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Topography of the fascia and cellular spaces of the breast
Last reviewed: 19.10.2021
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On the surface of the thoracic walls, the jugular notch of the sternum is defined in the form of bony landmarks, the collarbones to the right and left of it, at the bottom - the xiphoid process of the sternum, as well as the ribs and costal arches. The jugular notch of the sternum corresponds to the lower edge of the II thoracic vertebra. The lower boundary of the body of the sternum is at the level of the IX thoracic vertebra. The angle of the sternum is projected onto the intervertebral disk between the IV and V thoracic vertebrae. On the surface of the chest wall, the contours of the large pectoral muscle and the deltoid-pectoral furrow are determined (in males). Women at the level of III-VI ribs have mammary glands separated by a gap. On the lateral surface of the chest is a dentate line formed by the initial teeth of the anterior dentate muscle and the external oblique muscle of the abdomen. The skin of the breast is thin, the men in the sternum and shoulder blades have hair follicles. Sweat and sebaceous glands are most numerous in the area of the sternum, scapula, on the lateral surfaces of the breast. Subcutaneous fat is expressed moderately, more in women. In the fiber pass the superficial veins, the terminal branches of the arteries (internal thoracic, intercostal, lateral thoracic), anterior and lateral branches of the intercostal nerves.
The superficial fascia, which is part of the superficial fascia of the body, is poorly developed. It participates in the formation of a capsule of the breast, giving deep into its connective tissue septum, dividing the gland into parts. The bundles of fascia that extend from the connective tissue capsule of the breast to the clavicle are called the ligament supporting the mammary gland (lig. Suspensorium mammae).
The pectoral fascia (fascia pectoralis), which lies below the surface, has two leaves (plates) - superficial and deep, which form the vagina of the large pectoral muscle.
The superficial plate of the thoracic fascia at the top is attached to the collar bone, medially - fused with the periosteum of the anterior surface of the sternum. This plate laterally continues into the deltoid fascia, which extends downwards into the armpit fascia.
A deep plate of the thoracic fascia is located on the posterior surface of the large pectoral muscle, between it and the small pectoral muscle. It forms the vagina of the small pectoralis muscle. Above, within the clavicle-thoracic triangle (between the upper edge of the small pectoral muscle and the clavicle), the deep plate thickens and acquires the name of the clavic fascia clavipectoralis. Laterally and downward from the small pectoral muscle, a deep plate of the thoracic fascia fuses with the surface plate of this fascia. Behind the small and large pectoral muscles, three triangles are distinguished. The wrist triangular is located between the clavicle at the top and the upper edge of the small pectoral muscle below. This triangle corresponds to the location of the clavicle-thoracic fascia. The thoracic triangle corresponds to the shape of the small pectoral muscle. The pectoral triangle is located between the lower edges of the small thoracic and large pectoral muscles. In the sternum, the thoracic fascia fuses with the periosteum of the sternum and forms a dense connective tissue plate - the anterior membrane of the sternum.
Between the two pectoral muscles lying in the fascial vagina, there is a pterygoal cell space. Under the small pectoral muscle is a deep podrugnoe space. Both are filled with a thin layer of fat.
In addition to these fascia, the thoracic and intrathoracic fascia proper are also distinguished. Actually, the thoracic fascia (fascia thoracica) covers the outer intercostal muscles from the outside, as well as the ribs, fused with their periosteum. The intestinal fascia (fascia endothoracica) lining the thoracic cavity from the inside, i.е. It is located from the inside to the internal intercostal muscles, the transverse muscle of the breast and the internal surfaces of the ribs.