THE BREASTTHE BREASTA REVIEW OFA REVIEW OF 1-EMBRYOLOGY1-EMBRYOLOGY2-SURGICAL ANATOMY2-SURGICAL ANATOMY3-PHYSIOLOGY3-PHYSIOLOGY4-CLINICAL EXAMINATION (to evalate a 4-CLINICAL EXAMINATION (to evalate a l!"#l!"#The breast or mammary gland is found The breast or mammary gland is found in both sexes.in both sexes.Well developed in female after puberty,Well developed in female after puberty,Rudimentary in maleRudimentary in maleA modifed sweat gland.A modifed sweat gland.E!R"#$#%"E!R"#$#%" &n 'th()th w* of fetal development&n 'th()th w* of fetal development Twoventralbandsofthi+*ened Twoventralbandsofthi+*ened e+toderm,AAR"R&-%E./&$0$&1E.2are e+toderm,AAR"R&-%E./&$0$&1E.2are evidentevident Extent of mil* line/mammary ridge(from base of Extent of mil* line/mammary ridge(from base of forelimb,futureaxilla2toregionofhind forelimb,futureaxilla2toregionofhind limb,inguinal area2 limb,inguinal area2 ridgesdisappearaftershorttimeex+eptin ridgesdisappearaftershorttimeex+eptin pe+toral region pe+toral region ea+hbreastdevelopswhenaningrowthof ea+hbreastdevelopswhenaningrowthof e+todermformsaprimarytissuebudin e+todermformsaprimarytissuebudin mesen+hyme.mesen+hyme. 3rimary bud initiates the development 4'(56 se+ondary3rimary bud initiates the development 4'(56 se+ondary buds buds Epithelial+ordsdevelopfromse+ondarybudsandEpithelial+ordsdevelopfromse+ondarybudsand extend into surrounding mesen+hyme. extend into surrounding mesen+hyme. a7or,la+tiferous2du+tsdevelop,whi+hopenintoa7or,la+tiferous2du+tsdevelop,whi+hopeninto shallow mammary pit. shallow mammary pit. 3roliferationofmesen+hymetransformsthemammary3roliferationofmesen+hymetransformsthemammary pit into nipple. pit into nipple. AA.T&A8(bilateralabsen+eofbreasttissueandAA.T&A8(bilateralabsen+eofbreasttissueand nipple, nipple,Whenbreasttissueisabsentunilaterallype+toralWhenbreasttissueisabsentunilaterallype+toral mus+les are often absent. mus+les are often absent.3#$"A.T&A8( ,A99E..#R" !REA.T2 3#$"A.T&A8( ,A99E..#R" !REA.T2 ore than one breast on one or both sides,anywhereore than one breast on one or both sides,anywhere along mil* ridge along mil* ridge ."A.T&A8(webbingbetweenthebreastsa+ross."A.T&A8(webbingbetweenthebreastsa+ross midline midlineCONGENITAL ABNORMALITIES O$ BREASTCONGENITAL ABNORMALITIES O$ BREAST3#$"T:E$&A8( ,A99E..#R" 1&33$E.23#$"T:E$&A8( ,A99E..#R" 1&33$E.2

&mperfe+t development of mammary &mperfe+t development of mammary rudiment,sothatsupernumerary rudiment,sothatsupernumerary nipplesaresituatedirregularlyover nipplesaresituatedirregularlyover breast/or along mil* ridgebreast/or along mil* ridgeAT:E$&A ; absen+e of AT:E$&A ; absen+e of nipple nipple &1 lies in axilla lies in axilla Extent8( verti+al( 5nd to )th ribs in+lusive Extent8( verti+al( 5nd to )th ribs in+lusive :ori?ontal(fromlateralborderofsternumto:ori?ontal(fromlateralborderofsternumto anterior axillary line. anterior axillary line.AnatomyAnatomyAnatomyAnatomy1.15-20 lobes2.lobe:lobules, small branch, andlarger ducts.3.Radial fashion4.eri!heral !ortions of lobes often o"erla!AnatomyAnatomy&EEP RELATION&EEP RELATION !reast rests on !reast rests on( fas+ia of pe+toralis ma7or ms ( fas+ia of pe+toralis ma7or ms( serratus anterior ( serratus anterior( ext. obli@ue abdominis mus+le ( ext. obli@ue abdominis mus+le( upper extent of re+tus sheath ( upper extent of re+tus sheath Retromammarybursaidentifedonposterioraspe+tofRetromammarybursaidentifedonposterioraspe+tof breastbreastbetweeninvestingfas+iaofbreast>fas+iaofbetweeninvestingfas+iaofbreast>fas+iaof pe+toralis ms.pe+toralis ms. $&%AE1T.#A9##3ER(Thebreastisan+horedtothe$&%AE1T.#A9##3ER(Thebreastisan+horedtothe overlying s*in > to the underlying pe+toral fas+ia by bandsoverlying s*in > to the underlying pe+toral fas+ia by bands of +onne+tive tissue. of +onne+tive tissue.ARCHITECTURE O$ GLAN& ARCHITECTURE O$ GLAN&

( A+ini (B lobules (B lobes ( A+ini (B lobules (B lobes( $obes arranged in radiating pattern > +onverge on nipple ( $obes arranged in radiating pattern > +onverge on nipple( Ea+h lobe is drained by a du+t. ( Ea+h lobe is drained by a du+t.( 46 to 4' du+ts open into nipple ( 46 to 4' du+ts open into nipple( -u+ts surrounded by loose+onne+tive tissue,> fat gives( -u+ts surrounded by loose+onne+tive tissue,> fat gives roundness. roundness.($argerdu+tsusuallygiverisetodu+tpapillomandu+t($argerdu+tsusuallygiverisetodu+tpapillomandu+t e+tasia. e+tasia.(-istalsmallerdu+tsrisetofbroadenoma,during(-istalsmallerdu+tsrisetofbroadenoma,during development2 development2( 9yst formation > s+lerosing adenosis ,involutional period2 ( 9yst formation > s+lerosing adenosis ,involutional period2( 9an+er intralobular portion of terminal du+ts ( 9an+er intralobular portion of terminal du+ts1&33$E ARE#$A 9#3$EC 1&33$E ARE#$A 9#3$EC Epidermis ; pigmented. ore dar*er with physiologi+al +hanges Epidermis ; pigmented. ore dar*er with physiologi+al +hanges Areola(seba+eous,sweat,>a++essoryglands.produ+esmallAreola(seba+eous,sweat,>a++essoryglands.produ+esmall elevations,#1T%#ER" TD!ER9$E2 elevations,#1T%#ER" TD!ER9$E2!$##- .D33$" !$##- .D33$"(ARTER&A$ (ARTER&A$4. perforating br of internal thora+i+/mammary artery 4. perforating br of internal thora+i+/mammary artery5. lateral bran+hes of posterior inter+ostal arteries 5. lateral bran+hes of posterior inter+ostal arteriesE. bran+hes from axillary artery E. bran+hes from axillary artery( superior thora+i+ ( superior thora+i+( lateral thora+i+ ( lateral thora+i+( pe+toral bran+h of thora+oa+romial artery ( pe+toral bran+h of thora+oa+romial artery