Sunday 26 June 2016

The Breasts-The Breasts at Puberty-Young Women-The Breast atPregnancy-Postmenopause-Blood Supply to Breast-Arteries-Veins-Lymph Drainage-

The Breasts
The breasts, they are situated in the pectoral region so they are not anatomically part of the upper limb and their blood supply and lymphatic drainage is largely into the armpit. Their clinical importance cannot be overemphasized.
The breasts are specialized accessory glands of the skin that secrete milk. They are present in both sexes. In males and immature females, they are similar in structure. The nipples are small and surrounded by a colored area of skin called the areola. The breast tissue consists of a system of ducts embedded in connective tissue that does not extend beyond the margin of the areola.

Puberty
At puberty in females, the breasts gradually enlarge and assume their hemispherical shape under the influence of the ovarian hormones. The ducts elongate, but the increased size of the glands is mainly from the deposition of fat. The base of the breast extends from the 2nd to 6th rib and from the lateral margin of the sternum to the midaxillary line. The greater part of the gland lies in the superficial fascia. A small part, called the axillary tail, extends upward and laterally, pierces the deep fascia at the lower border of the pectoralis major muscle, and enters the axilla.
Each breast consists of 15 to 20 lobes, which radiate out from the nipple. The main duct from each lobe opens separately on the summit of the nipple and possesses a dilated ampulla just before its termination. The base of the nipple is surrounded by the areola. Tiny tubercles on the areola are produced by the underlying areolar glands.
The lobes of the gland are separated by fibrous septa that serve as suspensory ligaments. Behind the breasts is a space filled by loose connective tissue called the retromammary space.

Young Women
In young women, the breasts tend to protrude forward from a circular base.



Pregnancy
Early In the early months of pregnancy, there is a rapid increase in length and branching in the duct system. The secretory alveoli develop at the ends of the smaller ducts, and the connective tissue becomes filled with expanding and budding secretory alveoli. The vascularity of the connective tissue also increases to provide adequate nourishment for the developing gland. The nipple enlarges, and the areola becomes darker and more extensive as a result of increased deposits of melanin pigment in the epidermis. The areolar glands enlarge and become more active.
Late During the second half of pregnancy, the growth process slows. The breasts, however, continue to enlarge, mostly because of the distention of the secretory alveoli with the fluid secretion called colostrum. Postweaning Once the baby has been weaned, the breasts return to their inactive state. The remaining milk is absorbed, the secretory alveoli shrink, and most of them disappear. The interlobular connective tissue thickens. The breasts and the nipples shrink and return nearly to their original size. The pigmentation of the areola fades, but the area never lightens to its original color.

Postmenopause
After the menopause, the breast atrophies. Most of the secretory alveoli disappear, leaving behind the ducts. The amount of adipose tissue may increase or decrease. The breasts tend to shrink in size and become more pendulous. The atrophy after menopause is caused by the absence of ovarian estrogens and progesterone

Blood Supply

Arteries
The branches to the breasts include the perforating branches of the internal thoracic artery and the intercostal arteries. The axillary artery also supplies the gland via its lateral thoracic and thoracoacromial branches.

Veins
The veins correspond to the arteries.



Lymph Drainage
The lymph drainage of the mammary gland is of great clinical importance because of the frequent development of cancer in the gland and the subsequent dissemination of the malignant cells along the lymph vessels to the lymph nodes.
The lateral quadrants of the breast drain into the anterior axillary or pectoral group of nodes (situated just posterior to the lower border of the pectoralis major muscle). The medial quadrants drain by means of vessels that pierce the intercostal spaces and enter the internal thoracic group of nodes (situated within the thoracic cavity along the course of the internal thoracic artery). A few lymph vessels follow the posterior intercostal arteries and drain posteriorly into the posterior intercostal nodes (situated along the course of the posterior intercostal arteries); some vessels communicate with the lymph vessels of the opposite breast and with those of the anterior abdominal wall.





























































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