Mammary

Gland
 OBJECTIVES
• By the end of the lecture, the student should be
able to:
Describe the shape and position of the female breast.
Describe the structure of the mammary gland.
List the blood supply of the female breast.
Describe the lymphatic drainage of the female breast.
Describe the applied anatomy in the female breast.
 BREAST (MAMMA)
1. Introduction
2. External features
3. Nipple (Mammila/ MP)
4. Areola
5. Internal structure
6. Functions
7. Arterial supply
8. Venous drainage
9. Nervous supply
10.Lymphatic drainage
11.Male breast
12.Applied anatomy
 INTRODUCTION
Mammary Glands exist in both sexes.

Rudimentary in males throughout life

Start developing at puberty in females

Most of the development occurs during

later months of pregnancy and lactation
Introduction
 INTRODUCTION
 Modifications of sweat glands
 Ectodermal in origin
 noncapsulated
 Most prominent superficial
structures
 Variable shape & size- depend on
genetic, racial, dietary, age, parity,
menopausal status
 Shapes- hemispherical, conical,
pendulous, piriform, thin, flattened
Different shapes & sizes
 EXTERNAL FEATURES
 Lie within superficial fascia
 Base extends vertically from 2-6th rib,
transversely from sternal edge – mid axially
line (MAL)
 Axillary tail of Spence
 Lies upon deep pectoral fascia (DF)
 Pectoralis major, serratus ant,
abdominal ext oblique
 Retromammary space-b/w breast & DF
 At the greatest prominence-nipple,
surrounded by the areola
STRUCTURE OF MAMMARY
GLAND
 It is non capsulated gland.
 It consists of lobes and
lobules which are embedded
in the subcutaneous fatty
tissue of superficial fascia.
 It has fibrous strands
(ligaments of cooper) which
connect the skin with deep
fascia of pectoralis major.
 It is separated from the deep
fascia covering the underlying
muscles by a layer of loose
areolar tissue which forms the
retromammary space. What is
its Importance?
STRUCTURE OF MAMMARY
GLAND
 It is formed of 15-20 lobes.
 Each lobe is formed of a
number of lobules.
 The lobes and lobules are
separated by interlobar and
interlobular fibrous & fatty
tissue, called ligaments of
Cooper. (Importance)?
 It has from 15-20 lactiferous
ducts which open by the same
number of openings on the
summit of the nipple.
STRUCTURE OF MAMMARY GLAND
• It consists of lobes
and lobules which
are embedded in the
subcutaneous fatty
tissue of superficial
fascia.
• It has fibrous strands
(ligaments of cooper)
which connect the
skin with deep fascia
of pectoralis major.
STRUCTURE OF MAMMARY GLAND
• It is separated from
the deep fascia
covering the
underlying muscles
by a layer of loose
areolar tissue which
forms the
retromammary
space. What is its
Importance?
STRUCTURE OF MAMMARY GLAND
• It is formed of 15-20
lobes.
• Each lobe is formed of a
number of lobules.
• The lobes and lobules are
separated by interlobar
and interlobular fibrous
& fatty tissue, called
ligaments of Cooper.
(Importance)?
STRUCTURE OF MAMMARY
GLAND
• It has from 15-20
lactiferous ducts
which open by the
same number of
openings on the
summit of the
nipple.
POSITION
 2/3 of its base lies on
the pectoralis major
muscle, while its
inferolateral 1/3 lies on:
 Serratus anterior &
 External oblique
muscles.
 Its superolateral part
sends a process into
the axilla called the
axillary tail or
axillary process.
 NIPPLE/MAMMILLA/MAMMARY PAPILLA
 Projects centrally from the anterior
aspect
 Variable shapes- cylindrical, conical to
flattened
 Variable locations- in men & most
young women & nulliparous- 4 ICS,
~10cm from AML
 Capable of undergoing sort of erection
from mechanical excitement
 Devoid of fat, hair & sweat gland
NIPPLE
• The nipple lies opposite
4th intercostal space.
• It carries 15-20 narrow
pores of the lactiferous
ducts.
• Areola :
• It is a dark pink
brownish circular area of
skin that surrounds the
nipple.
 Nipple (ctd.)
 Epidermis has a deeply folded base
interdigitating with dermal papillae
 Scattered sebaceous glands open on
to its surface
 Numerous melanocytes
 Internally composed of numerous
collagenous dense CT & numerous
elastic fibers which spread beneath
areola, wrinkling the overlying skin
 Smooth muscle cells- disposed in a
predominantly circular direction &
radiating out from its base into the
surrounding breast.
 Their contraction, induced by
cold/tactile/emotional stimuli causes
erection of nipple & wrinkling of
surrounding areola.
 Lactiferous ducts traverse nipple, their
15-20 minute orifices opening on to its
wrinkled tip.
 AREOLA
 Discoid area of skin encircling
base of nipple
 Colour varies- parity & race
 Darkening of nipple & areola
occurs in 2nd month of cyesis;
though it becomes a little paler
after paturition, colour change is
permanent.
 Areola (ctd.)
 Many sebaceous glands, greatly
enlarged in cyesis & lactation as
subcutaneous tubercles; oily secretion a
protective lubricant in lactation.
 Areola glands of Montgomery-
intermediate in structure b/w lactiferous
& sweat glands.
 At perimeter of areola are large sudorific
& sebaceous glands.
 It as about 22-60mm in diameter
 INTERNAL ORGANIZATION OF
THE BREAST

