BREAST/ MAMMARY GLAND

A B • Modified sweat gland • Accessory organ of reproductive system • Well developed after puberty in female

• Provides milk to the newborn Mammary Gland SITUATION Anterolateral Dissection • Superficial • Auxiliary tail ( of spence ) in EXTENT • Vertical : 2nd -6th rib • Horizontal : Lateral Border of – Mid axillary line

Mannnary Gland S agittal Section DEEP RELATIONS Gland S agittal Section • Retro mammary space • Pectoral • , Serratus anterior, External oblique abdominis • , •2nd –6th rib & 2nd –5th with its contents

of of

pple pple

i

sinus sinus

N

gland gland

Lactiferous Lactiferous

mammary mammary

duct duct

Lactiferous Lactiferous

Lobes Lobes

muscle muscle

the the

"7" "7"

/ /

ligaments ligaments

major major

Suspensory Suspensory

-+

-

-

Pectoralis Pectoralis ~--¥:'1:-- STRUCTURE OF BREAST SKIN Areola (no Nipple & hair &fat) PARENCHYMA(15-20 lobes) lactiferous duct- l.sinus –alveolus STROMA Fibrous (suspensory ligament) Fat • • • BLOOD SUPPLY

P..,,ORll l,qj,o,,ol Arterial: supply from RIO!ll<~ M e

l~tic .md ..,noon dr~l~;,g,. ip.,~3 ·~ lat1N1l 1rw;I !ll,lperiOr' • Branches of lat. Thoracic, pal\ oi lho bn:U\ inlo Ill!

1.-nmm"'Y _., superior thoracic, acromio .,~n:,111'1«actoart<·t Limi,1,•lil> o•d V

• Follows the arteries • Converge towards the base of the nipple & forms an anastomotic v. circle • Venous circle S/F • Internal thoracic, lower part of neck Deep- • Internal thoracic,axillary, posterior intercostal Nerve supply

• Anterior & lareral cutaneous branches of4th to 6th intercostal nerves • Milk secretion is controlled by prolactin Lymph vessels &nodes

• Superficial lymphatics- skin except nipple &

areola Lymph Vessels and Nodes of Mammary Gland • Deep lymphatics- Parenchyma, nipple & areola Ly111pl1,ressels a11dNodes of lVla1mnaf)r Gla11cl

Apical

Supraclavicular

Central axillary Lat. axillary~

Post. axillary/ Internal thoracic

Anerior axillary Applied anatomy

• Carcinoma- -Puckering of skin -Peau d’ orange -Bilateral spread -Dropping into the pelvis • Abcess- radial incision Axilla

• Gateway to the A upper limb Middle scalene muscle Anterior scalene muscle • Irregularly shaped Lateral margin of rib I pyramidal space

Medial wall-- ++ ------ir~>-----:;;;-=,(--~ -Four sides Lateral wall -- -r-, Anterior wall -- -r-, - --:: -Apex or inlet -Floor Axillary inlet

A

• Lateral border of first Middle scalene muscle Anterior scalene muscle

Lateral margin of rib I

rib • Posterior surface of

Medial wall - - -+-+ ----,--- -.r""--;o~ the clavicle Lateral wall -- --+--+- Anterior wall ---+- -+---- • Superior border of the Scapula Anterior wall of axilla • Pectoralis major • Clavipectoral fascia enclosing pectoralis minor & subclavius

Cephalic vein Pectoral branch of thoraco-acromial artery

Glavipectoral triangle ---- -1---.a.:::..:::-=;------, t­ Cephalic vein Pectoralis minor - --- 4- ---':---;--:;;;;;:i;;;;c- --:;;-, - Clavicular head Clavipectoral fascia --- --t-i7-;'<; ;t--:-::­ Pectoralis major --- - -+ - -,-

Medial pectoral nerve

Attachment of fascia ------l-+--,r-- -;;iH t'-'71.. to floor of axilla

Pectoralis major Posterior wall

nsms,ol 1sluqs:ias1qu2 • Subscapularis svisn 1sluqs:i2s1qu2 • • Lattisimus dorsi,

e:isqa 1slu9ns1bsuP teres major avian l(l&llixs • sosqe 1slu9nsi1T- --!------' ' J ls1smu rt xeltmu::nl:i 1oi1st2oq • '{19tiS 1sluqs:i2 X9llmu:i,b • nisv i8 '(ISfls

------1---- lsvistn i 1sluensi1T • Long head of svisn lsibs1 • '(1911&ii rt:is1d sbnulo1q • triceps ------~-- - iirt:is,d 2qsoi1I 1o bssrt gnoJ Medial wall of the axilla

• Upper four ribs Long thoracic nerve

Intercostobrachial nerve with intercostal (lateral cutaneous branch of T2) muscles • Serratus anterior Lateral wall

• Upper part of shaft sulcus of humerus (bicipital groove) Pectoralis --+- ---+ major

eres major

Latissimus dorsi

Fig. 7.43 Lateral wall of the axilla. sheath

Axillary

fold

skin

on

axilla

skin

of

axillary fold

of

axillary

floor

skin

Dome

Anterior

Posterior Floor of the axilla Fascia & dome of skin Supported by clavipectoral fascia • • Omoh1Joid muscle.

