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Transcript of Breast anatomy
Dr. Ahmed Al-Zahrani
-The adult female breast is located within the superficial fascia of the anterior chest wall.
-The base of the breast extends from :
the 2nd rib superiorly to the 6th or 7th rib inferiorly.
and from the sternal border medially to the midaxillary line laterally.
Deep pectoral fascia
Medial 1/2 of clavicle.
lateral half of sternum, 2nd to 6th costalcartilages, aponeurosis of extenal oblique muscle.
lateral lip of bicicpital groove of humerus.
Nerve supply :
medial & lateral pectoral nerve (C5,6,7,8 & T1)
Shaped like a pyramid with an apex, a base, and four walls.
Contents of the axilla
a. Lies in superficial fascia of the pectoral region (except for tail)
b. Axillary tail of Spence pierces the deep fascia & lies in the deep fascia
c. Deep relations
i. Pectoral fascia: the deep fascia which the breast lies on
ii. Muscles which lies deeper to the breast
1. Pectoralis major
2. Serratus anterior
3. External oblique
iii. Retro mammary space: loose
areolar tissue which separates the breast from the pectoral fascia
3rd,4th and 5th rib.
cricoid process of scapula.
Nerve supply :
medial pectoral nerve (C6,7,8)
Upper eight ribs.
medial border and inferior angle of scapula
Nerve supply :
Long thoracic nerve (5,6,7).
axillary artery and its branches
axillary vein and its tributaries.
lymph vessles and axillary ly
lower 1/3 of lateral border of scapula
medial lip of bicicpital groove of humerus.
Nerve supply :
lower subscapular nerve (C6,7)
spines of lower six vertebrae
lower three or four ribs
inferior angle of scapula
floor of bicibtal groove of humerus.
Nerve supply :
Thoracodorsal nerve ( C6,7,8 )
at the lateral border of first rib as a continuation of the subclavian.
at the lower border of teres major muscle.
closely related to the cords of brachial plexus and their branches (enclosed with the in axillary sheath)
the pectoralis minor muscle crosses in front of it and divides it into three parts.
- Highest thoracic artery.
- Thoracoacromial artery.
- Lateral thoracic artery.
- Subscapular artery.
- anterior and posterior circumflex humeral arteries.
arise from the posterior cord of brachial plexus and runs downward to supply latissimus dorsi.
lies on the subscapularis muscle .
If it is cut, internal rotation and abduction will be weakened, although there is no deformity.
The nerve and its associated vessels can be found near the medial border of the latissimus dorsi about 5 cm above a plane passing through the 3rd sternochondral junction.
Long thoracic nerve
(C5,6,7) arise from the roots of the brachial plexus in the neck and enters the axilla by passing down over the lateral border of the first rib behind the axillary vessels and brachial plexus, descend over the lateral surface of SERRATUS ANTERIOR, which it supplies.
Section of the nerve results in the “winged scapula” deformity.
Unless actually invaded by cancer, this nerve should be spared.
The landmark for locating the nerve: is the point at which the axillary vein passes over the 2nd rib. Careful dissection of this area will reveal the nerve descending on the 2nd rib posterior to the axillary vein.
Lateral Pectoral Nerve
arise from the lateral cord of brachial plexus
supply of the clavicular as well as of the sternal portions of the pectoralis major muscle, superficial to the axillary vein and lies at the medial edge of the pectoralis minor.
Medial Pectoral Nerve
arise from the medial cord of brachial plexus
pierces the pectoralis minor and supplies pectoralis Major & minor.
superficial to the axillary vein and lateral to the pectoralis minor muscle.
Formed at the lower border of teres major muscle by the union of the venae comitantes of the brachial artery and basilic vein.
: runs upward on the medial side of axillary artery .
at the lateral border of 1st rib by becoming subclavian vein.
receives tributaries which correspond to the branches of axillary artery and the cephalic vein.
enter the breast from its superomedial and superolateral aspects.
The blood supply is from:
- the medial mammary branches of the
internal thoracic artery
- lateral mammary branches of
lateral thoracic artery
- lateral cutaneous branches of the
posterior intercostal arteries
The axillary, internal thoracic, and the 3rd to 5th intercostal veins drain the mammary gland.
These veins follow the arteries.
Axillary Lymph Nodes
Pectoral (or anterior) lymph nodes
Along the medial wall of the axilla
From - anterior thoracic wall, including from the mammary gland
To – central and apical lymph node groups.
Scapular (or posterior) lymph nodes
Along the margin of the posterior axillary wall of the axilla
From – posterior thoracic wall and the periscapular region
To – central and apical lymph node groups
Central lymph nodes
3 large LN
deeply in relation to the pectoralis minor muscle, close to the base of the axilla
From- all others
To – apical lymph nodes
Interpectoral nodes (Rotter’s nodes)
These lie between the pectoralis major and minor muscles.
Often there is a single node.
They are the smallest group of the axillary nodes and
will not be found unless the pectoralis major is removed.
Humeral (or lateral) lymph nodes
medially and posteriorly to the axillary vein,
From – upper limb, except the lymph transported by the lymphatic vessels that accompany the cephalic vein
To – apical lymph node groups.
Apical lymph nodes
From – all axillary LN
To - right side into the right lymphatic duct (ductus lymphaticus dexter), and on the left side into the thoracic duct.
Then into the confluence at the junction of
the internal jagular vein and subclavian vein
Levels Of Axillary Lymph Nodes
Each breast is composed of between 15 and 20 lobes
Each lobe has a duct terminating at the nipple.
each duct has a dilation called a lactiferous sinus near its termination
These lobes, together with their ducts, are anatomical but not surgical units.
Morphology Of The Breast