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Questions and Answers
Where does lymph from the parasternal nodes ultimately drain into?
Which nerves supply the breast?
How can carcinoma of the breast spread?
What is the term for the thickened, leatherlike appearance of the skin in breast cancer?
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What is the term for the edema, or excess fluid in the subcutaneous tissue, that can occur in breast cancer?
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What is the space between the breast and the deep pectoral fascia filled with?
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Which of the following arteries is NOT a contributor to the arterial supply of the breast?
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What is the function of the suspensory ligaments of Cooper?
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What is the anatomical term for the circular pigmented area surrounding the nipple?
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How many lactiferous ducts are present in each breast?
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What is the extension of the mammary gland located in the superolateral quadrant?
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What is the primary source of arterial supply to the breast?
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Where does most of the venous drainage of the breast occur?
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Which lymph nodes receive most of the lymphatic drainage from the lateral quadrants of the breast?
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Where does lymph from the inferior breast quadrants may drain to?
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What is the significance of lymphatic drainage of the breast in relation to cancer?
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Where does lymph from the axillary nodes drain to?
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Study Notes
Breast Structure and Function
- The breast rests on the pectoral fascia covering the pectoralis major (2/3) and the fascia covering the serratus anterior muscle (1/3)
- The retromammary space (bursa) separates the breast from the deep pectoral fascia, allowing for some degree of movement
- The breast is composed of 15-20 lobules of glandular tissue, each drained by a lactiferous duct that opens independently on the nipple
- Each duct has a dilated portion, the lactiferous sinus, just deep to the areola
Breast Quadrants
- The breast is divided into four quadrants for anatomical location and description of pathology (e.g., cysts and tumors)
- The axillary tail is an extension of the mammary gland of the superolateral quadrant
Vascularity
- The arterial supply of the breast is derived from:
- Medial mammary branches of perforating branches and anterior intercostal branches of the internal thoracic artery
- Lateral thoracic and thoraco-acromial arteries, branches of the axillary artery
- Posterior intercostal arteries, branches of the thoracic aorta in the intercostal spaces
- Venous drainage is mainly to the axillary vein, with some drainage to the internal thoracic vein
Lymphatic Drainage
- Lymphatic drainage is important for the metastasis (spread) of cancer cells
- Lymph passes from the nipple, areola, and lobules of the gland to the subareolar lymphatic plexus, and from it:
- Most lymph (>75%) drains to the axillary lymph nodes (pectoral, humeral, subscapular, central, and apical)
- Some lymph may drain directly to other axillary nodes, or to interpectoral, deltopectoral, supraclavicular, or inferior deep cervical nodes
- Lymph from the medial breast quadrants drains to the parasternal lymph nodes or to the opposite breast
- Lymph from the inferior breast quadrants may pass deeply to abdominal lymph nodes (inferior phrenic nodes)
- Lymph from the axillary nodes drains to infraclavicular and supraclavicular nodes and from them to the subclavian lymphatic trunk
Carcinoma of Breast
- Carcinomas of the breast are malignant tumors, usually adenocarcinomas arising from the epithelial cells of the lactiferous ducts
- Breast cancer can spread via lymphatics (lymphogenic metastasis) and veins
- Clinical signs include:
- Lymphedema (edema, excess fluid in the subcutaneous tissue), which may result in deviation of the nipple and a thickened, leatherlike appearance of the skin
- Peau d'orange sign (orange-peel appearance)
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Description
This quiz covers the anatomy of the breast, including its structure, fascia, and ligaments.
