Breast

 Breast: most prominent superficial structures in the anterior thoracic wall,

especially in women
 Consist of glandular and supporting fibrous tissue embedded within a fatty
matrix, together with blood vessels, lymphatics and nerves
 Well developed in women, less in male
 Breast in male:
o Rudimentary and functionless
o Consisting of only a few small ducts or epithelial cord
o The fat present in male breasts is not different from that of
subcutaneous tissue elsewhere
o Glandular system does not normally develop
 Located in subcutaneous tissue overlying the pectoralis major and minor
muscles
 Greatest prominence: nipple
 Nipple surrounded by a circular pigmented area of skin called areola
 Female breast:
o Amount of fat surrounding the glandular tissue determines the size of
non-lactating breasts
o The roughly circular body of the female breast rest on a bed of the
breast
o Bed of the breast extends transversely from the lateral border of the
sternum to the midaxillary line and vertically from the second through
sixth ribs
o 2/3 of the bed are formed by the pectoral fascia overlying the
pectoralis major; the other third, by the fascia covering the serratus
anterior
o Between the breast and the pectoral fascia is a loose subcutaneous
tissue plane or potential space-the retromammary space (bursa), which
containing a small amount of fat, allows the breast some degree of
movement on the pectoral fascia
o A small part of the mammary gland may extend along the inferolateral
edge of the pectoralis major toward the axillary fossa (armpit),
forming an axillary process or tail (of Spence). Some women
discover this (especially when it may enlarge during a menstrual
 cycle) and become concerned that it may be a lump (tumor) or
enlarged lymph nodes
o The mammary glands are firmly attached to the dermis of the
overlying skin, especially by substantial skin ligaments (L. retinacula
cutis), the suspensory ligaments (of Cooper).
o These condensations of fibrous connective tissue (the suspensory
ligaments (of Cooper)), particularly well developed in the superior
part of the gland, help support the lobes and lobules of the mammary
gland
o During puberty (ages 8–15 years), the breasts normally enlarge, owing
in part to glandular development but primarily from increased fat
deposition.
o The areolae and nipples also enlarge.
o Breast size and shape are determined in part by genetic, ethnic, and
dietary factors
o The lactiferous ducts give rise to buds that develop into 15–20
lobules of the mammary gland, which constitute the parenchyma
(functional substance) of the mammary gland
o Thus each lobule is drained by a lactiferous duct, all of which
converge to open independently.
o Each duct has a dilated portion deep to the areola, the lactiferous
sinus, in which a small droplet of milk accumulates or remains in the
nursing mother.
o As the neonate begins to suckle, compression of the areola (and
lactiferous sinus beneath it) expresses the accumulated droplets and
encourages the neonate to continue nursing as the hormonally
mediated let-down reflex ensues.
o The mother’s milk is secreted into—not sucked from the gland by—
the baby’s mouth
o areolae contain numerous sebaceous glands, which
enlarge during pregnancy and secrete an oily substance that
provides a protective lubricant for the areola and nipple.
o areola and nipple are particularly subject to chaffing and irritation as
mother and baby begin the nursing experience
o nipples are conical or cylindrical prominences in the centers
of the areolae
 o Nipples have no fat, hair, or sweat glands.
The tips of the nipples are fi ssured with the lactiferous ducts
opening into them
o Nipples are composed mostly of circularly arranged smooth muscle
fibers that compress the
lactiferous ducts during lactation and erect the nipples in
response to stimulation, as when a baby begins to suckle
o Mammary glands are modified sweat glands; therefore, they have no
capsule or sheath
o The rounded contour and most of the volume of the breasts are
produced by subcutaneous fat, except during pregnancy when the
mammary glands enlarge and new glandular tissue forms
o The milk-secreting alveoli (L. small hollow spaces) are arranged
in grape-like clusters. In most women, the breasts enlarge
slightly during the menstrual period from increased release
of gonadotropic hormones—follicle-stimulating hormone (FSH) and
luteinizing hormone (LH)—on the glandular tissue

 Vasculature of breast
o Arterial supply
  Medial mammary branches of perforating branches
and anterior intercostal branches of the internal thoracic
artery, originating from the subclavian artery
 Lateral thoracic and thoraco-acromial arteries, branches
of the axillary artery
 Posterior intercostal arteries, branches of the thoracic
aorta in the 2nd, 3rd, and 4th intercostal spaces
o venous drainage of the breast: mainly to the axillary
vein, but there is some drainage to the internal thoracic vein
o Lymphatic drainage
 Lymph passes from the nipple, areola, and lobules of the
gland to the subareolar
lymphatic plexus
 Most lymph (>75%), especially from the lateral breast
quadrants, drains to the axillary lymph nodes, initially to
the anterior or pectoral nodes for the most part. Some lymph
may drain directly to other axillary nodes or even to
interpectoral, deltopectoral, supraclavicular, or inferior deep
cervical nodes
 Most of the remaining lymph, particularly from the medial
breast quadrants, drains to the parasternal lymph nodes
or to the opposite breast, whereas lymph from the inferior
quadrants may pass deeply to abdominal lymph nodes (sub
diaphragmatic inferior phrenic lymph nodes)
 Lymph from the skin of the breast, except the nipple and
areola, drains into the ipsilateral axillary, inferior deep
cervical, and infraclavicular lymph nodes and into the
parasternal lymph nodes of both sides
 Nerves
o Derive from anterior and lateral cutaneous branches of the 4th–6th
intercostal nerves
o The branches of the intercostal nerves pass through the pectoral
fascia covering the pectoralis major to reach overlying subcutaneous
tissue and skin of the breast. The branches of the intercostal nerves
convey sensory fibers from the skin of
the breast and sympathetic fibers to the blood vessels in the
breasts and smooth muscle in the overlying skin and nipple