1. THE
Pectoral region
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2. THE BREAST / MAMMARY GLAND:
The breasts are specialized accessory glands of the skin that secrete milk
They are present in both sexes. In males and immature females, they are similar in structure.
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3. THE BREAST …
In the adult female, the base of the breast, i.e. its attached surface, extends vertically from the second or third to the sixth rib, and in the transverse plane from the sternal edge medially almost to the midaxillary line laterally. However, it may extend through the deep fascia up to the apex of the axilla (the axillary tail of Spence)
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5. THE BREAST …
In young adult females, each breast is a rounded eminence lying within the superficial fascia, largely anterior to the upper thorax but spreading laterally to a variable extent.
The trunk superficial fascial system splits to enclose the breast to form the anterior and posterior lamellae. Posterior extensions of the superficial fascial system connect the breast to the pectoralis fascia, part of the deep fascial system.
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6. THE BREAST …
Between the breast and the deep fascia the loose connective tissue in the ‘submammary (Retromammary) space' allows the breast some degree of movement on the deep pectoral fascia
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7. THE BREAST …
The mammary gland is firmly attached to the dermis of the overlying skin, by the suspensory ligaments (of Cooper). These condensations of fibrous connective tissue, particularly well developed in the superior part of the gland, help support the mammary gland lobules.
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8. THE BREAST …
During puberty, the breasts normally enlarge, owing in part to glandular development but primarily from increased fat deposition.
Breast shape and size depend upon genetic, racial and dietary factors, and the age, parity and menopausal status of the individual
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9. NIPPLE AND AREOLA
The nipple projects from the centre of the breast anteriorly. The level of the nipple varies widely.
In females, its site is dependent on the size and shape of the breasts, but it overlies the fourth intercostal space in most young women. In the male, the nipple is usually sited in the fourth intercostal space in the midclavicular line.
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10. NIPPLE AND AREOLA
The areola is the disc of skin that circles the base of the nipple. It contains numerous sweat and sebaceous glands which open directly onto the skin surface.
The oily secretion of these specialized sebaceous glands acts as a protective lubricant and facilitates latching of the neonate during lactation: the glands are often visible in parous women, arranged circumferentially as small elevations, Montgomery's tubercles, around the areola close to the margin
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11. SOFT TISSUE
The breasts are composed of lobes which contain a network of glandular tissue consisting of branching ducts and terminal secretory lobules in a connective tissue stroma
Each breast consists of 15 to 20 lobes, which radiate out from the nipple. The main duct from each lobe opens separately on the summit of the nipple and possesses a dilated ampulla just before its termination
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12. SOFT TISSUE
Each lobule is drained by a lactiferous duct, which usually opens independently on the nipple.
Deep to the areola, each duct has a dilated portion, the lactiferous sinus, in which a small droplet of milk accumulates or remains in the nursing mother. As the infant begins to suckle, compression of the areola (and the lactiferous sinus beneath it) expresses the accumulated droplets and encourages the infant to continue nursing
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13. Vasculature of the Breast
The breasts are supplied by branches of the axillary artery, the internal thoracic artery, and some intercostal arteries.
The axillary artery supplies blood via the superior thoracic artery, the pectoral branches of the thoracoacromial artery, the lateral thoracic artery and the subscapular artery.
The internal thoracic artery supplies perforating branches to the anteromedial part of the breast.
The second to fourth anterior intercostal arteries supply perforating branches more laterally in the anterior thorax
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16. Posterior intercostal vein Internal thoracic vein
Venous Drainage:
Internal vertebral venous plexus
Azygous vein
Posterior intercostal vein
Axillary vein
Internal thoracic vein
Intracranial saggital & transverse sinus
CIRCULUS VENOSUS
Clavicle and humerus
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18. Lymphatic Drainage
The lymph vessels from the medial quadrants of the breast pierce the second, third, and fourth intercostal spaces and enter the thorax to drain into the lymph nodes alongside the internal thoracic artery.
The lymph vessels from the lateral quadrants of the breast drain into the anterior or pectoral group of axillary nodes. It follows, therefore, that a cancer occurring in the lateral quadrants of the breast tends to spread to the axillary nodes. Thoracic metastases are difficult or impossible to treat, but the lymph nodes of the axilla can be removed surgically
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20. Lymphatic Drainage
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22. Lymphatic Drainage… Drainage Supraclavicular nodes
Infraclavicular nodes
Parasternal nodes
Axillary nodes
Sub diaphragmatic lymph nodes
Subperitoneal lymph plexus
Krukenberg’s tumour
Hepatic nodes
Drainage
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23. Nerve Supply:
The nerves of the breasts derive from the anterior and lateral cutaneous branches of the 4th-6th intercostal nerves
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24. Polymastia and Polythelia
Polymastia (supernumerary breasts) or polythelia (accessory nipples) may occur superior or inferior to the normal pair, occasionally developing in the axillary fossa or anterior abdominal wall. Supernumerary breasts usually consist of only a rudimentary nipple and areola, which may be mistaken for a mole (nevus) until they change pigmentation with the normal nipples during pregnancy.
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26. Micromastia & Macromastia
Micromastia: An excessively small breast on one side occasionally occurs, resulting from lack of development.
Macromastia :Diffuse hypertrophy of one or both breasts occasionally occurs at puberty in otherwise normal girls
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27. Amastia Failure of breast development (amastia)
Note: a nipple and/or areola may be present, but no glandular tissue
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28. Gynecomastia
Breast hypertrophy (Slight temporary enlargement of the breasts) in males after puberty is relatively rare (< 1%) and may be age related or drug related (e.g., after treatment with diethylstilbestrol for prostate cancer).
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29. witch's milk
At birth the breasts have reached a similar developmental stage in both sexes: the combination of fetal prolactin and maternal oestrogen may give rise to transient hyperplasia and secretion of ‘witch's milk'.
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30. MUSCLES OF PECTORAL REGION
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31. Muscles of Pectoral Region:
Pectoralis major & minor; Subclavius
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34. Pectoralis major: Origin: Insertion: Actions: Nerve supply:
Clavicular head: anterior surface of medial half of clavicle
Sternocostal head: anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique muscle
Insertion:
Lateral lip of intertuberculus
sulcus of humerus Sc
Actions: C
Adducts arm and rotates it medially; clavicular fibers also flex arm
Nerve supply:
Medial and lateral pectoral nerve
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35. Pectoralis minor: Origin: Insertion: Actions:
It arises from the upper margins and outer surfaces of the third, fourth, and fifth ribs, near their cartilages
Insertion:
inserted into the medial border and upper surface of the coracoid process of the scapula.
Actions:
drawing the scapula inferior and medial, towards the thorax
Nerve supply: Medial pectoral nerve
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36. Subclavius: Origin: Insertion:
Junction of first rib and its costal cartilage
Insertion:
Groove on the undersurface of the middle third of the clavicle
Action:Stabilise the calvicle during the shoulder movements
Nerve supply: Subclavius is supplied by the subclavian branch of the brachial plexus, which contains fibres from C5 and 6.
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