BREAST:

ANATOMY AND PHYSIOLOGY

ANATOMY
BREAST / MAMMARY GLAND
• Modified sweat gland
• Composed of 15 to 20 lobes, which are each composed of several
lobules.
• Lies in the Superficial fascia overlying the pectoralis major, serratus
anterior, and external oblique abdominal muscles, and the upper
extent of the rectus sheath.
• Extends from:
• 2nd -3rd rib to the inframammary fold at the 6th-7th rib
• Lateral border of the sternum to the anterior axillary line
BREAST / MAMMARY GLAND
• Cooper’s Suspensory ligament
• Fibrous bands of connective tissue from the dermis
to the pectoral fascia
• Provide structural support to the breast
• Retromammary bursa
• Between the investing fascia of the breast and the fascia of the pectoralis major
muscles
• Allows the breast to move freely
• Upper outer quadrant of the breast
• Contains a greater volume of tissue than do the other quadrants, and is the most
common site of breast carcinoma
NIPPLE-AREOLA COMPLEX
• Pigmented and is variably corrugated
• Nipple
• Usually at the level of the 4th ICS
• Contains numerous sensory nerve endings
and Meissner’s corpuscles, which effects milk letdown.
• Areola
• Contains sebaceous glands, sweat glands, and accessory glands
(Montgomery’s tubercles)
• Lobule -> Lobe -> Lactiferous duct -> Lactiferous sinus
BLOOD SUPPLY: ARTERIES

1. Perforating branches of Internal Mammary (Thoracic) artery

• 2ND to 4th anterior intercostal perforating branches – “Medial Mammary arteries”
BLOOD SUPPLY: ARTERIES

2. Branches from the Axillary artery:

• Highest thoracic, Lateral thoracic, and
pectoral branches of the Thoracoacromial
artery
• Lateral thoracic artery -- “Lateral Mammary
arteries”
• supplies the serratus anterior, pectoralis major
and pectoralis minor, and subscapularis muscles

3. Lateral branches of the Posterior Intercostal

arteries
BLOOD SUPPLY: VEINS
1. Perforating branches of the Internal Thoracic vein
2. Perforating branches of the Posterior Intercostal veins
3. Tributaries of the Axillary vein

*Batson’s vertebral venous plexus

- invests the vertebrae and extends from
the base of the skull to the sacrum
- provide a route for breast cancer metastases
to the vertebrae, skull, pelvic bones, and
central nervous system.
NERVE SUPPLY
Lateral cutaneous branches of the 3rd to 6th
Intercostal nerves
• Innervates the breast and anterolateral
chest wall

Anterior branches of the Supraclavicular

nerve (from the Cervical plexus)
• Innervates the skin over the upper
portion of the breast
LYMPHATIC DRAINAGE: AXILLARY LYMPH
NODES
- Usually receive >75% of the lymph drainage from the breast

Level I - lateral to the pectoralis minor muscle

• Includes the Axillary vein, External mammary, and Scapular
groups

Level II – superficial or deep to the pectoralis minor

• Central and Interpectoral groups

Level III - medial or above to the pectoralis minor

• Subclavicular group (Apical)
 Level No. of Location Drainage
LN
Axillary vein group I 4-6 Medial or posterior to the Axillary Upper extremity
(Lateral) vein
External mammary I 5-6 Lower border of the pectoralis Lateral aspect of the breast
group (Anterior or minor muscle contiguous with the
Pectoral) lateral thoracic vessels
Scapular group I 5-7 Posterior wall of the axilla at the Lower posterior neck, the
(Posterior or lateral border of the scapula posterior trunk, and the
Subscapular) contiguous with the subscapular posterior shoulder
vessels
Central group II 3-4 Posterior to the pectoralis minor Axillary vein, external
muscle mammary, and scapular
groups of lymph nodes, and
directly from the breast
Subclavicular group III 6-12 Posterior and superior to the All of the other groups of
(Apical) upper border of the pectoralis axillary lymph nodes
minor muscle
Interpectoral group 1-4 Between the pectoralis major and Directly from the breast
(Rotter’s lymph nodes) pectoralis minor muscles
PHYSIOLOGY
BREAST DEVELOPMENT AND
FUNCTION
Initiated by a variety of hormonal stimuli:
• Estrogen
• Ductal development
• Progesterone
• Differentiation of epithelium and for lobular development
• Prolactin
• Lactogenesis in late pregnancy and the postpartum period.
• It upregulates hormone receptors and stimulates epithelial development.
BREAST
DEVELOPMEN
T
Adolescence

Pregnancy

Lactation

Senescence
PREGNANCY, LACTATION, AND
SENESCENCE
• Pregnancy (↑ ↑ estrogen, progesterone)
• breast enlarges as the ductal and lobular epithelium proliferates, the areolar
skin darkens, and the accessory areolar glands (Montgomery’s glands)
become prominent
• Lactation (↓ estrogen, progesterone; ↑ prolactin)
• Prolactin – milk production; increases after delivery of the placenta
• Oxytocin – milk letdown; its release is stimulated with nursing
• Senescence/Menopause (↓ estrogen, progesterone)
• involution of the ducts and alveoli of the breast
• Fibrous connective tissue are replaced by adipose tissue