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Breast

Breast. Sanjaya Adikari Department of Anatomy. Consists of milk producing glands Glands are modified sweat glands Assist reproduction in women Rudimentary in men Lies in the subcutaneous tissue. Extension transverse – LSB to MAL vertical – 2 nd to 6 th rib

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Breast

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  1. Breast Sanjaya Adikari Department of Anatomy

  2. Consists of milk producing glands • Glands are modified sweat glands • Assist reproduction in women • Rudimentary in men • Lies in the subcutaneous tissue

  3. Extension transverse – LSB to MAL vertical – 2nd to 6th rib • Position of nipples 4th ICS in males 10 cm from AML • Size is variable due to the amount of fat surrounding the glandular tissue. • Extent of the base is fairly constant

  4. suspensory ligaments of Cooper • Connects the dermis of the skin to the posterior capsule • Contains loose connective tissue retro-mammary space posterior capsule • Condensation of the membranous layer of superficial abdominal fascia of Scarpa pectoral fascia

  5. Structure • 15 – 25 lobes • Each lobe drains by its lactiferous duct • Lobes consist of many lobules • Lobules consist of alveolar ducts • Lobules are separated by loose connective tissure • Lobes are separated by dense connective tissue

  6. of Cooper 15-25 breast lobes 15-25

  7. Resting breast Lobule • Lined by cuboidal cells • Myoepithelial cells between the cuboidal cells and the BM • Cyclical changes according to the ovarian cycle Alveolar ducts

  8. Changes due to oestrogen, progesteron, prolactin etc. • Numerous secretory alveoli formed by proliferating alveolar duct epithelium • Interlobular connective tissue becomes less • Alveoli and ducts get filled with Colostrum • Colostrum is a protein-rich fluid containing maternal antibodies Breast during pregnancy

  9. Consists entirely of glandular tissue • Alveoli are dilated with milk • Interlobular connective tissue disappears • Prolactin promotes the production of milk • Oxytocin causes contraction of myoepithelial cells and ejection of milk Lactating breast

  10. Blood supply Thoracoacromial trunk

  11. Development of breasts • Mammary line or ridge develops at 7 weeks IUL • Thickening of epidermis • Persists only in thoracic region • If persists in other regions cause accessory nipples – common in axillary region • Epithelial sprouts formed and canalized

  12. axilla inguinal region

  13. Development ….cont. • Lactiferous ducts open into an ‘epithelial pit’ • After birth the nipple is formed by proliferation of underlying mesenchyme • Persistance of epithelial pit causes inverted nipples. • An underlying tumour can also cause nipples to invert • Lobule formation occurs only in the female after puberty

  14. 75% 25% Lymph drainage

  15. Lymph drainage • About 75% passes to axillary nodes • Rest of it mainly passes to parasternal nodes • Superficial lymphatics of the breast have connections with the opposite breast

  16. lateral Axillary lymph nodes apical anterior posterior central

  17. Flow of lymph from axillary nodes Jugular lymph trunk Subclavian lymph trunk Right lymph duct

  18. lump 4 cm Breast Quadrants Upper outer quadrant Bulk of the tissues most benign/malignant conditions occur in this quadrant

  19. suspensory ligaments of Cooper dimpling retro-mammary space posterior capsule pectoral fascia

  20. Mammogram Tumour

  21. Tension lines of the skin

  22. Lactiferous ducts Radial incision Tension lines of the breast surgical incisions

  23. Radical mastectomy whole breast, pec. Major & minor, axillary fat,fascia & LNs Modified radical mastectomy preserve pec. Major but remove pec. minor Simple mastectomy only the breast Extended simple mastectomy breast with axillary tissue Mastectomy

  24. Sentinel node/s • First node/s to spread of a malignancy • Radioisotope labeled method • Blue dye injected around the tumour • These are assessed during surgery • Removed if tumour cells are detected

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