Department of Anatomy

College of Health Sciences

Dr Ray Ude (JP)

Pectoral Region; Breast

Pectoral Region

SECTION I
 THE ANATOMY

OF THE PECTORAL REGION

IN

8 QUESTIONS
1. Where is the pectoral region?
The pectoral region is external to the
anterior thoracic wall and anchors the upper
limb to the trunk.
2. What does the pectoral region consist of?
Superficial compartment
Contains skin, superficial fascia, breasts

Deep compartment
Contains muscles & associated structures
3. What are the muscles of the pectoral region?
Four pectoral muscles move the pectoral girdle

Pectoralis major Clavicular head: Medial half of

clavicle
Medial border
Coracoid process
Pectoralis minor of of scapula
scapula
Sternocostal head:
Serratus anterior Stabiliz Anterior surface of
Lateral lip of
es
3rd-5th ribs
Adducts and sternum, superior six
intertubercular sulcus of
scapula
near their costal cartilages,
Subclavius medially
humerus
Protracts
costal
rotates & aponeurosis of external
Lateral parts of
cartilages oblique muscle
rotates
humerus scapula
1st-8th ribs
4. What movements does the pectoralis major muscle ?
Pectoralis major
powerful adduction
medial rotation of the arm

clavicular
head flexing
the humerus

sternocostal
head extending
it back
5. What movements do pectoralis minor & subclavius ?
Pectoralis minor
stabilizes the scapula
touch an object that is just out of reach.

Assists in elevating the ribs

Subclavius
Anchors and depresses the clavicle,
stabilizing it during movements of the upper
limb.
 6. What movements does the serratus anterior ?
one of the most powerful muscles
of the pectoral girdle
 Strong protractor of scapula –Abduction
 used when punching or reaching anteriorly(boxer's
muscle).
7. How are these muscles innervated?
Pectoralis major Medial & Lateral pectoral nerves
Pectoralis minor Medial pectoral nerve
Subclavius Nerve to subclavius
Serratus anterior Long thoracic nerve

10
8. ..the claviopectoral fascia and triangle?
Deep to the pectoral
fascia & pectoralis major Clavipectoral
triangle
Descends from the cephalic vein can
clavicle be found.
formed by
pectoralis major,
deltoid & clavicle

Deltopectoral groove
 Breast

SECTION II
 OBJECTIVES

• By the end of the lecture, the student should be

able to:
• Describe the shape and position of the breast.
• Describe the structure of the mammary gland.
• List the blood supply of the breast.
• Describe the lymphatic drainage of the breast.
• Describe the applied anatomy in the breast.
 Introduction/General Information
• Embryologically: belong to integument
• Functionally: part of reproductive
system
1. Respond to sexual stimulation
2. Feed babies
• C. Modified apocrine sweat glands
• apex of cell becomes part of secretion and breaks off

• D. Present in males and females

FEMALE BREAST
 Parts, Shape & position of the Gland
• It is conical in shape.
• It lies in superficial
fascia of the front of
chest.
• It has a base, apex
and tail.
• Its base extends from
2nd to 6th ribs.
• It extends from the
sternum to the
midaxillary line
laterally.
• It has no capsule.
SHAPE AND POSITION OF FEMALE BREAST
• 2/3 of its base lies
on the pectoralis
major muscle, while
its inferolateral 1/3
lies on:
• Serratus anterior &
• External oblique
muscles.
• Its superolateral
part sends a process
into the axilla called
the axillary tail or
axillary process.
SHAPE AND POSITION OF FEMALE BREAST
• Nipple:
• It is a conical eminence that
projects forwards from the
anterior surface of the breast.
• The nipple lies opposite 4th
intercostal space.
• It carries 15-20 narrow pores
of the lactiferous ducts.
• Areola :
• It is a dark pink brownish
circular area of skin that
surrounds the nipple.
• The subcutaneous tissues of
nipple & areola are devoid of
fat.
STRUCTURE OF MAMMARY GLAND
• It is non capsulated gland.
• It consists of lobes and lobules
which are embedded in the
subcutaneous fatty tissue of
superficial fascia.
• It has fibrous strands
(ligaments of cooper) which
connect the skin with deep
fascia of pectoralis major.
• It is separated from the deep
fascia covering the underlying
muscles by a layer of loose
areolar tissue which forms the
retromammary space. What is
its Importance? (allows the breast to move
freely).
STRUCTURE OF MAMMARY GLAND
• It is formed of 15-20 lobes.
• Each lobe is formed of a
number of lobules.
• The lobes and lobules are
separated by interlobar and
interlobular fibrous & fatty
tissue, called ligaments of
Cooper. (Importance)? These
ligaments give the breasts support by connecting the skin of
the breasts to the pectoralis muscles below them.

• It has from 15-20 lactiferous

ducts which open by the
same number of openings on
the summit of the nipple.
 ARTERIAL SUPPLY
• 1. Perforating
branches of internal
thoracic (internal
mammary) artery
(60%).
• 2. Mammary
branches of lateral
thoracic artery
(30%).
• 3. Mammary
branches of
Intercostal arteries
(10%).
 VENOUS SUPPLY

• Veins are
corresponding to
the arteries.
• Circular venous
plexus are found
at the base of
nipple.
• Finally, veins of
this plexus drain
into axillary
(primary) &
internal thoracic
veins.
 Nerve supply

