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BREAST/ MAMMARY GLAND• Modified sweat gland • Accessory organ of
reproductive system• Well developed after puberty in
female• Provides milk to the newbornSITUATION • Superficial• Auxiliary tail ( of spence ) in
Axilla
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EXTENT• Vertical : 2nd -6th rib• Horizontal : Lateral Border of sternum – Mid axillary line
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DEEP RELATIONS• Retro mammary space• Pectoral fascia• Pectoralis major, Serratus
anterior, External oblique abdominis
• Clavipectoral fascia, Pectoralis minor
• 2nd – 6th rib & 2nd – 5th
intercostal space with its contents
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STRUCTURE OF BREAST• SKIN
Nipple & Areola (no hair &fat)
• PARENCHYMA(15-20 lobes)lactiferous duct- l.sinus –alveolus
• STROMAFibrous (suspensory ligament)Fat
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BLOOD SUPPLYArterial: supply from anterior Surface (posterior- Avascular)
• Perforating Branches of internal thoracic artery
• Branches of lat. Thoracic, superior thoracic, acromio thoracic(thoraco acromial)
• Lat. Branches of posterior intercostal artery
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VENOUS DRAINAGE
• Follows the arteries• Converge towards the base of the nipple &
forms an anastomotic v. circle• Venous circle S/F• Internal thoracic, lower part of neck
Deep-• Internal thoracic,axillary, posterior
intercostal
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Nerve supply
• Anterior & lareral cutaneous branches of4th to 6th intercostal nerves
• Milk secretion is controlled by prolactin
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Lymph vessels &nodes
• Superficial lymphatics-skin except nipple & areola
• Deep lymphatics-Parenchyma, nipple & areola
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Internal thoracic
Supraclavicular
Apical
Anerior axillary
Post. axillary
Lat. axillary
Central axillary
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Applied anatomy
• Carcinoma--Puckering of skin-Peau d’ orange-Bilateral spread-Dropping into the pelvis
• Abcess- radial incision
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Axilla
• Gateway to the upper limb
• Irregularly shaped pyramidal space -Four sides-Apex or inlet-Floor
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Axillary inlet
• Lateral border of first rib
• Posterior surface of the clavicle
• Superior border of the Scapula
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Anterior wall of axillaPectoralis majorClavipectoral fascia enclosing pectoralis minor & subclavius
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Posterior wall
• Subscapularis• Lattisimus dorsi,
teres major• Long head of
triceps
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Medial wall of the axilla
• Upper four ribs with intercostal muscles
• Serratus anterior
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Lateral wall • Upper part of shaft
of humerus (bicipital groove)
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Floor of the axilla
• Fascia & dome of skin• Supporetd by
clavipectoral fascia
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Contents of axilla
• Axillary artery & it’s branches• Axillary vein & it’s branches• Infraclavicular part of brachial plexus• Axillary lymph nodes & lymphatics• Long thoracic nerve & intercostobrachial nerves• Fat & areolar tissue• Proximal parts of biceps brachii,
coracobrachialis & axillary process of breast
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Axillary artery• Continuation of
subclavian artery• Outer border of first
rib to lower border of teres major
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Axillary vein• Continuation of
basilic vein• Receives tributaries
like venae comitantes of brachial artery, cephalic vein, veins corresponding to branches to axillary artery
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Axillary sheath
• Derived from prevertebral layer of deep cervical fascia
• Envelops axillary artery & brachial plexus
• Axillary vein is not included
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Axillary lymph nodes
• Anterior axillary• Posterior axillary• Central group• lateral group• Apical
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Brachial plexus• Formed by ant. Primary rami of C5 – T1
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Brachial plexusBranches from roots-• Long thoracic
nerve(C567)• Dorsal scapular
nerve(C5)Branches from trunks-• Suprascapular
(C56) • Nerve to subclavius
(C56)
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Branches of lateral cord
• Lateral pectoral nerve (C567)
• Musculocutaneous nerve (C567)
• Lateral root of median nerve (C567)
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Branches of medial cord• Medial pectoral
nerve (C8T1) • Medial cutaneous
nerve of arm (C8T1)• Medial cutaneous
nerve of forearm (C8T1)
• Ulnar (C8T1)• Medial root of
median (C8T1)
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Branches of posterior cord
• Upper subscapular(C56)
• Thoracodorsal(C678)• Lower subscapular
(C56)• Axillary (C56)• Radial( C5678T1)
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Other nerve supply of upper limb
• Supraclavicular branches from cervical plexus
• Intercostobrachial nerve (lateral cutaneous branch of second intercostal nerve)
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Injuries to brachial plexus
• Erb’s paralysisInjury to upper trunk
• Klumpke’s paralysisInjury to lower trunk
• Injury to nerve to serratus anteriorWinging of scapula
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• Erb’s paralysisInjury to upper trunk nerve root involved are C-5 & 6
Cause of injury-undue separation of head from shoulder in birth injury, fall on shoulder and during anesthesia
Muscles paralyzed- Biceps, deltoid, brachialis, brachioradialis, supraspinatus, infraspinatus & supinator
Deformity- Arm adducted & medially rotated, forearm extended & pronated. Deformity is known as policeman’s tip hand or porter’s tip hand
Biceps & supinator jerk are lostSensation lost over a small area over lower part of
deltoid
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Porter’s tip hand Erb’s point
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• Klumpke’s paralysisInjury to lower trunk. Nerve root involved are
C8 &T1Cause of injury-Undue abduction of arm as in
clutching some thing with the hand after a fall from height, or some times birth injury
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• Muscles paralyzed- Intrinsic muscles of hand & ulnar flexor of wrist & fingers
• Deformity- Claw hand due to unopposed action of long flexors & extensors, There is hyperextension at metacarpophalangeal joint & flexion at interphalangeal joint
• Cutaneous anesthesia & analgesia along the ulnar border of forearm & hand
• Horner syndrome- Ptosis, miosis, anhydrosis enophthalmos & loss of ciliospinal reflex
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• Injury to nerve to Serratus anterior
Winging of scapulaCause- Sudden pressure from
above, carrying heavy loads on shoulder
Disability- loss of pushing & punching movements , arm cannot be abducted beyond 90 degree
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Applied importance of axilla
• Boils• Axillary lymphadenopathy• Abcess