Breast contains

1. Glandular tissue
2. Stroma
3. Adipose tissue
 GLANDULAR TISSUE
 Consists of branching ducts &
terminal lobules.
 Ducts converge on to the 15-20
larger lactiferous ducts which open
on to the apex of the nipple.
 Deep to the areola, each duct has a
dilated portion, the lactiferous
sinus.
 glandular tissue (ctd.)
 Lobules— portions of gland that are
secretory (or with potential to do so).
 Each lobule made up of numerous
blind-ending branches or expansions—
alveoli/acini, converging on an alveolar
duct.
 Close to openings of lactiferous duct
on nipple stratified cub. replaced by
keratinized strat squa ET.
 Acini lined by cuboidal/columnar ET
(depending on state of activity) &
interspersed within the basal row of
cells are myoepithelial cells.
 Alveolar ducts- columnar; larger ducts
(2-cell thick); smaller ducts (1-cell
thick).
 Lobe- a lactiferous duct (LD) connected
to a system of ducts & lobules,
enclosed & intermingled with CT
stroma.
 STROMA
 CT stroma penetrates b/w & encloses
lobules, where it has a loose texture,
allowing rapid expansion of secretory
tissue in cyesis.
 Fibrous condensations of stromal tissue
extend from the ducts to dermis of
overlying skin.
 Often well developed in upper part of
breast as suspensory ligaments of
Astley Cooper.
 ADIPOSE TISSUE
 Hghly variable in amount.
 Surrounds surface of gland.
 Typically present in interlobar
stroma.
 Determines form & size of
breast.
 ARTERIES
1. INTERNAL THORACIC
 Medial mammary br of perforating br
2-4th branches (2nd usually largest)
enlarged during lactation
 Anterior intercostal
2. COSTOCERVICAL TRUNK
 Lateral mammary br of lateral cut br
of post intercostal
 arteries ctd.
3.AXILLARY
 Lateral mammary br from lateral
thoracic
 Pectoral br of thoraco-acromia
 subscapular
4.OTHERS
 Sup intercostal (post intercostal –
2nd ICS)
 Brances from thoracic aorta in 3 &
4th ICS
 The internal mammary artery, a branch of
the subclavian artery,provides
approximately 60% of total breast flow,
mainly to the medial portion, by anterior
 and posterior perforating branches
 Veins are
VENOUS DRAINAGE
corresponding
to the arteries.
 Circular venous
plexus are found
at the base of
nipple.
 Finally, veins of
this plexus drain
into axillary &
internal thoracic
veins.
 NERVES
 Anterior & lateral cut. branches of
4-6th IC nerves.
 IC nerves convey sensory fibres to
skin of breast, sympathetic fibres to
blood vessels in breast & smooth
muscle in the overlying skin & nipple
 LYMPHATIC DRAINAGE
 The lymphatic and venous drainages of
the breast are of great importance in the
spread of carcinoma.