• Long thoracic nerve

• Thoracodorsal nerve
• Medial pectoral nerve
• Lateral pectoral nerve
AXILLARY LYMPH NODES
• They are arranged into 5 groups which
lie in axillary fat :
• Pectoral (Anterior) group : which lies
on the pectoralis minor along lateral
thoracic vessels.
• Subscapular (Posterior) group : which
lies on posterior wall of axilla on lower
border of subscapularis along
subscapular vessels.
• Brachial (Lateral) group : lies on lateral
wall of axilla along 3rd part of axillary
vessels.
• Central group : lies in axillary fat at the
base of axilla.
• Apical group : lies at apex of axilla.
• Subclavian lymph trunk:
• it is formed by union of efferent lymph
vessels of apical group. It usually opens
in subclavian vein. On the left side it
usually opens into thoracic duct.
LYMPHATIC DRAINAGE

• Subareolar lymphatic
plexus :
• Lies beneath the areola.
• Deep lymphatic plexus:
• Lies on the deep fascia
covering pectoralis
major.
• Both plexuses radiate in
many directions and
drain into different
lymph nodes.
LYMPHATIC DRAINAGE • Central & lateral parts of the
gland (75%) drain into pectoral
group of axillary lymph nodes.
• Upper part of the gland drains
into apical group of axillary lymph
nodes.
• Medial part drains into internal
thoracic (parasternal) lymph
nodes, forming a chain along the
internal thoracic vessels.
• Some lymphatics from the medial
part of the gland pass across the
front of sternum to anastomose
with that of opposite side.
• Lymphatics from the inferomedial
part anastomose with lymphatics
of rectus sheath & linea alba, and
some vessels pass deeply to
anastomose with the sub
diaphragmatic lymphatics.
 Normal Findings

• Minor size variation in the breasts and areolar

areas
• Usually breast on dominant side is larger
• Nipples should point upward and outward,
may point outward and downward
 Normal Findings

• Breasts, areolar areas, nipples should be

symmetrical
• Breasts are convex, without flattening,
retractions, or dimpling
• Free from masses, tumors, primary or
secondary lesions
 Normal Findings

• No discharge from nipples in nonpregnant,

nonlactating female
• Usually, palpable lymph nodes less than 1
cm in diameter are clinically insignificant
• Palpation should not elicit pain
 APPLIED ANATOMY- CANCER BREAST
• It is a common surgical condition.
• 60% of carcinomas of breast
occur in the upper lateral
quadrant.
• 75% of lymph from the breast
drains into the axillary lymph
nodes.
• In case of carcinoma of one
breast, the other breast and the
opposite axillary lymph nodes are
affected because of the
anastomosing lymphatics
between both breasts.
• In patients with localized cancer
breast, a simple mastectomy,
followed by radiotherapy to the
axillary lymph nodes is the
 Signs and Symptoms

Most common:
lump or
thickening in
breast. Often
painless

Discharge Redness or pitting

or of skin over the
bleeding breast, like the skin
of an orange
Change in size Change in color
or contours of or appearance
breast of areola
• The lactiferous
ducts are radially Applied Anatomy
arranged from the
nipple, so incision
of the gland should
be made in a radial
direction to avoid
cutting through the
ducts.
• Infiltration of the
ligaments of
Cooper by breast
cancer leads to its
shortening giving
peau de’orange
appearance of the
breast.
 Mammography

• Use a low-dose x-ray system to examine breasts

• Digital mammography replaces x-ray film by solid-
state detectors that convert x-rays into electrical
signals. These signals are used to produce images
that can be displayed on a computer screen (similar
to digital cameras)
• Mammography can show changes in the breast up to
two years before a physician can feel them
Mammography Equipment
 Detection of Malignant Masses
Malignant masses have a more spiculated
appearance

malignant benign
 Noncancerous Conditions

• Fibrocystic changes: Lumpiness, thickening and swelling,

often associated with a woman’s period
• Cysts: Fluid-filled lumps can range from very tiny to about
the size of an egg
• Fibroadenomas: A solid, round, rubbery lump that moves
under skin when touched, occuring most in young women
• Infections: The breast will likely be red, warm, tender and
lumpy
• Trauma: a blow to the breast or a bruise can cause a lump

10/25/2024
 Mammary ridge

• Mammary ridge
extends from the axilla
to the inguinal region.
• In human, the ridge
disappears EXCEPT for a
small part in the
pectoral region.
• In animals, several
mammary glands are
formed along this ridge.
 The Male Breast
• Gynecomastia
– Prepubertal gynecomastia
• Rare, adrenal carcinoma and testicular tumor can cause this.
– Pubertal gynecomastia
• Occurs in 60-70% of pubertal boys.
– Senescent gynecomastia
• 40% of aging men have this to some degree.
• Drugs, such as steroids, digitalis, hormones, spironolactone, and antidepressants can cause this.
• Male breast carcinoma
– 0.7% of all breast cancers
– <1% of male cancers
– Average age of diagnosis is 63.6 years old
– Painless unilateral mass that is usually subareolar with skin fixation, chest wall fixation,,
and ulceration.
– Mostly ductal carcinoma
– Males generally present at later stage than woman
• Overall survival worse in men, however when compared stage for stage the survival rates are
similar.
Which is correct regarding the mammary gland ?
It extends from the 2nd to 8th ribs.
Its base lies on the pectoralis major muscle.
It has 4-8 lactiferous ducts.
Its most lymph drains into the parasternal lymph nodes.

The lymphatics from upper part of mammary gland drain into :

The parasternal lymph nodes.
Subdiaphragmatic lymph nodes.
Apical group of axillary lymph nodes.
Pectoral group of axillary lymph nodes.

The lactiferous ducts of mammary gland are :

Less than 10.
From 10-15.
From 15-20.
More than 20.
 THANK YOU

Any Questions???