Topic 3 MAMMMO
COOPER'S LIGAMENTS
- Fibrous membranes that incompletely sheathe, but support the lobes of the breast.
ADIPOSE OR FATTY TISSUE
- Fills in the spaces between glandular and fibrous tissue and largely determines the breast size.
TERMINAL DUCT LOBULAR UNIT (TDLU)
- Is the critical hub of the functioning breast.
TERMINAL DUCT LOBULAR UNIT (TDLU)
- Responsible for milk production and hormonal and nutritional exchange
RETROMAMMARY SPACE.
- The arrangement of loose connective tissue in this space allows the breast to move fairly freely over the fascia covering pectoralis major.
COOPER'S LIGAMENTS
- The ligaments attach at the base of the breast and extended outward, attaching to the anterior superficial fascia of the skin.
Ligaments of Cooper or Cooper's Ligaments
- These thickened fascial strands Extend into the breasts to provide a supporting framework
GLANDULAR TISSUE
- includes the breast lobes & breast ducts
GLANDULAR TISSUE
- is made up of milk ducts and glands
1. FIBROUS TISSUES 2. GLANDULAR OR SECRETORY 3. ADIPOSE OR FATTY
3 MAJOR TYPES OF BREAST TISSUE
superior and lateral thoracic, thoracoacromial, subscapular arteries
4 axillary artery
PECTORALIS MAJOR MUSCLE
A fan-shaped muscle originating from the anterior rib cage, sternum, and clavicle
RETROMAMMARY PATHWAY
Comes from deeper portion of the breast
INTERNAL MAMMARY PATHWAY
Connections may lead across the median plane and hence to the contralateral breast
RETROMAMMARY SPACE.
Deep to the point where the breast attaches to the posterior layer of the superficial fascia is a zone of loose areolar tissue called
AXILLARY OR LATERAL PATHWAY
Dominant pathway ( received >75% of lymph from breasts)
AXILLARY OR LATERAL PATHWAY
Drains several quadrants o breast either directly or via Sappey's plexus to axillary nodes
RETROMAMMARY PATHWAY
Drains to the subclavicular plexus
AXILLARY OR LATERAL PATHWAY
Either runs around inferior border of pectoralis major to reach the pectoral group of lymph nodes or pass directly to the subscapular group.
15 to 20 glands
Embedded in the breast's fatty and fibrous tissue are ____ ____ called LOBES
AXILLARY OR LATERAL PATHWAY
Few channels from superior breast to apical group sometimes interrupted by the infraclavicular group of lymph nodes
Sappey's plexus
From this plexus, lymphatic drainage takes place through three main routes that parallel venous tributaries
cycle changes, menstrual cycle, and hormone fluctuation.
Increase and decreases in number and size of TDLU depending on life
PECTORALIS MAJOR MUSCLE
It adducts, flexes and medially rotates the arm
SERRATUS ANTERIOR MUSCLE
It arises from the upper eight ribs and wraps around the rib cage to insert posteriorly along the entire medial border of the anterior portion of the scapula
SERRATUS ANTERIOR MUSCLE
It becomes the major protractor for the upper limb ("boxer's muscle").
PECTORALIS MINOR MUSCLE
It originates from ribs III to V, inserts onto the coracoid process of the scapula by pulling it inferiorly and anteriorly.
PECTORALIS MAJOR MUSCLE
Its large sternocostal head joins with the smaller clavicular head and inserts onto the anterior superior portion of the humerus
PECTORALIS MINOR MUSCLE
Lies deep to the pectoralis major and covers the second part of the axillary artery and the cords of the brachial plexus
thoracic duct and left subclavian vein
Lymphatics from the left breast ultimately terminate in the
right subclavian vein
Lymphatics from the right breast ultimately terminate in the
CENTRAL PORTION OF THE BREAST and IN THE UPPER OUTER QUADRANT, EXTENDING TOWARD THE AXILLA.
Most of the glandular tissue is found in the
TDLU
Most pathology, including most types of cancer, arises from the
INTERNAL MAMMARY PATHWAY
Originates from both the medial and lateral quadrants of the breast
Sappey's plexus
Originates from breast lobules and flows through intramammary nodes and channels into a subareolar plexus,
RETROMAMMARY PATHWAY
Other pathways occur when usual channels are blocked in disease. Lymph may pass to the contralateral breast, cervical nodes, peritoneal cavity, and liver through the diaphragm or through rectus sheath.
