ANATOMY OF THE BREAST

dr. MN Milla, MCE

Department of Anatomy and Histology
Faculty of Medicine
Sultan Agung Islamic University

Learning Objectives

Definition of Breast
Location of Breast
Development of woman breast
Morphology and supports of woman breast
Breast vascularisation
Breast innervation
Breast Lymphatic Drainage System
Clinical Features

DEFINITION
The breast is a gland in mammals, which in a
female contains the mammary gland that
secretes milk used to feed infants.

LOCATION
upper ventral region of the torso of a primate, in
left and right sides
This glands enlarge from 2 6 th ribs, from
sternum until medial axillaris line
About 2/3 of the glands are laid on pectoralis
major muscle , about 1/3 are laid on anterior
seratus muscle
The breast or mammary gland is tightly
connected to the skin through suspensorium
ligament of cooper

DEVELOPMENT
Both men and women develop breasts from the
same embryological tissues. However, at puberty,
female sex hormones, mainly estrogen, promote
breast development, resulting far more
prominen women's breasts than those of men.
During pregnancy, the breast is responsive to a
complex interplay of hormones that cause tissue
development and enlargement in order to
produce milk. Three such hormones are estrogen,
progesterone and prolactin, which cause
glandular tissue in the breast and the uterus to
change during the menstrual cycle

 Approximately two years after the onset of puberty (a

girls first menstrual cycle), the hormone estrogen
stimulates the development and growth of the glandular,
fat, and suspensory tissues that compose the breast.
This continues for approximately four years until
establishing the final shape of the breast (size, volume,
density) when she is a woman of approximately 21 years
of age.[
About 90% of women's breasts are asymmetrical to
some degree, either in size, volume, or relative position
upon the chest. Asymmetry can be manifested in the size
of the breast, the position of the nipple-areola complex
(NAC), the angle of the breast, and the position of the
inframammary fold, where the breast meets the chest.

MORPHOLOGY
the breast is a cone with the base at the chest wall, and
the apex at the nipple, the center of the NAC (nippleareola complex)
The supercial tissue layer (superficial fascia) is
separated from the skin by 0.52.5 cm of subcutaneous
fat (adipose tissue). The suspensory Coopers ligaments
are fibrous-tissue prolongations that radiate from the
superficial fascia to the skin envelope.
Each breast contains 1520 lactiferus lobes that
converge to the nipple, to ducts 2.04.5 mm in
diameter are immediately surrounded with dense
connective tissue that functions as a support
framework

 Each ducts in lobules will drain in papilla

mammae as lactifery excretorius ducts
Close to the papilla this ducts will enlarge ,
knowns as lactifery sinus
There are alveoli that will proliferate due to
hormonal change in lpregnancy or lactation.
The papilla mammae has an ampula that will
enlarge right before its end

The mammary glands ( lateral view)

The mammary glands ( ant view)

 A pigmented area around the papilla

mammae is called Areola mamae
Under the areola mammae we can find:
- Some involuntary muscles
- Lymphatic plexus
Areola mammae contain no fat tissue

 ;. The subcutaneous adipose tissue covering the

lobes gives the breast its size and shape. Each
lobe is composed of many lobules, at the end of
which are sacs where milk is produced in
response to hormonal signals
The glandular tissue of the breast is biochemically
supported with estrogen; thus, when a woman
reaches menopause (cessation of menstruation)
and her body estrogen levels decrease, the milk
gland tissue then atrophies, withers, and
disappears, resulting in a breast composed of
adipose tissue, supercial fascia, suspensory
ligaments, and the skin envelope.

 The dimensions and the weight of the breast

vary among women, ranging approximately
5001,000 grams
The tissue composition ratios of the breast
likewise vary among women; some breasts
have greater proportions of glandular tissue
than of adipose or connective tissues, and vice
versa;

 The morphologic variations in the size, shape, volume,

tissue density, pectoral locale, and spacing of the
breasts determine their natural shape, appearance,
and configuration upon the chest of a woman; yet such
features do not indicate its mammary-gland
composition (fat-to-milk-gland ratio), nor the potential
for nursing an infant child
The shape of the breasts is naturally determined by the
support of the suspensory Cooper's ligaments, the
underlying muscle and bone structures of the chest,
and the skin envelope

SUPPORTS
suspensory ligaments sustain the breast from the
clavicle (collarbone) and the clavico-pectoral
fascia (collarbone and chest),
The base of each breast is attached to the chest
by the deep fascia over the pectoralis major
muscles. The space between the breast and the
pectoralis major muscle is called retromammary
space and gives mobility to the breast.

The mammary gland

and supportives tissues

VASCULARIZATION
- Rami perforantes a. torakalis interna/ a.
mamaria interna.
- A. torakalis lateralis (branch from a. axillaris)
- A. torakoakromialis ( branch from a. axillaris )

Cabang cabang A. Subclavia:

A. Vertebralis
A. mammaria Interna
Truncus Thyreocervicalis
Truncus Costo cervicalis
A. Dorsalis Scapula ( A. Scapularis
descendens )

INNERVATION
2 -6th intercostal nerves

LYMPHATIC DRAINAGE
Approximately 75% of the lymph from the breast
travels to the ipsilateral (same-side) axillary
lymph nodes, whilst 25% of the lymph travels to
the parasternal nodes (beside the sternum bone),
to the other breast, and to the abdominal lymph
nodes.
The axillary lymph nodes include the pectoral
(chest), subscapular (under the scapula), and
humeral (humerus-bone area) lymph-node
groups, which drain to the central axillary lymph
nodes and to the apical axillary lymph nodes.

 Lymphatic drainages of the breasts are collected in nipple

area as sub areolar lymphatic plexus
From this plexus 2 or 3 vessels across to the pectoralis
lymphatic nodes
The lymphatic vessels from the lateral quadrant will drain
to the axillaris anterior
The lymphatic vessels from the medial quadrants will drain
to the intercostal space then to the internal thoracalis
nodes.
Some lymphatic ducts will follow the a. interkostalis
posterior.

 The lymphatic drainage of the breasts is

especially relevant to oncology, because
breast cancer is a cancer common to the
mammary gland, and cancer cells can
metastasize (break away) from a tumour and
be dispersed to other parts of the womans
body by means of the lymphatic system.

CLINICAL FEATURES
Gynecomastia
Gynecomastia is a common condition and
represents a benign proliferation of glandular
tissue of the male breast.
Gynecomastia occurs in three different age
groupsneonatal, pubertal and elderly.
Due to transplacental passage of estrogen,
transient stimulation of breast tissue occurs in
infancy.

 Due to transplacental passage of estrogen,

transient stimulation of breast tissue occurs in
infancy.
Pubertal gynecomastia has a peak incidence in
males age 13-14 years and is probably due to
an imbalance of estrogen and androgens.
Involution generally occurs by 16-17 years

Pathological conditions