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Dr. Nipun
MBBS, Dhaka
Youngest known survivor of breast cancer
“You are never too
young for breast cancer”

 Diagnosed at age of
            2 years
  Total Mastectomy

Juvenile Secretory
Breast Carcinoma
 Mammary gland.

 Present in both sexes.

 Rudimentary in male.

 Well developed in female after

                           puberty.

 Apocrine gland.
- In the superficial fascia of the pectoral region.


 Vertically: 2nd to 6th ribs.
 Horizontally: lateral border of sternum to mid-
  axillary line.


•   Above: Clavicle
•   Below: 7th to 8th ribs
•   Medially: Midline
•   Posteriorly : to the edge of latissimus dorsi
2nd rib
          Pectoralis major




                Skin




6th rib         Fat
Deep relations:
Skin:
  • Nipple
  • Areola
Parenchyma
Stroma
Skin
                      Areola
Nipple




   Tubercle of Montgomery
Parenchyma:
 Lobes:                                        Lobules
- 15 – 20 in number
- Composed of minute glandular
                                               Ductules
structures called lobules
- Lobules empty via ductules in
lactiferous ducts                           Lactiferous duct

 Lactiferous ducts:
- Open on to nipple                       Lactiferous sinus
- Contains ampulla near its end
(Reservoir of milk or abnormal discharge)
                                                Nipple
Stroma:
Partly fibrous & partly fatty

 Ligaments of Cooper:
- Anchors the breast with skin
- Cancer cells may infiltrate
these ligaments, so the breast
becomes fixed & contraction of
the ligaments can cause retraction
or puckering (folding) of the skin.
Non-lactating   Lactating
Extremely vascular
1. Internal thoracic artery – perforating branches
2. Axillary artery –
         1. Lateral thoracic artery
         2. Superior thoracic artery
         3. Acromiothoracic artery
3. Posterior intercostal arteries – lateral branches

Arteries are distributed in the anterior surface.
Posterior surface is relatively avascular.
Axillary artery

Superior thoracic
           artery

Acromiothoracic
    artery

Lateral thoracic
          artery             Internal thoracic
                                  artery




 Posterior intercostal
              arteries
o Veins follow the arteries.
o First converge around the nipple to form an
  anastomotic venous circle & then form 02 sets of
  veins.
  • Superficial veins: drain into Internal thoracic
      vein & superficial veins of the lower part of
      the neck
  • Deep veins: drain into Internal thoracic ,
      Axillary & Posterior intercostal veins
Axillary vein




                             Anastomotic
                             venous circle




    Internal thoracic vein
• 4th to 6th intercostal nerves
by their Anterior & Lateral
cutaneous branches;

• Milk secretion by Prolactin,
not by nerves
• Axillary (85%) (Sentinel Lymph Node)
    •   Anterior
    •   Central
    •   Apical
    •   Lateral
    •   Posterior
    •   Interpectoral
• Internal mammary / Parasternal (10%)
•   Others (5%)
    •   Supraclavicular
    •   Cephalic / Deltopectoral
    •   Posterior intercostal
    •   Subdiaphragmatic
    •   Subperitoneal
Axillary lymph nodes
                            Apical



                           Central
  Lateral
                       Interpectoral

Posterior                              Internal
                                       mammary
                                        lymph
  Anterior                              nodes
Devoid of valves.
   Superficial lymphatics  skin over breast
  except nipple & areola
   Deep lymphatics  parenchyma as well as nipple
  & areola


 Subareolar plexus
             Subareolar plexus
   (of Sappy) of Sappy
4




Mammary ridge
Milk line
   Amastia (Absence of breast)
   Polymastia (Supernumerary breasts)
   Athelia (Absence of nipple)
   Polythelia (Supernumerary nipples)
   Gynaecomastia (in Klinefelter’s syndrome)
Polythelia
Nipple retraction