INTERNAL MAMMARY PATHWAY
Passes through the intercostal spaced and pectoralis major into parasternal/internal mammary lymph nodes
SUBCLAVIUS MUSCLE
Small, rounded and inferior to the clavicle. It joins the inferior surface of the clavicle to rib I and pulls the clavicle inferiorly and anteriorly.
8 ribs
Structural support for the pectoral muscle and the mammary glands is primarily provide by the upper
T
T/F: the lymphatic vessels flow in the opposite direction of the blood supply and drain into the lymph nodes.
internal mammary artery
The blood supply from the breast comes primarily from the _________ _______ ______ which runs underneath the main breast tissue.
subcutaneous superficial fascia.
The breast develops within the layers of the
fascia
The breast is loosely attached to the ______ covering the pectoralis major muscle and this allows the breast to move over.
TERMINAL DUCT LOBULAR UNIT (TDLU)
The portion of the ductal structure starting at the extralobular duct and ending at the terminal ductules.
LYMPHATIC DRAINAGE OF THE BREAST.
The retromammary space also plays an important role in the
Ligaments of Cooper or Cooper's Ligaments
The supportive structure of the breast also considered as the
Ligaments of Cooper or Cooper's Ligaments
The tissues which make up the breast lie in between, anchored by extensions of these fascial membranes, and known as
sternoclavicular joint
The upper limb is connected to the chest by the _____________________ with the pectoral muscle providing muscular attachment to the anterior aspect of the torso
elastic
This cooper's ligament is not _______ like breast tissues.
superficial
__________ of these fascial layers is positioned directly under the skin and forms the anterior boundary of the mammary gland.
breast
a specialized gland structure that evolves essentially as an appendage of the skin
ADIPOSE OR FATTY TISSUE
are radiolucent, resting in areas of higher optical density on the mammogram.
Ducts
are the tiny tubes that carry milk from the lobules to the nipple.
Level 2
axillary lymph nodes lying behind pectoralis minor
Level 1:
axillary lymph nodes lying below pectoralis minor
Level 3
axillary lymph nodes lying between the upper border of pectoralis minor and the lower border of clavicle
Perforating branches of second, third and fourth intercostal arteries
contribute to the supply of the entire breast.
glandular tissue
cooper's ligaments are not individually appreciated on the mammogram but are of particular significance because of their notable effect on the
LOBES
each of which has many smaller lobules, or sacs, that produce milk.
breast veins
follow the mentioned arteries, they drain into the axillary, internal thoracis and second to fourth intercostal veins.
deepest layer
forms the posterior boundary and sits over the muscles of the chest wall.
Fibrous tissue and fat
give the breast their size and shape and hold the other tissues in place.
Extralobular Stroma
hold the larger ductal structures
mammary gland or the breast tissue
is the network of lobules, ducts, surrounded by the fatty and fibrous connective tissues.
blood supply
it provides nutrients such as oxygen to the breast tissue
Lobules
produce milk and are often called GLANDULAR TISSUE
Intralobular Stroma
specialized tissue that gives the lobule its shape and definition
branches of axillary artery
supply blood of the lateral part of the breast.
branches of the internal thoracic artery
supply blood to the medial part of the breast as the medial mammary arteries.
Fibrous tissue, also known as CONNECTIVE TISSUE,
supports the breast and holds everything in place.
fascia
the breast tissue is encircled by a thin layer of connective tissue called
PECTORALIS MAJOR MUSCLE
the largest in the breast and pectoral region
anterior and lateral cutaneous branches of the second to sixth intercostal nerves
these are responsible for breast innervation
SERRATUS ANTERIOR MUSCLE
thin muscular sheet overlying the lateral part of the thoracic cage and intercostal muscles
Fibrous or Supportive or Connective
tissue is the same tissue that ligaments and scar tissue are made of.
lymphatic vessels
vessels that are very important because breast carcinomas tend to spread by travelling through these vessels, creating metastatic deposits in distant parts of the body.