gross anatomy, histology and embryology and applied anatomy of mammary gland

1. MAMMARY GLAND
LECTURE BY DR. ABDUL WAHEED ANSARI
PROF. OF ANATOMY,
MES MEDICAL COLLEGE,
PERINTALMANNA.KERALA. INDIA.
Friday, October 7, 2016
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2. THE SPECIFIC LEARNING
OUTCOMES
• 1. Identify the gross anatomical features-
location, extent, deep relations, and structure
and blood supply of breast.
• 2. Distinguish normal histology of lactating and
non-lactating phase of breast.
• 3. Analyze the lymphatic drainage of breast
and evaluate its clinical importance.
• 4. Correlate the normal development of breast
and its clinical significance.
• 5. Interpret the normal mammogram.
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3. REFERENCES
• 1. Clinically Oriented Anatomy-Keith Moore, 6th
edn. Chapter 1 pages 98, 99,101,103-106.
• 2. Clinical Anatomy by regions –Snell, 8th
edn.chapter-9 pages 427-432.
• 3. DiFiore’s Histology, 12th end. Chapter 21,
pages 549-555.
• 4. Langman’s embryology-Sadler, 12th
edn.chapter21 page 342.
• 5.http://www.medscape.org/viewarticle/548921_3
• 6.http://www.oucom.ohiou.edu/dbms-
witmer/downloads/2012-04-24 DashnerRPAC-
BREAST ANATOMY.PDF
• http://slideplayer.com/slide/5725038/ 3

4. GROSS ANATOMY OF BREAST
• All mammals have mammary glands.
• The mammary glands are modified skin
glands (sweat glands).
• In human beings the functional breast is
seen in adolescent females and nursing
mothers.
• In some genetic disorder-Klienfelter
syndrome males also have gynecomastia.
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5. Mammary glands are located on
anterior chest wall in superficial fascia
• Longitudinally it extends from 2nd rib to the
6th rib. Horizontally from side of breast
bone to the mid axillary line, the tail of
breast extends in the axilla.
• An area around the nipple is called as
areola, it is rosy pink before pregnancy
and it changes its color to dark black area
during first pregnancy and never returns to
spinster stage color.
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7. GROSS ANATOMY OF BREAST
• The gland is composed of mostly fat and
admixed with the compound tubuloalveolar
pattern of glands.
• The mammary gland functionally is an
apocrine gland where apart of breast cells are
shed into the secretion and constitute the
milk.
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8. THE COOPER’S LIGAMENTS
• Cooper's ligament, also
known as the
suspensory ligaments
and ligamenta
suspensoria mammaria,
are connective tissue in
the breast that maintain
structural integrity.
• They fix the breast from
skin to the pectoral
fascia.
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9. 15-20 lactiferous ducts open under the
nipple
• The human breast rests on the
pectoral fascia and pectoralis
major, minor, serratus anterior
and external obliques
abdominis muscles.
• The malignant breast get
adhered to the pectoral fascia
and underlying muscles when
it infiltrates the deep
structures.
• Some additional or ectopic
breast may be found all along
the mammary line from axilla
to inguinal region.
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10. THE ECTOPIC BREAST
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11. THE BLOOD SUPPLY OF
BREAST
• The blood supply to the breast is
derived from 3 sources. The
predominant supply of blood comes
from the perforating branches of the
internal mammary arteries, derived
from the thyrocervical trunk of
subclavian.
• The breast is further supplied by the
lateral thoracic and thoracoacromial
arteries (branches of the axillary
artery) as well as posterior intercostal
arteries (branches of the thoracic
aorta).
• Venous drainage of the breast is
mainly accomplished by the axillary
vein. The subclavian, intercostal, and
internal thoracic veins drain the breast.
The posterior intercostal veins drain
the breast and communicates with the
vertebral veins and that are continuous
with the intracranial vein, and this
forms the route through which cancer
may spread to cranial cavity and back
bone. 11