Thoracoac:romial artery and cephalic 1Jein

...- Cla'.1k:le

,...... -.....- __.. Subcla'.1ius muscle and f.:1scia n

,· ,...... ----~------~ , , ..--- ____.Costocoracoid ligament ...... i:·:i

__..... __,/,.,.,.,,/ / -.- ~--_,,__/~/-/// _..----Costoooraooid membrane (") I ------

------Lateral peoor.:11 neriJe E:ody of sc.:1pul.:1 ------~------

1 / -~:::-:---~--~------___:__ ~__ .o.p:~ill.:1ry art1~r~~ -~nd 1. ein 1 .•. //// / _ ~ --- ector.:11s minor muse el J lntraspinatus muscle------_------·------Medi-:11 pectoral ner'.1e / / Subs,::.:1pularis muscle------_ ------~ Pectoral (anterior ~ Pectoralis major a:-:illary) lymph nodes muscle and fascia

T eres minor muscle

T eres major muscle Suspensory ligament of a:-:illa

A:-:illary fascia (fenestr ated) Central a:-:illary lymph nodes Horizontal section at the level of joint Pectoralis minor Disc of sternoclav icu lar joint head of biceps and coracobrachialis

Long head of biceps

-R Su bscapularis Axillary Suprascapular ne u rovascu lar Rhomboid major vessels and N. bundle Contents of axilla

• & it’s branches • & it’s branches • Infraclavicular part of brachial plexus • Axillary lymph nodes & lymphatics • Long thoracic nerve & intercostobrachial nerves • Fat & areolar tissue • Proximal parts of biceps brachii, coracobrachialis & axillary tail of breast Axillary artery

• Continuation of Subclavius Pectoralis minor

Superior thoracic artery subclavian artery Thoraco-acromial artery Subscapular artery

• Outer border of first Anterior circumflex humeral artery

Posterior circumflex humera l artery (quadrangular space) ---t---+-- - --'!!ll Latissimus dorsi ------+---- rib to lower border of Circumflex scapular branch --1>.s,1,111 -+-- --➔ (triangular space) Teres major------+- --_,.,__ teres major Thoracodorsal ar1ery ---, f-- - H' -t-,,-A--'t:I Profunda brachil artery -- ~~ (triangular interval) Axillary vein

• Continuation of scalene "" ~ Subclavian vein "-/j basilic vein Axillary vein • Receives tributaries Deltoid like venae comitantes of brachial artery, cephalic vein, veins corresponding to branches to axillary artery sheath

Axillary

fold

skin

on

axilla

skin

of

fold axillary

of

axillary

floor

skin

Dome

Anterior

Arm

Posterior Axillary sheath Derived from prevertebral layer of deep cervical fascia Envelops axillary artery & brachial plexus Axillary vein is not included • • • Axillary lymph nodes

Lyn:1ph\ 7essels and Nodes oflvlanm1a111 Gland • Anterior axillary • Posterior axillary • Central group • lateral group • Apical ch

n

bra

N. N.

N.

N.

c

i

cutaneous thoracic

intercoscal

intercostal 1

st Phren

Long

I

3rd

Lateral –T

.

N 5

lntercostobrachial

N.

N.

N. N.

N.

and

Nn.

arm

of

forearm

Radial

cutaneous

Brachial plexus N. cutaneous Median pectoral

of

Axillary

N.

Subscapular

Medial

Medial

thoracodorsal

Lateral

Musculocutaneous Formed by ant. Primary rami of C rami Formed by ant. Primary • • mnervates tne r11ombo 1d m c1ior <1nd m111or mu scle · muscle. Brachial plexus from Lhcir deep su rfaces.

I I A I Terminal I Cords Divisions Trunks : Roots nerves I Branches from roots- I : (anterior rami) I I I I Musculocutaneou4 lateral ~•oral nerve Su~asc.ipular 00 ~ Dorsal scapulat nerve I I ~ : ~ /___., CS I I I I :---~ I /<'.!,:, ~---~---~ .._,__._,,,.,.,.,,. _...A Contributlo • Long thoracic nerve Arlterior Supeno, ~ 10ph rer'llc: ·'-- :-. --..· nerve "'-.~·~✓77r- 1 1 , /, 1C6 A :N•Netosubdr•r -, Pos.terior ,. Middle C7i • Dorsal scapular 'I : ·r i l~ C8 Medial ____--_,~_-_-_- ,n:re-""'----.-;-~ I nerve I I J =I T1 : M,lo..l oect""1I I I Med~I cwant,u5-f'let\1'8'O J 3ml I I LOt'tgthOre.tic Medr Cllt.ll'\E'OUSn et,,e-Of forearm I Branches from trunks- I """"'

• Suprascapular B • Nerve to subclavius long thoracic nerw

tercostobrachial nerve ateral cutaneous branch of T2)

Medial cutaneous nerve of arm Median nerve

ord ord

l l c

d d

cor

l l

Media

Latera

ery ery

art

illary illary

Ax

arm arm

of of

cutaneous cutaneous

nerve nerve ateral ateral Branches of lateral cord Lateral pectoral nerve Musculocutaneous nerve Lateral root of median nerve • • •

ord ord

l l c

d d

cor

l l

Media

Latera

ery ery

art

illary illary

Ax

arm arm

of of

cutaneous cutaneous

nerve nerve ateral ateral Branches of medial cord Medial pectoral nerve Medial cutaneous nerve of arm Medial cutaneous nerve of forearm Ulnar Medial root of median • • • • • Branches of posterior cord

• Upper sub scapular • Thoracodorsal • Lower sub scapular • Axillary • Radial Other nerve supply of upper limb

• Supraclavicular branches from cervical plexus • Intercostobrachial nerve (lateral cutaneous branch of second intercostal nerve) Injuries to brachial plexus

• Erb’s paralysis Injury to upper trunk • Klumpke’s paralysis Injury to lower trunk • Injury to nerve to serratus anterior Winging of scapula Applied importance of axilla

• Boils • Axillary lymphadenopathy • Abscess