Breast Structure and

Development
Dr. Tin Swe Aye
Learning outcomes

Describe the gross anatomy and

histology of the breasts

Describe breast development

Describe the clinical importance of

lymphatic drainage of the breast
 Breast / Mammary Gland

• Specialized accessory gland of the skin or

modified sweat gland
• Males and females breasts before puberty –
similar in structure
• At puberty – females breasts gradually enlarge
and assume their hemispherical shape

3
 Development Around 6th week of
gestational age
• All Milk Line cells have
potential to become breast
tissue
• Normally regresses except Upper limb bud
for in the midthoracic
region
• The milk line as the
primitive structure
Milk Line
mammary ridge
ECTODERM

Lower limb bud

 Mid-thoracic Mammary tissue
region

Milk Line

9th week involutes sparing the chest area

 Development
• 2 – 6% Failure to
involute
• Presents with super
numerary breasts
and nipples
• This can occur all the
way along the milk
line.
 Development

• Extrammamary
tissue
(polimastia)

• Amastia
Bilateral accessory breasts
Polymastia
 Development

• Polymastia
 Polythelia and polymastia
• Polythelia
– Milk lines fail to regress
– Supernumerary nipples
– 7-10cm below typical
nipple position

• Polymastia
– Supernumerary breast
tissue
– Normally present above
typical breast position
 Development

• Accessory nipples
(Polythelia)
Supernumerary nipples
Supernumerary nipples
 Amastia
• Milk lines completely
regress – Amastia (no
breast tissue forms) –
can be unilateral or
bilateral
• Associated with
failure to develop
pectoralis major
 Breast development
Transverse section

Epidermis of skin
ECTODERM Mid-thoracic
region

Primary bud Mesenchyme

ECTODERM
Invading underlying
mesenchyme
Describe breast development
 Development mammary pit

Epidermis
Primary bud

• Around the 12th week,

Secondary bud
epithelium starts to in
grow and form the
mammary pit.
• Giving origin to Mesoderm

lactiferous sinus, ducts

and lobules.
 Breast development
Epidermis of skin
Mammary pit – site of developing breast tissue
ECTODERM

Primary bud
Transverse section
proliferates

15-20
Secondary buds
ECTODERM

Describe breast development

inverted nipples
 BONES
• STERNUM
– manubrium
– xiphoid process
• SCAPULA
– spine
– medial border
– inferior angle
• RIBS

Human Anatomy, Larry M.

Frolich, Ph.D.
 Female Breast Contact
anterior Axillary
anatomy Lymph nodes

“Rounded eminence”
• Female breast
is comprised
from rounded
eminence and Areola

axillary tail
Nipple Axillary tail
of Spence

Describe the gross anatomy and histology of the breasts

 Breast
anatomy -
examination
• Five regions: Axillary tail
Upper inner

• 4 Quadrants plus Upper outer

axillary tail
• Upper inner
• Upper outer
Lower outer
• Lower inner Lower inner

• Lower outer

Describe the gross anatomy and histology of the breasts

 Breast quadrants

• It is important for
description of
tumors and cyst
• Approximately 60%
of carcinomas of
the breast occur in
the superior lateral
quadrant

22
 CRRM2 Thoracic wall
Rib 2 Subclavius

Intercostal muscle Female Breast

Pec Minor anatomy
Pec Major Describe the gross anatomy
Fatty tissue and histology of the breasts

Montgomery’s tubercles - sebum

Areola Erectile smooth

muscle
Nipple (Longitudinal,
Retromammary
space circular)

15-20 lactiferous ducts

Rib 6
Suspensory ligaments of Cooper

Terminal ductules –
Superficial fascia where breast cancer develops
Lateral
view Deep fascia Potential secretory alveoli
 Side view of female Breast
1. The base of the breast extends from the
second to the sixth rib and from the
lateral margin of the sternum to the
midaxillary line.

