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S U R G I C A L A N A T O M Y O F B R E A S T
Dr. Ahmed Almumtin
I N T R O D U C T I O N
• A modified sweat gland.
• Compartmentalized fat bounded
by CT septa.
• Glandular lobules drained...
• lies over the 2nd - 6th rib.
• Two-thirds rests on pectoralis
major.
• One-third lies on the serratus
anterior.
• The lo...
F O U R Q U A D R A N T S A N D A TA I L
• 4 quadrants.
• Majority of cancers develop
in upper outer quadrant.
• Large amo...
R E T R O M A M M A RY S PA C E
• Reteromammary space: is loose
auroral tissue that separates then
breast from the pectora...
S U R FA C E A N D A E S T H E T I C S
• The tail of Spencer.
• Determinants of
aesthetics.
L I G A M E N T S
• Cooper’s ligament.
• Suspensory ligament of
the breast.
• Fibrous septa anchor deep
layer of skin to d...
I N F R A S T R U C T U R E
• Tumors may grow through
retromammary space.
• Subsequently invade deep
fascia & pec. major m...
A P P L I E D C L I N I C A L A N AT O M Y
• Skin dimpling.
• Nipple retraction.
• Peau d'orange
• Lymphoedema of
ipsilate...
B L O O D S U P P LY
• Vessels of the Breast
• Enter from supr./med.
& supr./lat. aspects
• Penetrate deep
surface of brea...
A R T E R I A L S U P P LY T O T H E B R E A S T
• Lateral (mammary)
thoracic a.
• Internal (mammary)
thoracic a.
• Interc...
V E N O U S D R A I N A G E
• Corresponds
to arterial
system.
• Cephalic vein
LY M P H AT I C S
• Lat. drainage is via 5
groups of axillary nodes
• Supr. drainage is via 1
group of interpectoral
nodes...
LY M P H AT I C S
• Pectoral nodes ( 4-5 nodes,
most drainage).
• Subscapular (posterior) nodes
(6-7),
• Lateral nodes (4-...
LY M P H AT I C S
LY M P H AT I C S I N A S S O C I AT I O N W I T H
V E S S E L S
• Pectoral – lat. thoracic vessels
• Subscapular – subsca...
LY M P H N O D E L E V E L S ( B E R G ’ S )
• 3 Levels of surgical dissections
relative to pec. minor.
• Level I – below ...
C L I N I C A L S I G N I F I C A N C E
• Cancer cells tend to spread along lymph passages
• Typical spread is supr./later...
N E R V E S U P P LY
• Cutaneous
innervation.
• Medial pectoral n.
• Lateral pectoral n.
• Long thoracic n.
N E R V E S U P P LY
N E R V E S U P P LY
• Take care!:
• LTN
• Thoracodorsal
• lateral and medial
pectoral nerve
T H E A X I L L A
• Axillary sheath (axillary
a. & brachial plexus).
• Axillary v. &
lymphatics (outside
sheath).
• Fat & ...
T H E A X I L L A • very busy space.
S U R G I C A L A P P R O A C H T O A X I L L A
• In modified radical mastectomy
• Conservative breast surgery
M A S T E C T O M Y
• Radical Mastectomy.
• modified radical mastectomy
• Simple mastectomy
• skin sparing mastectomy
• Ni...
B O U N D R I E S F O R M A S T E C T O M Y
• Clavicle.
• inframammary fold
(above rectus sheath)
• Sternum (midline).
• L...
S I M P L E M A S T E C T O M Y
• Definition.
• frequency.
M O D I F I E D R A D I C A L M A S T E C T O M Y
• definition.
• indication
R A D I C A L M A S T E C T O M Y
• definition.
• success rates.
S K I N S PA R I N G M A S T E C T O M Y
• Definition.
N I P P L E - A R E O L A R S PA R I N G
M A S T E C T O M Y
• Definition.
• Criteria
C H O I C E O F T H E P R O C E D U R E
• Radical mastectomy - No longer used.
• Lymph node status
• Desired time of recon...
I N C I S I O N S I N B R E A S T S U R G E RY
I N C I S I O N S F O R M A S T E C T O M Y
• depends upon: location, size, reconstruction plans
• SSM.
• MRM
• NASM
Stewart!
* design
according
to tumour
location
• The drains are left in place until the drainage of serous
fluid has decreased to approximately 25 to 30 mL per
24-hour p...
Surgical anatomy of breasts
Surgical anatomy of breasts
Surgical anatomy of breasts
Surgical anatomy of breasts
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Surgical anatomy of breasts

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The surgical anatomy of the breast, surgical procedures, surgical approach to a breast mass. Mastectomy types and differences. Lymphatic drainage