 About three quarters of the lymphatic

drainage is to the axillary nodes:

 (1) Lymphatics pass around the edge of

the pectoralis major and reach the
pectoral group of axillary nodes;
 (2) routes through or between the
pectoral muscles may lead directly to the
apical nodes of the axilla

 (3) lymphatics follow the blood vessels

through the pectoralis major and enter
the parasternal (internal thoracic) nodes;
 (4) connections may lead across the
median plane and hence to the
contralateral breast
 (5) lymphatics may reach the sheath
of the rectus abdominis and the
subperitoneal and subhepatic
plexuses.

 It should be noted that free

communication exists between nodes
below and above the clavicle and
between the axillary and cervical
nodes.
 LYMPHATIC DRAINAGE
 In summary and in numbers:

 ~75% drains into axillary nodes.

 ~20% to internal mammary chain
(parasternal)
 Lower quadrants to inf. Phrenic
(abdominal) nodes.
AXILLARY LYMPH NODES
 They are arranged into 5
groups which lie in
axillary fat :
 Pectoral (Anterior)
group : which lies on the
pectoralis minor along
lateral thoracic vessels.
 Subscapular (Posterior)
group : which lies on
posterior wall of axilla on
lower border of
subscapularis along
subscapular vessels.
AXILLARY LYMPH NODES
 Brachial (Lateral) group : lies
on lateral wall of axilla along 3rd
part of axillary vessels.

 Central group : lies in axillary

fat at the base of axilla.

 Apical group : lies at apex of

axilla.

 Subclavian lymph trunk:

 it is formed by union of efferent
lymph vessels of apical group.
 It usually opens in subclavian
vein.
 On the left side it usually opens
into thoracic duct.
LYMPHATIC DRAINAGE • Central & lateral parts of
the gland (75%) drain into
pectoral group of axillary
lymph nodes.
• Upper part of the gland
drains into apical group of
axillary lymph nodes.
• Medial part drains into
internal thoracic
(parasternal) lymph
nodes, forming a chain
along the internal thoracic
vessels.
LYMPHATIC DRAINAGE • Some lymphatics from the
medial part of the gland
pass across the front of
sternum to anastomose
with that of opposite side.
• Lymphatics from the
inferomedial part
anastomose with lymphatics
of rectus sheath & linea
alba, and some vessels pass
deeply to anastomose with
the sub diaphragmatic
lymphatics.
 lymphatic drainage ctd.
 Note that other groups of axillary nodes
may be involved- central, lateral, apical
 Newer nomenclature
 Low nodes (level 1)
 Middle nodes (level 2)
 Upper/apical (level 3)

