Axilla and Breast
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Extends b/w the coracoid process, clavicle, and thoracic wall and envelops the subclavius and pectoralis minor muscles.
What are the 3 components of the Clavipectoral Fascia?
- 1) Costocoracoid ligament
- 2) Costocoracoid membrane
- 3) Suspensory ligament of the axilla
Part of clavipectoral fascia. Thickening of fascia between coracoid process and first rib
Part of clavipectoral fascia. Between subclavius and pectoralis minor muscles and is pierced by cephalic vein, thoracoacromial artery, and lateral pectoral nerve.
Suspensory ligament of the axilla
Part of clavipectoral fascia. Inferior extension of fascia and is attached to axillary fascia, maintaining the hollow of the armpit.
- Continuous anteriorly with pectoral and clavipectoral fasciae(suspensory ligament of the axilla), laterally with brachial fascia, and posteromedially with fascia over latissimus dorsi.
- Forms floor of axilla and attached to the suspensory ligament of axilla that forms hollow of the armpit by traction when arm is abducted
Tubular fascial prolongation of the prevertebral layer of deep cervical fascia into the axilla enclosing the axillary vessels and brachial plexus.
Pyramid shaped space between upper thoracic wall and arm
Boundaries of Axilla
- Medial wall: Upper ribs and intercostal muscles and serratus anterior muscle
- Lateral wall: Intertubercular groove of humerus
- Posterior wall: Subscapularis, teres major, and latissimus dorsi muscles
- Anterior wall: pectoralis major and pectoralis minor muscles and clavipectoral fascia
- Base: Axillary fascia and skin
- Apex: Interval b/w clavicle, first rib, and upper border of scapula
Contents of the Axilla
- 1) Brachial plexus and its branches
- 2) Axillary artery
- 3) Axillary Vein
- 4) Lymph nodes
- 5) Axillary tail
many branches, including the superior thoracic, thoracoacromial, lateral thoracic, thoracodorsal, and circumﬂex humeral (anterior and posterior) arteries.
formed by the union of the brachial veins (venae comitantes of the brachial artery) and the basilic vein, receives the cephalic vein and veins that correspond to the branches of the axillary artery, and drains into the subclavian vein.
(tail of Spence) is a superolateral extension of the mammary gland.
Axillary Lymph Nodes
- 1. Central Nodes
- 2. Brachial (lateral) nodes
- 3. Subscapular (posterior) nodes
- 4. Pectoral (anterior) nodes
- 5. Apical (medial or subclavicular) nodes
Lie near the base of the axilla between the lateral thoracic and subscapular veins; receive lymph from the lateral, anterior, and posterior groups of nodes; and drain into the apical nodes.
Brachial (Lateral) Nodes
Lie posteromedial to the axillary veins, receive lymph from the upper limb, and drain into the central nodes.
Subscapular (posterior nodes)
Lie along the subscapular vein, receive lymph from the posterior thoracic wall and the posterior aspect of the shoulder, and drain into the central nodes.
Pectoral (anterior) nodes
Lie along the inferolateral border of the pectoralis minor muscle; receive lymph from the anterior and lateral thoracic walls, including the breast; and drain into the central nodes.
Apical (medial or subclavicular) nodes
Lie at the apex of the axilla medial to the axillary vein and above the upper border of the pectoralis minor muscle, receive lymph from all of the other axillary nodes (and occa-sionally from the breast), and drain into the subclavian trunks.
What does the breast contain?
Consists of mammary gland tissue, ﬁbrous and fatty tissue, blood and lymph vessels, and nerves.
What are the boundaries of the breast?
Extends from the second to sixth ribs and from the sternum to the midaxillary line and is divided into the upper and lower lateral and medial quadrants.
Which fascia contain the mammary glands?
What supports the breast?
Is supported by the suspensory ligaments (of Cooper), strong ﬁbrous processes, that run from the dermis of the skin to the deep layer of the superﬁcial fascia through the breast
usually lies at the level of the fourth intercostal space and contain smooth muscle ﬁbers that contract on tactile stimulation inducing ﬁrmness and prominence
a ring of pigmented skin around the nipple
How is blood supplied to the breast?
Receives blood from the medial mammary branches of the anterior perforating branches of the internal thoracic artery, the lateral mammary branches of the lateral thoracic artery, the pectoral branches of the thoracoacromial trunk, and the lateral cutaneous branches of the posterior intercostal arteries
How is the breast innervated?
Is innervated by the anterior and lateral cutaneous branches of the second to the sixth intercostal nerves
More than one pair of breasts
More than one pair of nipples
absence of breasts
absence of nipples
What type of gland is the mammary gland?
modiﬁed sweat gland located in the fatty superﬁcial fascia
a small part of the mammary gland that extends superolaterally sometimes through the deep fascia to lie in the axilla
What separates the breast from the deep fascia of the chest?
Loose areolar tissue known as the retromammary space, allows breast some movement over pectoralis major muscle
What allows milk to pass to the tip of the nipple?
Lactiferous duct, 15-30 lobes of grandular tissue radiating from nipple
What serves as a reservoir for milk during lactation?
Lactiferous sinus, enlarged part of lactiferous duct
What is a sentinel node (biopsy) procedure?
- Surgical procedure to determine extent of spread or stage of cancer (most commonly breast cancer) by use of an isotope injected into tumor region.
- Sentinel lymph node is 1st lymph node(s) to which cancer cells are likely to spread from the primary tumor.
In which quadrant is breast cancer most likely to occur?
Upper lateral quadrant ~60% of cases and forms a palpable mass in advanced stages.
What happens when breast cancer begins?
It enlarges, attaches to Cooper's ligaments, and produces shortening of ligaments, causing depression or dimpling of the overlying skin.
What is an advanced sign of inflammatory breast cancer?
- Peau d'orange (texture of an orange peel)
- Edematous swollen and pitted breast skin due to obstruction of subcutaneous lymphatics. Cancer may also attach to and shorten lactiferous ducts resulting in a retracted or inverted nipple.
- It may invade deep fascia of pectoralis major muscle, so that the contraction of the muscle produces a sudden upward movement of the entire breast.
What is a radical mastectomy?
Extensive surgical removal of breast and its related structures, including pectoralis major and minor muscles, axillary lymph nodes and fascia, and part of thoracic wall.
What are some side effects of a radical mastectomy?
May injure long thoracic and thoracodorsal nerves and may cause postoperative edema of upper limb due to lymphatic obstruction caused by removal of most of the lymphatic channels that drain the arm or by venous obstruction caused by thrombosis of the axillary vein
What is a modified radical mastectomy?
- Excision of the entire breast and axillary lymph nodes, with preservation of pectoralis major and minor muscles
- Pectoralis minor is usually retracted or severed near its insertion into coracoid process.
Surgical excision of only palpable mass in carcinoma of breast
What is the great importance of lymphatic drainage from the breast?
Frequent development of cancer and subsequent dissemination of cancer cells through lymphatic stream
Where does the breast drain lymphatic fluid?
- Lateral quadrants: Into axillary nodes (~75% drains here, specifically into pectoral (anterior nodes))
- Medial quadrants: into parasternal (internal thoracic) nodes (follows perforating vessels through pectoralis major and thoracic wall to enter parasternal (internal thoracic) nodes along internal thoracic artery
- Can also drain to apical nodes and may connect to lymphatics draining opposite breast and to lymphatics draining anterior abdominal wall
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