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Surgical anatomy of breasts

  1. 1. S U R G I C A L A N A T O M Y O F B R E A S T Dr. Ahmed Almumtin
  2. 2. I N T R O D U C T I O N • A modified sweat gland. • Compartmentalized fat bounded by CT septa. • Glandular lobules drained by 15-20 lactiferous ducts. • Lactiferous ducts converge & open onto nipple. • Areola surrounds nipple & conceals sebaceous glands • (i.e., produce lubrication for nipple). Compartmentalisation Gland Lobules & Lac. Ducts
  3. 3. • lies over the 2nd - 6th rib. • Two-thirds rests on pectoralis major. • One-third lies on the serratus anterior. • The lower medial edge overlaps the upper part of the rectus sheath. • Medially from the sternal edge, to the mid-axillary line
  4. 4. F O U R Q U A D R A N T S A N D A TA I L • 4 quadrants. • Majority of cancers develop in upper outer quadrant. • Large amount of glandular tissue here. • An axillary tail
  5. 5. R E T R O M A M M A RY S PA C E • Reteromammary space: is loose auroral tissue that separates then breast from the pectoralis major muscle. • The retromammary space is often the site of of breast implantation due to its location away from key nerves and structure that support the breast.
  6. 6. S U R FA C E A N D A E S T H E T I C S • The tail of Spencer. • Determinants of aesthetics.
  7. 7. L I G A M E N T S • Cooper’s ligament. • Suspensory ligament of the breast. • Fibrous septa anchor deep layer of skin to deep fascia. • superfacial (avascular plane) separates the glandular portion and adipose portion. Astley Cooper
  8. 8. I N F R A S T R U C T U R E • Tumors may grow through retromammary space. • Subsequently invade deep fascia & pec. major m. • Leads to fixation of malignant breast lesion to chest wall. • Shortens suspensory (Cooper’s) ligs. • Leads to irregular dimpling of skin or retraction of nipple
  9. 9. A P P L I E D C L I N I C A L A N AT O M Y • Skin dimpling. • Nipple retraction. • Peau d'orange • Lymphoedema of ipsilateral upper limb post-mastectomy.
  10. 10. B L O O D S U P P LY • Vessels of the Breast • Enter from supr./med. & supr./lat. aspects • Penetrate deep surface of breast. • Exhibit extensive branches. & anastomoses.
  11. 11. A R T E R I A L S U P P LY T O T H E B R E A S T • Lateral (mammary) thoracic a. • Internal (mammary) thoracic a. • Intercostal aa. • Thoracoacromial a
  12. 12. V E N O U S D R A I N A G E • Corresponds to arterial system. • Cephalic vein
  13. 13. LY M P H AT I C S • Lat. drainage is via 5 groups of axillary nodes • Supr. drainage is via 1 group of interpectoral nodes • Med. drainage is via 1 group of parasternal nodes • Ultimate drainage is via subclavian lymph trunk to vv. (i.e., jxn. of subclavian v. & IJV)
  14. 14. LY M P H AT I C S • Pectoral nodes ( 4-5 nodes, most drainage). • Subscapular (posterior) nodes (6-7), • Lateral nodes (4-6). • Central nodes (3-4), ?Neck? • Apical nodes (6-12) • Interpectoral (Rotter’s) nodes (1-4) • Parasternal nodes
  15. 15. LY M P H AT I C S
  16. 16. LY M P H AT I C S I N A S S O C I AT I O N W I T H V E S S E L S • Pectoral – lat. thoracic vessels • Subscapular – subscapular vessels • Humeral – distal (3rd) part of axillary v. • Central – middle (2nd) part of axillary v. • Apical – proximal (1st) part of axillary v. • Interpectoral – pectoral vessels • Parasternal – int. thoracic vessels
  17. 17. LY M P H N O D E L E V E L S ( B E R G ’ S ) • 3 Levels of surgical dissections relative to pec. minor. • Level I – below (lateral to) pec. minor • Level II – deep to pec. minor • Level III – above (medial to) pec. minor
  18. 18. C L I N I C A L S I G N I F I C A N C E • Cancer cells tend to spread along lymph passages • Typical spread is supr./laterally to axillary lymph nodes • Unilateral lymphatic blockage may occur • Lymph (with cancer cells) can then drain to opposite side
  19. 19. N E R V E S U P P LY • Cutaneous innervation. • Medial pectoral n. • Lateral pectoral n. • Long thoracic n.
  20. 20. N E R V E S U P P LY
  21. 21. N E R V E S U P P LY • Take care!: • LTN • Thoracodorsal • lateral and medial pectoral nerve
  22. 22. T H E A X I L L A • Axillary sheath (axillary a. & brachial plexus). • Axillary v. & lymphatics (outside sheath). • Fat & connective tissue • Cutaneous nerves
  23. 23. T H E A X I L L A • very busy space.
  24. 24. S U R G I C A L A P P R O A C H T O A X I L L A • In modified radical mastectomy • Conservative breast surgery
  25. 25. M A S T E C T O M Y • Radical Mastectomy. • modified radical mastectomy • Simple mastectomy • skin sparing mastectomy • Nipple-Areolar spaing mastectomy.
  26. 26. B O U N D R I E S F O R M A S T E C T O M Y • Clavicle. • inframammary fold (above rectus sheath) • Sternum (midline). • Latissimus dorsi (ant. border)
  27. 27. S I M P L E M A S T E C T O M Y • Definition. • frequency.
  28. 28. M O D I F I E D R A D I C A L M A S T E C T O M Y • definition. • indication
  29. 29. R A D I C A L M A S T E C T O M Y • definition. • success rates.
  30. 30. S K I N S PA R I N G M A S T E C T O M Y • Definition.
  31. 31. N I P P L E - A R E O L A R S PA R I N G M A S T E C T O M Y • Definition. • Criteria
  32. 32. C H O I C E O F T H E P R O C E D U R E • Radical mastectomy - No longer used. • Lymph node status • Desired time of reconstruction. • Criteria of NSM. • Prophylactic
  33. 33. I N C I S I O N S I N B R E A S T S U R G E RY
  34. 34. I N C I S I O N S F O R M A S T E C T O M Y • depends upon: location, size, reconstruction plans • SSM. • MRM • NASM
  35. 35. Stewart! * design according to tumour location
  36. 36. • The drains are left in place until the drainage of serous fluid has decreased to approximately 25 to 30 mL per 24-hour period
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The surgical anatomy of the breast, surgical procedures, surgical approach to a breast mass. Mastectomy types and differences. Lymphatic drainage

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