objectives Breast anatomy Blood supply Lymphatic drainage
Breast cancer
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Breasts
Slide 5
Breast Glandular tissue embedded within superficial fascia of
anterior chest wall Modified sweat glands Overlying pectoral
muscles Rudimentary in males and pre-pubertal females Size and
shape of adult female breast varies Determined by amount of fat
surrounding glandular tissue
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Extent- Base Extending from lateral border of sternum to
midaxillary line and from 2nd to 6th ribs. Majority of breast
overlies deep pectoral fascia of pec major muscle, with remainder
overlying fascia of serratus anterior Retromammary space A
potential space filled with loose connective tissue Breast is
separated from pectoralis major muscle Axillary tail (of Spence) A
small part of mammary gland extend toward axilla
Slide 7
Slide 8
Axillary tail (of Spence)
Slide 9
Structure of Breast Areola Surrounds the nipple Circular
pigmented area of skin Breast composed of 15 to 20 lobules of
glandular tissue Formed by septa of suspensory ligaments Each
lobule is drained by a lactiferous duct Each lactiferous duct opens
on nipple Firmly attached to overlying skin by Suspensory ligaments
(of Cooper)
Slide 10
Nipple location 4th intercostal space
Slide 11
Coopers Suspensory Ligaments
Slide 12
Vasculature of Breast oArterial supply oAnterior intercostal A.
(from internal thoracic artery) oLateral thoracic A. (from axillary
artery)
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Arterial Supply to the Breast
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Venous drainage- oLateral thoracic drain into Axillary vein
(main) oAnterior intercostal drain into Internal thoracic vein
Slide 15
Veins of mammary gland
Slide 16
Lymphatic Drainage of Breast Lymph from nipple, areola, and
lobules of mammary glands- subareolar lymphatic plexus From there,
a system of interconnecting lymphatic channels drains lymph to
various lymph nodes Majority (75%) of lymph, especially from
lateral quadrants pectoral nodes axillary nodes Remaining lymph,
especially from medial quadrants parasternal lymph nodes along
internal thoracic vessels
Slide 17
Breast Quadrants
Slide 18
Lymphatic drainage of breast
Slide 19
Some lymph from lower quadrants inferior phrenic nodes Lymph
from medial quadrants can cross to opposite breast via parasternal
nodes Secondary metastases of breast carcinoma can spread to
opposite breast in this way
Slide 20
Subdiaphragmatic Lymph Channels Channels to Contralateral
Breast Axillary Lymph Channels Major Routes of Metastasis
Slide 21
Carcinoma of the Breast Approximately 60% of carcinomas of the
breast occur in the upper lateral quadrant. The cancer cells are
swept along the lymph vessels and follow the lymph stream. The
entrance of cancer cells into the blood vessels accounts for the
metastases in distant bones. The lymphatic spread of cancer to the
opposite breast, to the abdominal cavity, or into lymph nodes in
the root of the neck is caused by obstruction of the normal
lymphatic pathways by malignant cells or destruction of lymph
vessels by surgery or radiotherapy.
Slide 22
Peau dorange sign Leathery thickening of the skin Often dimpled
and has prominent pores That gives the skin the appearance of
orange peel The dimples and the pores results from shortening of
the suspensory ligament because of cancerous invasion
Slide 23
Peau dorange sign:
Slide 24
Carcinoma of the Breast
Slide 25
Examination of Breast Clinically breast is divided into
quadrants: UI: upper inner UO: upper outer (includes axillary tail)
LI: lower inner LO: lower outer Breast palpation- Circular fashion,
beginning with nipple and moving outward Palpation should extend
into axilla to palpate axillary tails After palpation of one
breast, other should be palpated in same way Examine skin of breast
for a change in texture or dimpling (peau d'orange sign) and nipple
for retraction these signs indicate an underlying pathology
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Slide 27
Slide 28
Breast self exam
Slide 29
Mammography Mammography is a radiographic examination of the
breast This technique is extensively used for screening the breasts
for benign and malignant tumors and cysts. Extremely low doses of
x-rays are used so that the dangers are minimal and the examination
can be repeated often. Its success is based on the fact that a
lesion measuring only a few millimeters in diameter can be detected
long before it is felt by clinical examination.
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Slide 31
Mastectomy A simple mastectomy in which the pectoral muscles
are left intact. The axillary lymph nodes, fat, and fascia are
removed. Radical mastectomy is designed to remove the primary tumor
and the lymph vessels and nodes that drain the area.