                                                     Athelia




                          Polymastia
                                                    Gynaecomastia
Amastia of right breast
PHYSIOLOGY
- Important accessory organ of the female
  reproductive system.
- Provides nutrition to the new born in the form of
  milk.
Feed Your Faith, Your Fears Will Starve To Death

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Breast anatomy

  • 2. Youngest known survivor of breast cancer
  • 3. “You are never too young for breast cancer” Diagnosed at age of 2 years Total Mastectomy Juvenile Secretory Breast Carcinoma
  • 4.
  • 5.  Mammary gland.  Present in both sexes.  Rudimentary in male.  Well developed in female after puberty.  Apocrine gland.
  • 6. - In the superficial fascia of the pectoral region.  Vertically: 2nd to 6th ribs.  Horizontally: lateral border of sternum to mid- axillary line. • Above: Clavicle • Below: 7th to 8th ribs • Medially: Midline • Posteriorly : to the edge of latissimus dorsi
  • 7. 2nd rib Pectoralis major Skin 6th rib Fat
  • 8.
  • 10.
  • 11. Skin: • Nipple • Areola Parenchyma Stroma
  • 12. Skin Areola Nipple Tubercle of Montgomery
  • 13. Parenchyma:  Lobes: Lobules - 15 – 20 in number - Composed of minute glandular Ductules structures called lobules - Lobules empty via ductules in lactiferous ducts Lactiferous duct  Lactiferous ducts: - Open on to nipple Lactiferous sinus - Contains ampulla near its end (Reservoir of milk or abnormal discharge) Nipple
  • 14.
  • 15. Stroma: Partly fibrous & partly fatty  Ligaments of Cooper: - Anchors the breast with skin - Cancer cells may infiltrate these ligaments, so the breast becomes fixed & contraction of the ligaments can cause retraction or puckering (folding) of the skin.
  • 16. Non-lactating Lactating
  • 17. Extremely vascular 1. Internal thoracic artery – perforating branches 2. Axillary artery – 1. Lateral thoracic artery 2. Superior thoracic artery 3. Acromiothoracic artery 3. Posterior intercostal arteries – lateral branches Arteries are distributed in the anterior surface. Posterior surface is relatively avascular.
  • 18. Axillary artery Superior thoracic artery Acromiothoracic artery Lateral thoracic artery Internal thoracic artery Posterior intercostal arteries
  • 19. o Veins follow the arteries. o First converge around the nipple to form an anastomotic venous circle & then form 02 sets of veins. • Superficial veins: drain into Internal thoracic vein & superficial veins of the lower part of the neck • Deep veins: drain into Internal thoracic , Axillary & Posterior intercostal veins
  • 20. Axillary vein Anastomotic venous circle Internal thoracic vein
  • 21. • 4th to 6th intercostal nerves by their Anterior & Lateral cutaneous branches; • Milk secretion by Prolactin, not by nerves
  • 22.
  • 23. • Axillary (85%) (Sentinel Lymph Node) • Anterior • Central • Apical • Lateral • Posterior • Interpectoral • Internal mammary / Parasternal (10%) • Others (5%) • Supraclavicular • Cephalic / Deltopectoral • Posterior intercostal • Subdiaphragmatic • Subperitoneal
  • 24. Axillary lymph nodes Apical Central Lateral Interpectoral Posterior Internal mammary lymph Anterior nodes
  • 25. Devoid of valves.  Superficial lymphatics  skin over breast except nipple & areola  Deep lymphatics  parenchyma as well as nipple & areola  Subareolar plexus Subareolar plexus (of Sappy) of Sappy
  • 26.
  • 29.
  • 30. Amastia (Absence of breast)  Polymastia (Supernumerary breasts)  Athelia (Absence of nipple)  Polythelia (Supernumerary nipples)  Gynaecomastia (in Klinefelter’s syndrome)
  • 31. Polythelia Nipple retraction Athelia Polymastia Gynaecomastia Amastia of right breast
  • 33. - Important accessory organ of the female reproductive system. - Provides nutrition to the new born in the form of milk.
  • 34. Feed Your Faith, Your Fears Will Starve To Death