2. The greater part of the gland lies in the

superficial fascia and can be moved freely
in all directions

3. Two thirds of the bed of the breast are

formed by the pectoral fascia overlying
the pectoralis major; the other third, by
the fascia covering the serratus anterior
 Anatomy
4.Fixed to skin & underlying fascia by
fibrous C.T. bands
a. Cooper’s (Suspensory)
Ligaments
b. Ligaments may
retract when
breast tumors are present

5.The mature breast lies

in adipose tissue between the sub
cutaneous fat layer and
the superficial pectoral fascia.
6.The retromammary space, between the breast and
pectoralis major, contains lymphatics and small vessels.
Clinical importance of suspensory ligament:
 During cosmetic breast surgery usually stretching this ligament.

 Suspensory ligaments of Cooper’s – lobes of the gland are separated by fibrous

septa serve as suspensory ligaments. Mammary gland is firmly attached to the
dermis of the overlying skin by this ligament
26
 Separated from pectoralis major muscle by fascia, retromammary space

Clinical importance of retromammary space:

 During removal of the breast, the breast is separated from the pectoral
muscle in the plane of this space
Retromammary space – between the breast and the pectoral fascia is a loose
connective tissue plane or potential space, containing small amount of fat,
lymphatics and small vessels
27
 Axillary tail
• Nipple – greatest prominence of the breast
• Areola – circular pigmented area around the
nipple

• Areolar glands – tiny tubercles on the

areola

• Axillary tail – small part of mammary

gland may extend along the inferolateral edge of
the pectoralis major toward the axillary fossa
a. prolongation of upper, outer quadrant in
axillary direction
b. Passes under axillary fascia
c. May be mistaken for axillary lymph nodes

28
 The resting
The resting female
female
breast
breast
 Breast Anatomy
Areola: contains dark pigment that intensifies with pregnancy
a. Circular and radial smooth muscle fibers
b. Cause nipple erection
 Female Secretory lobe

Breast Fibro-fatty tissue

anatomy Lactiferous duct

Areolar sebaceous gland

Lactiferous sinus - artefact

Nipple

Describe the
gross anatomy
and histology of
the breasts
Extension and Parts

32
 Each breast consists of ~ 20 lobes
of secretory tissue

a. Each lobe has one lactiferous duct

b. Lobes (and ducts) arranged radially
c. Embedded in connective tissue & adipose of
superficial fascia
d. Lobes composed of lobules
e. Lobules comprise alveoli
Breast lobes and lobules

• One lobe per

lactiferous duct
(15-20 per
breast)

• Lobules form at
branches into
terminal ductules
 Mammary Glands
• Lactiferous duct – the main duct from each lobe opens on the summit of
the nipple and possesses a dilated ampulla or lactiferous sinus
• Lobes or lobules – 15 to 20 lobes, radiate out from the nipple, constitute
the parenchyma of the mammary gland
• Lactiferous (modified sweat) Glands
• Breast made of 15-25 lobes (each a compound alveolar gland)
• Lobes made of lobules called acini, alveoli
• Acini/Alveoli lined w/milk-secreting simple epithelial cells
• Lactiferous Ducts of lobes open at nipple
• Areola-ring of pigmented skin around nipple
– Sebaceous gland produce sebum during nursing
• Lobes separated by adipose tissue and suspended by connective tissue =
Suspensory Ligaments of the Breasts
Human Anatomy, Larry M. Frolich, Ph.D.
 Changes in the breast

• Before puberty - the mammary glands in both

sexes are composed only of lactiferous sinuses
near the nipple, with small, branching ducts
emerging from these sinuses

• Puberty – in female, glandular development,

primarily fat deposition. Areola and nipple
also enlarge.

