ANATOMY OF THE BREAST

DR. SHAHINDA AHMED ADEL

CONSULTATNT PEDIATRICIAN AND NEONATOLOGIST
MRCPCH
IBCLC
 BREAST ANATOMY
• BASIC UNITS ARE THE ALVEOLI(SECRETORY
ACINAR UNITS +DUCTULES )
• ALVEOLI JOIN TOGETHER LOBULES
SURROUNDED BY ADIPOSE AND
CONNECTIVE TISSUES.
• IN EACH BREAST, THERE ARE 15 TO 25
INTERWOVEN LOBES EACH CONTAINING
BETWEEN 10 AND 100 ALVEOLI.
 ALVEOLI (TERMINAL DUCT LOBAR UNIT)
ACINI + INTRALOBULAR AND EXTRALOBULAR DUCTS

Inner secretory luminal epithelial cells (LEP) lining the acini

(ductules). The outer layer is made of myoepithelial cells (MEP)
which are the contractile units. The basement membrane (BM) is
deep to the myoepithelial cell layer. ITD, intralobar terminal
duct; ETD, extralobar terminal duct.
 TERMINAL DUCTAL LOBULAR UNITS
The spaces around the lobules and the ducts are filled
with a stroma of adipose and connective tissue which sac-like acini that are responsible for milk
contain large numbers of lymphocytes and plasma cells. production, which are connected to the ductal
The latter increase in number at the start of lactation and system via the terminal duct.
are responsible for synthesis and release of the
immunoglobulins that convey passive immunity to the
new-born.

Two cell types line the ducts and lobules:

1.Columnar epithelium lines the lumen and is responsible
for milk production
2.Myoepithelial cells are present on the basement
membrane and contract to expel milk

Close to the opening of the lactiferous ducts on the nipple,

the lining changes to keratinised stratified squamous
epithelium, which is continuous with the external skin.
Within the ducts, this is shed and forms keratin plugs in
non-lactating breasts.
The breast is composed of approximately 15 to 20 lobes and these lobes are subdivided into lobules.
The lobules are made up of branched alveolar glands. Each lobe drains into a major lactiferous duct.
The lactiferous ducts dilate into a lactiferous sinus beneath the areola and then open through a
constricted orifice onto the nipple. The diagram shown is the breast in an inactive
state. (b) The terminal ductal–lobular unit (TDLU) refers to the basic functional unit of the breast with
30 to 50 alveolar or acinar cells grouped into a lobule and the associated ducts. A normal terminal
ductal lobular unit ranges between 1 and 4 mm in size.
 NIPPLE–AREOLAR COMPLEX
• AT FULL DEVELOPMENT  LOCATED AT THE FOURTH INTERCOSTAL SPACE
• 15 TO 20 SEGMENTS THAT CONVERGE AT THE NIPPLE IN A RADIAL ARRANGEMENT
• EACH BREAST HAS DUCT OPENINGS NIPPLE “PORES.”
• THE DUCTS ARE LINED WITH STRATIFIED SQUAMOUS EPITHELIUM NEAR THE NIPPLE, WITH COLUMNAR
EPITHELIUM AT MORE DISTAL AREAS, AND WITH HIGHLY VASCULAR CONNECTIVE TISSUE.
• THIS DUCTAL NETWORK CAN BE VERY COMPLEX AND HETEROGENEOUS AND MAY NOT ALWAYS
FOLLOW A PERFECT RADIAL PATTERN
• THE NIPPLE–AREOLAR COMPLEX CONTAINS MONTGOMERY GLANDS WHICH ARE EMBRYOLOGICALLY
BETWEEN SWEAT GLANDS AND MAMMARY GLANDS AND ARE CAPABLE OF SECRETING MILK.
• THE MONTGOMERY GLANDS OPEN AT THE MORGAGNI TUBERCLES, (SMALL RAISED PAPULES ON THE
AREOLA .THE SKIN OF THE NIPPLE IS CONTINUOUS WITH THE DUCTAL EPITHELIUM
• MONTGOMERY GLANDS IS A SCENT ORGAN AND THE FLUID FROM THEM PROVIDES A SENSORY
STIMULATION TO THE NEWBORN THAT NOT ONLY HELPS GUIDE HIM TO THE NIPPLES

The nipple and areola contain erectile smooth muscles.