12. BLOOD VESSELS SUPPLYING THE
BREAST
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13. THE LYMPHATIC DRAINAGE OF BREAST
• The lymphatic drainage of the
breast deserves special
attention, due to its role in the
metastasis of cancer cells.
• The majority of lymph (>75%),
particularly from the lateral
quadrants, drains to the axillary
lymph nodes.
• The remainder of lymph drains
to either the parasternal nodes
or the opposite breast (medial
quadrants) or the inferior
phrenic nodes (lower
quadrants).
• The sub areolar plexus drains
by collecting trunks into the
axillary nodes.
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14. CLINICAL ASPECT OF BREAST
LYMPHATIC DRAINAGE
• Peau-d’orange = A pitted or
dimpled appearance of the
skin, especially as
characteristic of some cases
of breast cancer or due to
cellulite.
• Dimpling of the skin over the
breast is due to involvement
of the Cooper’s ligaments.
• Blockage of the dermal
lymphatics of the breast due
to malignancy results in
oedema of the skin.
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15. FREQUENCY OF BREAST CANCER IN
ALL QUADRANTS
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16. NORMAL HISTOLOGY OF BREAST
• Non-lactating phase
• Embedded in the
surrounding connective
tissue there are inactive
tubular portions of breast
tissue is recognized.
• The alveoli develops
during early weeks of
pregnancy and lactation
begins after birth.
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17. THE LACTATING BREAST TISSUE
• The secretory units are alveoli,
which are lined by a cuboidal or
columnar epithelium.
• A layer of myoepithelial cells is
always present between the
epithelium and the basement
membrane of the branches of the
lactiferous duct and the alveoli.
• Secretion of milk proteins proceeds
by exocytosis (merocrine
secretion), whereas lipids are
secreted by apocrine secretion.
• Colostrum is the first formed milk
rich in IgE-immunoglobolins. It is
yellow in color.
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18. THE NORMAL DEVELOPMENT OF
BREAST
• Human breast is an
ectodermal in origin.
• Similar to any skin gland,
sweat gland – breast is a
modified sweat gland.
• There is a milk line
extending from axilla to the
inguinal region.
• In human all tissues
disappear and remaining
part develops as breast.
• The additional breast or
ectopic breast can be
present in axilla or along the
milk line.
• In cats and dogs the milk line
extends from fore limb to hind
limb regions.
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19. CONGENITAL FORMS OF
BREAST
• Amazia =complete
absence of breast
tissue.
• Polymazia=multiple
breast.
• Polythelia=multiple
nipples
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20. WHAT IS A MAMMOGRAM?
• It is a radiological study of
breast tissue.
• The breast shadow is analyzed,
showing the glandular patterns,
parenchymal and duct
branching, fibrous elements
and any nodules or calcification
are noted.
• A MRI is a magnetic resonance
imaging study of breast tissue,
it can find cancers of breast not
discovered by mammogram
• .
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22. Abnormal
mammogram
• 1=Abnormal axillary
lymph nodes
• 2=Breast tissue
• 3=Cancer in the
breast tissue
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23. REVIEW OF BREAST ANATOMY
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24. The internal vertebral veins may
communicate with cranial veins
• This is the route that
spread the malignancy
from breast to back bone
or cranial cavity.
• The metastasis of
carcinoma of breast to
cranial cavity and back
bone.
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26. A dermatome is a patch of skin supplied by a segmental
spinal nerve
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27. MCQS on breast anatomy
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28. MCQS ON BREAST
In lymphatic drainage of the
breast, the major portion (about
75%) enters eventually into which
group of nodes?
A. Central axillary
B. Deltopectoral
C. Lateral axilllary
D. Parasternal
E. Subscapular
A woman with breast cancer
subsequently develops metastases in
her vertebral column. The most
direct route for spread of the tumor
to the vertebral column was via:
A. Branches of the cephalic vein
B. Branches of the lateral thoracic
vein
C. Branches of the thoracoacromial
veins
D. Lymphatic vessels draining into
the axilla
E. Branches of the intercostal veins
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