Slide Share Presentation on Lymphatic Drainage Of Breast and its applied......

1. contents
 BREAST/MAMMARY GLAND: A BRIEF
INTRODUCTION
 FEATURES
 EXTENT
 LYMPHATICS
 LYMPH NODES
 AXILLARY LYMPH NODES
 LYMPHATIC DRAINAGE
 SOME SPECIAL POINTS
 SENTINEL LYMPH NODES
 APPLIED

2. BREAST/ MAMMARY GLAND
 Present in the
superficial fascia of
the pectoral region
 The breast is found in
both sexes,but is
rudimentary in the
male
 Modified sweat gland
 Constitutes an
important accessory
organ of female
reproductive system

3. Features
 Divided into four
quadrants-
UL,UM,LL,LM
 Axillary tail of spence-
A small part of the
mammary gland may
extend along the
inferolateral edgeof
the pectoralis major
towards the axillary
fossa(armpit)forming
axillary tail of spence.

4. EXTENT
 Vertically
from 2nd to 6th rib
 Horizontally
From lateral border of
sternum to mid
axillary line

5. LYMPHATICS
 Lymphatics resemble veins in
structure.
 Elastic in nature.
 Have valves which prevents
backflow.
 Along their length ,lymph nodes
are present.
 In Breast ,two types-
1)Superficial Lymphatics-
Drains skin over the Breast
except nipple and areola
2)Deep Lymphatics- a)
Drains the Parenchyma of
Breast .
b) Also
drains the nipple and areola.

6. LYMPH NODES/GLANDS
 Present along the length of
lymphatics.
 Have several lymphatics
leading towards
them(afferent) and one or two
leading away(efferent).
 Lymph From the breast drains
into:
1)Axillary Lymph Nodes
2)The internal mammary lymph
Nodes
3)some lymph also reaches
supraclavicular,cephalic,
posterior, intercoastal
,subdiaphgrametic and
subperitoneal lymph nodes.

7. THE AXILLARY LYMPH NODES
 The axillary lymph nodes (some 20–30
in number)
 drain
 lymphatics of the breast
 pectoral region
 Upper abdominal wall
 upper limb
 arranged in five groups :
 anterior :lying deep to pectoralis major
along the lower border of pectoralis
minor;
 posterior—along the subscapular
vessels;
 lateral—along the axillary vein;
 central—in the axillary fat;
 apical (through which all the other
axillary nodes drain)at the apex of the
axilla above pectoralis minor and along
the medial side of the axillary vein.

8. ARRANGEMENT OF PRINCIPAL AXILLARY
LYMPH NODES

9. A)Pectoralis Major Muscle.
B)Axillary Lymph Nodes (posterior)
C)Axillary Lymph Nodes (lateral)
D)Axillary Lymph Nodes (central)
E)Supraclavicular Lymph Nodes
F)Internal Mammary Lymph Nodes
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10. Lymphatic drainage
 Lymphatic spread of a growth of
the breast may occur further
afield when these normal
pathways have become
interrupted by malignant
deposits, surgery or
radiotherapy.
 Secondaries may then be found
in the
 lymphatics of the opposite breast
or in the opposite axillary lymph
nodes
 the groin lymph nodes (via lymph
vessels in the trunk wall)
 the cervical nodes
 in peritoneal lymphatics spreading
there in a retrograde manner from
the lower internal mammary nodes

11. SOME SPECIAL POINTS
 Lymph of the breast drains as:
 About 75% into axillary
nodes(anterior group)
 20% ---- internal mammary
nodes
 5% ---- posterior intercostal
nodes
 Internal mammary nodes drain
the lymph not only from the
inner half of the breast,but from
the outer half as well
 there is a tendency for the
lateral part of the breast to
drain towards the axilla and the
medial part to the internal
mammary chain

12. SOME SPECIAL POINTS CONTD.
 Subareolar plexus of Sappey –
plexus of lymph vessel present
deep to the areola
 Lymphatics from deep surface
of the breast pass through the
pectoralis major muscle and the
clavipectoral fascia to reach
the apical node,and also to the
internal mammary nodes
 Lymphatics from lower and
inner quadrants of the breast
may communicate with the
subdiaphragmatic and
subperitoneal lymph

13. SENTINEL LYMPH
NODES
 These are the hypothetical First Lymph Nodes draining a
cancer.
 The Concept Of sentinel Lymph Node is important because
Of the advent oF the Sentinel Lymoph Node Biopsy
technique.
 This Concept Helps in reducing the removal of non
tumourers lymph nodes thus preventing lymphedema.

14. APPLIED
 Lymph Vessels Of
breast comunicates with
those of abdomen.
 Cancer of breast can
spread to liver.
 Cancer cells may drop
to pelvis producing
secondary cancers
there.(KRUKENBERG’S
SYNDROME)
 Upper ,Outer Quadrant
contains large number
of glandular tissues and
is site of 60% of Breast
Carcinomas.

15. Peau d’orange
Interference with the lymphatic drainageby cancer may cause
lymphedema,which in turn may result in deviation of the nipple and a
thickened,leather like appearance of the skin.Prominent or ‘puffy’ skin between
dimpled pores give it an orange peel like appearance.

16. Nipple retraction
Retraction of nipples: Infilteration of Lactiferous Ducts
and their consequent fibrosis results in nipple retraction or
subareolar breast cancer result in nipple retraction.

17. SKIN TETHERING
 Larger Dimples Result from cancerous
invasion of the glandular tissue and
fibrosiswhich causes shortening or place
traction of the suspensory ligaments .

18. Mammography
 Radiographic Examination of the breasts -
mammography - is one of the techniques
used to detect breast masses.
 A Carcinoma Appears as a large jugged
density in the mammogram.
 Generally,the skin is thickened over the
tumour and the nipple is depressed.

19. MAMMOGRAPHY AND
MAMMOGRAM

20. SURGICAL INCISIONS OF
BREAST
 Given in the inferior breast quadrants
when possible because of less vascular
supply.
 Incisions That must be made near the
areola or on the breast itself are usually
directed radially to either side of the
nipple(Langer Tension Lines) or
circumferentially.

21. Thank you