 Rotter’s nodes-b/w pectoralis minor &

major
 MALE BREAST
 Remains rudimentary
throughout life.
 Formed of small ducts (without
lobules/alveoli) & a little of
supporting fibroadipose tissue.
 Areola well developed, although
limited in area & nipple is
relatively small.
 CLINICAL ANATOMY
 Fibroadenoma of breast
 Fibroadenocarcinoma of breast
 Mammography
 Lymphoscintigraphy
 Sentinel lymph node biopsy
 Lumpectomy
 Simple mastectomy
 Radical mastectomy
 Polymastia
 Polythelia
 Amastia
Frequency of Breast Cancer
 CLINICAL ANATOMY- CANCER BREAST
• It is a common surgical condition.
• About 60% of carcinomas of breast
occur in the upper lateral quadrant.
• 75% of lymph from the breast drains
into the axillary lymph nodes.
• In case of carcinoma of one breast, the
other breast and the opposite axillary
lymph nodes are affected because of
the anastomosing lymphatics between
both breasts.
• In patients with localized cancer breast,
a simple mastectomy, followed by
radiotherapy to the axillary lymph
nodes is the treatment of choice.
• The lactiferous
ducts are radially Applied Anatomy
arranged from the
nipple, so incision
of the gland should
be made in a radial
direction to avoid
cutting through the
ducts.
• Infiltration of the
ligaments of Cooper
by breast cancer
leads to its
shortening giving
peau de’orange
appearance of the
breast.
 Mammary ridge
• Mammary ridge
extends from the axilla
to the inguinal region.
• In human, the ridge
disappears EXCEPT for a
small part in the
pectoral region.
• In animals, several
mammary glands are
formed along this ridge.
Carcinoma of the brest
Large accessory right breast
 BILATERAL ACCESSORY
BREASTS-no areola, no nipple
Man with nipples in axillary &
inguinal regions
 A Letter
from
Mr. Dapo Wondering,
a concerned father,
to
Dr. Chima Atlas
Dear Dr. Chima Atlas,

My 15 year old daughter has her

eye on a spaghetti strap dress
with a bodice and ball gown type
skirt. However, the dress makes
her chest seem even smaller. She
wants to increase her breast size
so the dress will look better.
I told her to allow nature to take it's
course, but she is convinced that
this cream she saw advertised in a
magazine will help. I've told her that
it was a gimmick, but she won't
listen, and keeps nagging. Is there
anything she can do to enlarge her
breasts so the dress will fit better?
Thank you.
Mr. Dapo Wondering
Dear Mr. Wondering,

It's only natural that adolescent girls

worry about their breast size. Tell
your daughter that she is still
developing and will be until about age
19. Keep emphasizing the importance
of developing her mind and her inner
qualities, not her body. Women who
have not gotten past this adolescent
phase about breasts often take drastic
unnecessary measures to increase
their size.
 Regarding the dress:
A spaghetti strap dress needs
to fit just right to look good,
regardless of breast size. The
straps can't be too long, & the
bodice should have a good fit,
not loose. Also, try buying a
strapless bra & see if that
helps.
 If the back of the dress is too
low for a bra, you can buy bra
cups from fabric store & sew
those in the front for modesty
and shape. Tell your daughter,
Gywenth Paltrow looked lovely
in a spaghetti strap dress on
Oscar night, & she is not well
endowed.
 Regarding the lotion: Breast size is
mainly determined by genetics and
body weight. Breasts are made up of
fat, mammary glands, and ligaments.
There is no lotion or cream that will
increase breast size. Exercising the
chest increases the muscles under the
breast, not the breasts themselves.
 The doctor ctd.
Instead of worrying about her
breast size, tell her she's beautiful
the way she is. Explain how inner
beauty is what counts. If she's
worried about how she appears to
boys, tell her that any boy worth
caring about, won't care about her
breast size.
 the doctor ends
It's not how you look, it's how you
are. Inner beauty is about self-
esteem, taking care of yourself,
eating right, exercising, developing
one's mind, having hobbies and
interests, being kind, considerate,
and thoughtful of others. Inner
beauty is what keeps GOOD GUYS
interested, not breast size.

—Dr. Chima Atlas

 Test yourself
 A 40 years female presents with pain along the
medial side of arm. On examination- she has
palpable lump in upper outer quadrant of
breast and enlarged axillary lymph nodes.
This referred pain is due to enlarged lymph
nodes compressing-
 A- long thoracic nerve
 B- Intercostobrachial nerve
 C- lateral pectoral nerve
 D- medial cutaneous nerve of arm
 Test yourself
 Which of the following is correct about
lymphatic drainage of mammary gland?
 A- pectoral group of lymph nodes lie along
lower border of pectoralis major
 B-medial group of axillary lymph nodes drain
inner quadrants
 C- 75% of lymphatics from mammary glands
drained by Internal mammary nodes
 D- lymphatics from breast can
transmit to ovarian surface