PECTORAL REGION

• This is the anterior aspect of the thorax (chest)

• The important structures are present in this region are:
I. Muscles that connect the upper limb with the anterolateral chest wall
II. Breasts (mammary glands) which secrete milk (in female)

Breasts/Mammary glands
Introduction
• The breast is the most important structure present in the pectoral region
• It is found in both sexes (males and females)
• it is rudimentary and functionless in the males
• It is well developed in the female after puberty and also serve an accessory
organ of the female reproductive system
Shape
• It may be: hemispherical, conical, pyriform, pendulous or flat
Location
• The breast lies in the superficial fascia of the pectoral region
• it overlie the pectoralis major muscle
Division
• It is divided into 4 quadrants:
• Upper medial
• upper lateral
• lower medial
• lower lateral
• A small extension of the upper lateral quadrant, called the axillary tail of Spence,
passes through an opening in the deep fascia and lies in the axilla
• This opening is called foramen of Langer
• The amount of fat surrounding the glandular tissue
determines the size of non-lactating breasts Extent
• A non-lactating breast consists primarily of fat • Vertically, it extends from 2nd rib to 6th rib.
• At the greatest prominence of the breast is the • Horizontally, it extends from lateral border of
nipple the sternum to the midaxillary line
• The nipple is surrounded by a circular pigmented
area of skin called the areola
 Relations of the breast The Mammary bed
The deep aspect of the breast is related to the • 2/3 of the breast lies on the Pectoral fascia covering
following structures (from superficial to deep) the pectoralis major muscle
1) Pectoral fascia covering the pectoralis major • The remaining 1/3 of the breast lies over the fascia
muscle covering the serratus anterior muscle, while some
part overlaps inferiorly to cover the external oblique
2) 3 muscles: pectoralis major, serratus anterior, muscle
external oblique
• These structures which form a basis or foundation
for the mammary gland to rest on are collectively
called ‘the mammary bed’
• The breast is separated from the
pectoral fascia by a space filled with
loose connective/areolar tissue
• This potential space is called the
retromammary space (bursa)
• Because of the presence of this loose
tissue, the breast can be moved freely
up and down and side to side over the
pectoral fascia

Structure of the Breast

• The breast consist of 3 structures
1. Skin
2. Stroma
3. Parenchyma/glandular tissue
 Skin
It is the covering for the breast and presents the
following features:
• Nipple
• Areola
a) Nipple
• It is a conical projection below the center of the
breast
• It is usually at the level of the 4th intercostal
space
• The nipple is pierced by 15 to 20 lactiferous
duct
• It contains circular and smooth muscle fibres,
which make the nipple stiff and erect or flatten
• The nipple is the most sensitive part of the
breast to tactile stimulation and become erect
during sexual arousal because it is richly
b) Areola
• This is the pigmented circular area around the base of the nipple
• it is rich in modified sebaceous glands particularly at its outer margin
• They produce oily secretion, which lubricates the nipple and areola thereby
preventing them from drying and cracking during lactation
• These sebaceous glands become enlarged during pregnancy and lactation to
form small nodular elevations called the tubercles of Montgomery
• the areola also contains some sweat glands, and accessory mammary glands
• The skin of the areola and nipple is devoid of hair
• Below the areola lie the lactiferous sinus where stored milk is seen
• The color of the areola and nipple varies with the complexion of the woman
• During pregnancy the areola becomes darker and enlarged
Stroma
• It forms the supporting framework
of the gland
• It is partly fibrous and partly fatty
• The fibrous stroma forms septa,
known as the suspensory ligaments
of Cooper
• The suspensory ligaments of Cooper
connects the skin and gland to the
pectoral fascia
• The fatty stroma forms the main
bulk of the gland
• The fatty stroma is distributed all
over the breast, except beneath the
areola and nipple
Parenchyma (Mammary Gland)
• The parenchyma/glandular tissue of the
breast secrete milk to feed the newborn baby
• The gland consists of about 15 to 20 lobes
• Glands are arranged in a radial fashion like
the spokes of a wheel and converge towards
the nipple
• Each lobe is divided into lobules
• Each lobules contains clusters of acini
• Each lobe is drained by a lactiferous duct
• Lactiferous ducts converge towards the
nipple and open on it
• Near the termination of each duct is an
expanded part called the lactiferous sinus
• The lactiferous sinus serve as reservior of
milk during lactation
Arterial supply
• Perforating branches of the Internal
thoracic artery
• Lateral thoracic, superior thoracic &
acromiothoracic branches of the
Axillary artery
• Posterior intercostal arteries

Venous drainage
• Internal thoracic vein
• Axillary vein
• Posterior intercostal veins
The veins follows the arteries
Lymphatic drainage
• Axillary lymph nodes
• Internal mammary nodes
• Supraclavicular nodes
• Posterior intercostal nodes
• Cephalic nodes
Innervation
• Anterior and lateral cutaneous branches of 2nd -6th intercostal nerves
Clinical anatomy
A) Breast cancer (carcinoma of the breast)
• It is one of the most common cancers in the females. It arises from the epithelial cells
of the lactiferous ducts.
• In about 60% cases, it occurs in the upper lateral quadrant and commonly affects
females between 40–60 years of age
• Because of communications of the superficial lymphatics of the breast across
the midline, cancer may spread from one breast to the other
• Because of communications of the lymph vessels with those in the abdomen,
cancer of the breast may spread to the liver, and cancer cells may ‘drop’ into the
pelvis producing secondaries there
• Apart from the lymphatics, cancer may spread through the segmental veins.
Clinically it presents as:
(a) Presence of a painless hard lump
(b) Breast becomes fixed and immobile, due to infiltration of suspensory
ligaments
(c) Retraction of skin, due to infiltration of suspensory ligaments
(d) Retraction of nipple due to infiltration and fibrosis of lactiferous ducts
(e) peau d’orange’ appearance of the skin (i.e., skin giving rise to appearance like
that of the skin of the orange) due to obstruction of superficial lymphatics.
B) Mastectomy is the medical term for the surgical removal of one or both
breasts, partially or completely. A mastectomy is usually carried out to treat
breast cancer
• Lumpectomy is the removal of only the tumour
C) Radical mastectomy is a surgical procedure involving the removal of breast,
underlying pectoral muscles and lymph nodes of the axilla as a treatment for
advanced breast cancer