Hair follicles surround the nipple and areola but are not within the nipple and areola proper.
Contraction of bundles of smooth muscles beneath the nipple and areola cause the nipple to be firm and
protruding.
 ADIPOSE TISSUE Cooper’s ligaments
• BETWEEN AND AROUND THE • Attaching the deep layer of the
UNEVEN EDGES OF THE LOBES IS subcutaneous tissue to the dermis of the
A THICK LAYER OF FAT. skin

• THE AMOUNT OF ADIPOSE

TISSUE PRESENT DIFFERS
CONSIDERABLY AMONG
WOMEN—IN SOME, FAT
COMPOSES AS MUCH AS HALF
OF THE BREAST.
• THE AMOUNT OF ADIPOSE
TISSUE DOES NOT AFFECT EITHER Axillary tail (of Spence): variable extension along the
THE BREAST STORAGE CAPACITY inferior edge of pectoralis major towards the axilla.
OR THE MILK PRODUCTION usually lies within the subcutaneous fat but may penetrate
the axillary fascia to lie adjacent to the lymph nodes.
Occasionally it is a separate entity with ducts that do not
drain to the nipple.
 BLOOD SUPPLY OF THE BREAST
There are three main arterial systems:
Internal Thoracic (mammary) Artery
• 60% of the vascular supply to the breast
• Arising directly from the subclavian artery,
• Passes posterior to the subclavian vein and runs along the edge of the sternum,
deep to the costal cartilages.
• Perforating branches pass through the 2nd to 6th intercostal spaces to supply
the medial half of the breast.
• The 2nd and 3rd perforators are the predominant vessels (preferred for
anastomosis when reconstructing the breast with a free tissue transfer.)

Lateral Thoracic Artery

• branch of the second part of the axillary artery Posterior Intercostal Arteries
• supplies the upper outer quadrant of the breast • lateral branch of the posterior
• runs along the lower border of the pectoralis minor intercostal arteries divides into
muscle and curls around the lateral border of pectoralis posterior and anterior branches
major to enter the breast.. • anterior branches from the 3rd-6th
intercostal spaces supply the lateral
Viability of the nipple areolar complex is dependent on vessels that portion of the breast and the overlying
pass through the gland, which must therefore be preserved. skin through their mammary branches.
 VENOUS DRAINAGE OF THE
BREAST
• SUPERFICIAL SYSTEM
LIES WITHIN THE SUBDERMAL VENOUS PLEXUS.
• DEEP SYSTEM
• PARALLELS THE ARTERIAL SUPPLY.
• THE MEDIAL HALF OF THE BREAST DRAINS VIA VEINS THAT
ACCOMPANY THE PERFORATING BRANCHES OF THE INTERNAL
MAMMARY ARTERY THROUGH THE INTERCOSTAL SPACES, BACK
TO THE INTERNAL THORASIC VEIN
• THE LATERAL THORACIC VEINS DRAIN INTO THE AXILLARY VEIN.
• THE POSTERIOR INTERCOSTAL VEINS DRAIN INTO THE
AZYGOUS VEIN ON THE RIGHT AND THE HEMIAZYGOUS VEIN
ON THE LEFT.
 LYMPHATIC VESSELS OF THE
BREAST
• THE LYMPH VESSELS OF THE BREAST JOIN THE LYMPH
NODES OF THE AXILLA.
• THE MAJORITY OF LYMPH VESSELS FOLLOW THE
LACTIFEROUS DUCTS  CONVERGE TOWARD THE
NIPPLE, JOIN A PLEXUS SITUATED BENEATH THE
AREOLA (SUBAREOLAR PLEXUS).

