Anatomy of the Female Breast

• Structure

The normally developed female breast extends from the 3rd to the sixth rib vertically and from the sternum to the anterior axillary line and horizontally, covering a large part of the large thoracic and anterior anterior toothed muscle.

The glandular body itself consists of 15-20 cone-shaped lobules, which converge radially with their apices to the nipple. The inferior ducts of one large lobule are joined in a milky passage, which is buried by a small funnel-shaped opening in the tip of the nipple.

The mammary gland is placed on the fascia of the large pectoral muscle, with which it is connected by a loose connective tissue. At the level II-III of the rib, the surface fascia splits and forms a case for the mammary gland. From this case into its thickness radially there are connective tissue plates separating the parenchyma and adipose tissue of the gland into lobes. The fascial breast case is fixed to the clavicle with a dense band of the superficial fascia (Cooper ligament). Fiber of the breast by localization is divided into intra- and extra-capsular. The latter is located most superficially.

• Blood supply

The blood supply of the breast is provided from three different sources: 1) from the posterior intercostal arteries, 2) from the branches of the internal thoracic artery and 3) from the lateral thoracic artery. The branches of the posterior intercostal vessels supply the inner and, to a lesser extent, the lateral part of the gland. The main source of blood supply to the breast is the internal thoracic artery. Its perforating branches extend through the four upper intercostal spaces immediately adjacent to the sternum. The largest vessel in 60% of cases is the second perforating branch, in 40% of cases - the third perforating branch. Damage to these vessels during endoprosthetics of the mammary glands leads to severe bleeding. The blood supply of the areola and nipple is carried out due to a rich network of arterial anastomoses located directly in the skin, formed by the branches of all three sources. Venous drainage of the mammary gland is carried out through deep and superficial veins. Deep veins accompany arterial trunks, while the superficial venous network is located under the skin and is represented by a network of vessels with wide loops (circulus venosus Halleri).

• Lymphatic system

Lymphatic vessels of the mammary gland form a rich network and drain lymph in the following main directions: from its lateral sections to the axillary nodes, from the rear part to the supra-and subclavian, and from the upper medial to the peri-liminal lymph nodes. As a rule, aesthetic operations on the mammary gland do not lead to significant violations of lymph drainage.

• Innervation

The innervation of the skin covering the gland comes from three main sources. The outer part of the mammary gland is provided with the anterolateral cutaneous branches of the III-IV intercostal nerves, the inner one - the anterior medial branches of the II-IV intercostal nerves, the upper one - the branches of the supraclavicular nerve, originating from the cervical plexus. In addition, the branches of the medial and lateral thoracic nerves take part in the innervation of the mammary gland. Sensitive innervation of the nipple-areolar complex is provided by an anterior-lateral cutaneous branch of the IV intercostal nerve, which at the level of the axillary line perforates the intercostal muscles and divides into the posterior and anterior sensitive branches. The latter continues to go at the level of the fourth intercostal space under the fascia of the anterior dentate muscle to the outer edge of the large pectoral muscle and then, turning anteriorly, enters the gland tissue.

The terminal branches consist of 5 fascicles: three innervates the areola, one is the nipple and the last is the parenchyma of the gland around the areola. With orientation on the conventional dial, the nerve wires reach the right areola in the projection of 7 hours, and the left areola - 5 hours.

• The shape and dimensions of the mammary glands

The size and shape of the mammary glands are very variable in different periods of a woman's life. During puberty, five consecutive periods of the formation of the gland are distinguished: the initial - a flat pediatric form; a hill-like increase in volume with an increase in the diameter of the areola; a general increase in the volume of the gland, as well as areola, but without a clear contour formation of the areola and nipple; areola and nipple are formed into a distinct secondary elevation; The mature mammary gland has a common contour with the areola and the protruding nipple. The juvenile cone-shaped mammary gland becomes mature with time, gradually flattening the upper and medial quadrants. The mammary gland is a highly sensitive hormone-dependent organ that can affect the shape and volume of the gland at different periods of the woman's menstrual cycle. During life, gravity and pregnancy affect the shape of the breast and lead to its omission.

The ideal shape and size of the female breast are determined in accordance with racial, national, societal and aesthetic and in many ways individual perceptions. The volume of a normal mammary gland depending on the constitution, height and body weight of a woman can vary from 150 to 600 cm3. The nipple-areolar complex at normal,

Developed mammary gland should always be located just above the projection of the submammary fold, which is usually at the level of the sixth intercostal space.

The average statistical parameters of the "ideal" breast were calculated for a woman of 162 cm in height at the age of 17-18 years. The average diameter of the areola is 3.7 cm and varies from 2.8 to 4.5 cm. The distance between the jugular cavity and the nipple varies from 18 to 24 cm (average 21 cm). The distance from the submammary fold to the nipple is 6.5 cm (5 to 7.5 cm) on average. The inter-spacing distance is 2 1 cm (from 20 to 24 cm). The nipple is usually located 1-2 cm lateral to the midclavicular line and 11-13 cm from the midline. Most of the parameters change significantly when the patient is lying down.

[1], [2], [3], [4], [5]