical
plexus, specifically the anterior branches of the
supraclavicular nerve, supply a limited area of skin
over the upper portion of the breast
 Intercostobrachial nerve
o Lateral cutaneous branch of the second
intercostal nerve and may be visualized
during surgical dissection of the axilla
o Resection  loss of sensation over the
medial aspect of the arm

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