37
Mastitis : witches milk
Galactorrhoea in a non pregnant woman
Breast Examination Exam
 Describe the clinical
Lymphatic Sternocleidomastoid
importance
of lymphatic drainage of
drainage the breast
Clavicle
Deltoid
Infraclavicular lymph nodes (LN)
Pec. Minor
Cut edge of Pec. Major

Apical axillary LN (Lev3) 2-3 Level 3

nodes

Axillary Central 5 Level 2 nodes

vein axillary LN (Lev2)
75% of breast
Lateral lymph drains to
axillary LN (Lev1) axillary lymph
nodes
Anterior
axillary LN (Lev1) Level 1 > 2 >3

Posterior axillary LN (Level 1) 13 Level 1 nodes

 NME1.13
Lymphatics
The lymphatic system
and breast cancer metastasis
• 75% of drainage from the
breast goes to axillary Axillary nodes
lymph nodes
• 25% drains to Parasternal
nodes
parasternal nodes
 Cancer metastasis from
breast most likely to axilla
 Can spread from breast to
breast via parasternal
nodes
 Can also spread to
abdomen via diaphragm
Describe the clinical importance
of lymphatic drainage of the breast
 NME2.13
Lymphatics

Lymphatic drainage of the breast

Mammogram

Describe the clinical importance of lymphatic drainage of the breast

Vessels
1. Arteries: derived from thoracic branches of
three pairs of arteries
a. Axillary arteries
1) continuous with subclavian a.
2) gives rise to external mammary ( = lateral thoracic) artery

b. Internal mammary (thoracic) arteries

1) first descending branch of subclavian artery
2) supply intercostal spaces & breast
3) used for coronary bypass surgery

c. Intercostal arteries:
1) numerous branches from internal & external mammary arteries
2) supply intercostal spaces & breast
 Veins draining the Breast

Subclavian vein

External
mammary vein
 Describe the gross anatomy
and histology of the breasts
Male breast anatomy
and gynecomastia
Gynecomastia
Rudimentary
• During puberty 30- Lactiferous
ducts
60% males have Areola

enlargement of
Nipple
breast tissue

Male breast tissue

– lateral view
Male puberty & Gynaecomastia
Hypertrophy
Gynecomastia = in males

Other causes
1)testicular or pituitary tumor
2) cirrhosis
3) hypogonadism = not enough testoste
4) estrogen administration for
prostate cancer
 Signs of breast cancer

• Inversion of nipple
• Skin dimpling
• Peau d’orange

• Caused by changes in
underlying structure
 Clinical importance

Edema of skin
accompanied by
erythema

Tumors under the areola may result in

retraction of the nipple

Edema of the skin due to cutaneous lymphatic blockage

50
Mammogram
 Clinical importance

 Inverted nipple: congenital or due to cancer

 Carcinoma of the breast
 Ectopic nipple: a. “polythelia” or “hyperthelia”
b. additional nipples along milk line
 Supernumerary nipples – accessory nipples
 Polythelia – more than one nipple serving a single breast
 Polymastia – accessory breast tissue
 Amastia
 Athelia
 Gynecomastia 52
Overgrowth of areolae during puberty
Breast cancer & Inversion of Nipple
Rembrandt’s Bethsheba: Breast cancer
Carcinoma of breast,

Physical signs:
a. Slowly growing, painless mass
b. May demonstrate retracted nipple
c. May be bleeding from nipple
d. May be distorted areola, or breast contour
e. Skin dimpling in more advanced stages with
retraction of Cooper’s ligaments
f. Edema of skin
1)with “orange skin” appearance
(peau d’orange)
2) due to blocked lymphatics
g.Enlarged axillary or deep cervical lymph nodes
Breast carcinoma & skin dimpling
Breast cancer & Peau D’orange
Male breast
cancer
 References

• Clinically oriented Anatomy - Keith L. Moore,

5th edition

• Clinical Anatomy - Richard S. Snell, 7th edition

• Townsend: Sabiston Textbook of Surgery,

18th ed.

• Bland: The Breast, 4th ed.

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 Interactive atlas of histology

• Chapter 17

• http://mbbs-
tutorials.ncl.ac.uk/resources/Tutori
als/content/GH/Atlasv2.1GHSV.swf
THANK YOU