Mammary gland

Dr. Shilpa Gosavi

 Learning objectives
•Classification
•Size and shape
•Situation and extent
•Relations
•Blood supply
•Lymphatic drainage
•Applied importance

•Competencies – AN 9.1, 9.2, 9.3, 10. 4, 10.7

Pectoral region

Bony
landmarks

Midclavicular line

Mid axillary line

Axilla
Anterior axillary line
Anterior axillary fold
Posterior axillary line
Mid axillary line
Posterior
axillary fold
Mammary gland
•Secondary sexual character in
females
•Present in both sexes
•Well developed in females after
puberty
•Rudimentary in post pubertal
males
•Classification:
➢ Modified sweat gland
➢ Apocrine gland
•Situation: in superficial
fascia of Pectoral region

•Extent
•Vertical
•Horizontal

•Size and Shape:

•Parts:
Mammary gland - parts

Axillary
Nipple fascia
Areola
Lobes Tail of
Spence

Foramen of
Langer’s
 Mammary gland – relations
Pectoralis major Axillary
+ Fascia fascia

Pectoralis
minor Tail of
Spence
Clavipectoral
fascia
Foramen of
Langer’s
Retromammary
space
Mammary gland - relations

N. To Serratus
anterior

P. major

Serratus
anterior
Ext. oblique
 Mammary gland - structure

Parenchyma Stroma

Glandular Fibrous Interlobular

tissue connective adipose
tissue tissue
The part which
secretes
Support
Alveoli,
ducts, lobules & lobes
 Mammary gland - structure

Stroma
(Supporting part) Suspensory lig.
Fibrous stroma
Fatty stroma

Lactiferous
duct

Parenchyma Lobes
(Secretory part)
 Mammary gland - structure

Lobes Alveoli

Lactiferous
Lactiferous
sinus
duct opening
at nipple
 Mammary gland – Blood supply
Arterial supply
B/o Axillary A
Sup. Thoracic A.
B/o Internal
Acromio
thoracic A.
thoracic A.
Perforating br. –
Lateral thoracic 2,3,4th ICS
A.

B/o Post. Intercostal A. –

2, 3, 4th ICS
 Mammary gland – Blood supply
Azygos V. Internal
vertebral
Post. venous plexus
Intercostal V.
Axillary V.

Internal
thoracic V.

Route of spread
Circulus venosus of cancer cells

Venous drainage
Nerve supply

•Ant. And Lat. Cutaneous br. of T4-T6 spinal

nerves contain –
Somatic –for skin
Sympathetic – for smooth muscles and blood
vessels
•Secretions – under hormonal control
(Prolactin from Ant. Pituitary)
 Lymphatics from skin

Apical
Supraclavicula
Infraclavicular

Central

Lateral
Posterior

Superficial lymphatics Ant. group

Deep lymphatics
Lymphatics from skin
Supraclavicular
Upper medial
Upper lateral
Internal
mammary
Axillary

Lower lateral Lower medial

Subdiphragmatic
or
Subperitoneal
 Lymphatics from Parenchyma +
Nipple + Areola
Intercostal
Apical 5%
Axillary Internal
nodes 75% mammary
Ant. 20%
group
Subareolar
plexus of Sappy
 Lymphatic drainage

•Important due to spread of cancer via

lymphatics
•Mainly drained into Axillary nodes and Internal
mammary nodes.
•Other nodes- Supraclavicular nodes
Infraclavicular nodes
Post. Intercostal nodes
Subdiphragmatic nodes
Peritoneal nodes
Sequence of lymphatic drainage in axillary LN

Posterior Lateral
Anterior Central
Apical

Supraclavicular

Lt.----Thoracic duct
Rt. ----Lymphatic trunk
Lymphatic drainage
Lymphatics from the deep surface of the gland

Apical lymph nodes

Clavipectoral fascia
 Age changes
• At birth – Lactiferous ducts +
- No alveoli
- Areola +
- Nipple +
• At puberty – Branching of ducts
- Fat deposition
- Increase in fibrous stroma
• During pregnancy – Increase fat
(Oestrogen, Secretory alveoli develop
Progesteron)
 Age changes

• During lactation – Distended alveoli

• After lactation – Alveoli shrink
- Glandular tissue returns to
resting condition
• Elderly females – Small & Wrinkled
- Decrease in fat
- Decrease glandular tissue (atrophy)
• Colostrum
• Witch’s milk
Applied anatomy of
Mammary gland
 Applied Anatomy

Features of Cancer breast :

1. Developmental Anomalies
➢Retraction and puckering of
▪ Amazia overlying skin
▪ Polymazia ➢Retraction of nipple
▪ Athelia ➢Fixation of the breast
▪ Polythelia ➢Peau’d orange or oedema with
2. Gynaecomastia pitting
3. Incision for breast abscess ➢Involvement of Axillary nodes
4. Mammography ➢Secondaries / Metastasis
5. FNAC –Fine needle 8. Discharge from nipple
aspiration biopsy 9. Mastectomy – Simple / Radical
6. Carcinoma breast 10. Breast prosthesis
Development of mammary gland
Congenital anomalies

• Amastia
• Polymastia
• Athelia
• Polythelia
Gynacomastia

• Physiological
• In conditions like -
Klinfelter’s
syndrome/ Adrenal/
Pituitary diseases /
Liver failure
Breast abscess

Drainage of
Breast breast abscess
Mastitis
abscess
Radiating
incision – along
the ducts - to
avoid injury to
lactiferous ducts
 Radiological procedure to
Mammography detect breast tissue
abnormalities
FNAC –Fine needle aspiration biopsy

Examined under microscope for

detection of pathology
 Carcinoma breast
most common type of cancer in females

• Lump/ swelling in breast –

• Swelling under armpit/ axilla
• Change in size of one breast
• Puckering or dimpling of skin
• Nipples becoming inverted/ change in
shape or position
• Breast becoming immobile or fixed
• Discharge from nipple
Swelling in the breast –
• Hard
• Painless
• Commonly in upper and outer
quadrant

Swelling in axilla–
• Involvement of axillary lymph
nodes
Immobile and fix breast tissue –
involvement of pectoralis muscle and
fascia

Dimpling of skin – involvement of skin

Peu-de-orange appearance of skin

– involvement of superficial
lymphatics – edema of skin
Retraction of nipple – fibrosis of lactiferous duct
and suspensory ligaments
Nipple may become inverted
Change in position
Change in size of one breast
Discharge from nipple
Self examination

Early detection can save life

 Mastectomy

Simple mastectomy Breast tissue is removed

with nipple and areola

Radicle mastectomy Breast tissue is removed

with nipple, areola,
axillary lymph nodes and
P. major muscle
Breast implant
Implant is kept in retromammary space – between
pectoralis major muscle and breast tissue
Thank you