•Axilla: Lymph is drained from the nipple, areola and

glandular tissue to the subareolar lymphatic plexus. From
here, more than 75% of the lymph drains to the ipsilateral
axillary nodes, mainly via the anterior or pectoral nodes,
although some drains directly to the other axillary nodes.
•Contralateral breast: The remaining lymph, especially
from the medial half, drains to the parasternal nodes and
the opposite breast.
•Abdomen: Lymph from the inferior half can pass to the
abdominal lymph nodes and the inferior phrenic nodes.
 INNERVATION OF THE BREAST
• THE SENSORY NERVE SUPPLY IS DERIVED FROM
CUTANEOUS BRANCHES OF THE INTERCOSTAL
NERVES:
• MEDIALLY – ANTERIOR BRANCHES OF THE 1ST TO
6TH INTERCOSTAL NERVES
• LATERALLY – LATERAL BRANCHES OF THE 2ND TO
6TH INTERCOSTAL NERVES
• NIPPLE AREOLA COMPLEX – SUPPLIED BY THE
ANTERIOR BRANCH OF THE 4TH INTERCOSTAL NERVE.
THERE IS AN EXTENSIVE NERVE PLEXUS WITHIN THE
NIPPLE. THE SKIN OF THE NIPPLE AREOLA COMPLEX
.CONTAINS FREE NERVE ENDINGS, MEISSNER’S
CORPUSCLES AND MERKEL DISC ENDINGS
Merkel’s disks, which are unencapsulated, respond to light touch
Meissner’s corpuscles respond to touch and low-frequency vibration.
 INNERVATION OF THE BREAST
• THE AREOLA IS THE MOST SENSITIVE PART OF THE BREAST, THE SKIN
ADJACENT TO THE AREOLA IS LESS SENSITIVE, AND THE NIPPLE ITSELF
IS THE LEAST SENSITIVE.
• WOMEN WITH LARGER BREASTS REPORT LESS SENSATION THAN
WOMEN WITH SMALLER BREASTS
• THE FOURTH INTERCOSTAL NERVE PENETRATES THE POSTERIOR ASPECT
OF THE BREAST (LEFT BREAST AT 4 O’CLOCK, RIGHT BREAST 8 O’CLOCK)
AND SUPPLIES THE GREATEST AMOUNT OF SENSATION TO THE NIPPLE
AND TO THE
AREOLA

• MIDWAY TO THE NIPPLE AND AREOLA, THE FOURTH INTERCOSTAL

NERVE BECOMES MORE SUPERFICIAL. AS IT REACHES THE AREOLA, IT
DIVIDES INTO FIVE BRANCHES: ONE CENTRAL, TWO UPPER, AND TWO
LOWER. THE LOWERMOST BRANCH CONSISTENTLY PIERCES THE
AREOLA AT 5 O’CLOCK ON THE LEFT SIDE AND 7 O’CLOCK ON THE
RIGHT SIDE.
Any trauma to this nerve will cause
some loss of sensation in the breast
If the lowermost nerve branch is
severed, the mother will lose sensation
to the nipple and areola
 BREAST CHANGE DURING PREGNANCY
• BREASTS GROW LARGER, THE SKIN APPEARS THINNER, AND THE VEINS BECOME MORE PROMINENT.
• THE DIAMETER OF THE AREOLA INCREASES FROM ABOUT 34 MM IN EARLY PREGNANCY TO 50 MM
POSTPARTUM
• NIPPLES BECOME MORE ERECT, PIGMENTATION OF THE AREOLA INCREASES AND THE
MONTGOMERY’S GLANDS ENLARGE.
Serum prolactin levelsnipple growth
Serum human placental lactogen areolar growth the
Estrogen ductal system proliferation and differentiation
Progesterone promotes an increase in size of the lobes, lobules, and alveoli.
Adrenocorticotropic hormone (ACTH) and growth hormone combine
synergistically with prolactin and progesterone to promote mammary growth.