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Lymphatic anatomy: lymphatics of the breast and axilla
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Lymphatic mapping of the breast is altering the long-standing approach to the breast cancer treatment model: radical mastectomy with complete axillary lymphadenectomy. It is a dramatic departure from Halsted’s modality of 100 years ago.1 The status of the axillary lymph node has consistently been shown to be the most significant prognostic factor in patients with breast cancer.2 The breast lies within the superficial fascia of the anterior thoracic wall. It is situated between the second and sixth ribs and the sternal edge and midaxillary line. The posterior surface of the breast ends abruptly at the chest wall, where it reaches the pectoralis major fascia. It is composed of skin, parenchyma, and stroma. The stroma and connective tissue are intertwined with blood vessels, nerves, and lymphatics. Beneath the nipples are five to ten milk ducts which connect to five to ten additional ducts, each draining an individual breast lobe. Each lobe is composed of 20–40 lobules, which in turn connect to 10–100 tubulosaccular units called alveoli. The subcutaneous connective tissue surrounds glands and extends as septa between the lobes and lobules, providing support for the glandular elements. Cooper’s ligaments are suspensory structures that insert perpendicular to the dermis.
The Breast
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Inspection — With the patient’s arm down, a bulge or skin retraction may be noticed. With the arms raised above the head, skin dimpling can be seen. Such maneuver will place the pectoralis muscle primarily and Cooper’s ligaments, which are located between the back of the skin and pectoral fascia, under tension. Some tumors have a tendency to shorten the Cooper’s ligaments by invasion resulting in skin retraction. Skin retraction should not be confused with direct skin invasion by the tumor. Occasionally, a flattened or a predominant contour can be noted over the tumor site, or multiple predominant veins can be seen over the area. In large neglected breast carcinomas, the whole breast may retract and/or multiple satellite nodules will be seen in the skin. Nipple retraction may be seen in some locally advanced cases, or if the tumor is located centrally, i.e., under the areola or nipple, as a result of direct invasion. Direct skin invasion can be seen in locally advanced cases, exfoliative type, inflammatory carcinoma, and in Paget’s disease of the nipple.
Anatomy and physiology of lactation
Published in Maria Pollard, Evidence-based Care for Breastfeeding Mothers, 2018
The breasts, or mammary glands, are hemispherical in shape with an axillary tail and are situated on each side of the anterior chest wall (see Figure 3.1). They extend from the second to the sixth rib, from the sternum to the axilla (the Tail of Spence), over the pectoralis muscles. They are supported by fibrous connective tissue called Cooper’s ligaments. Every mother’s breasts vary in size; this is determined by the amount of fatty tissue, not glandular tissue. Size is not an indicator of milk storage capacity. Each mother’s storage capacity is also variable but, despite this, over a 24-hour period, all lactating mothers produce a similar amount of breastmilk (average 798g/24 hours) (Kent et al., 2006). The main difference will be noted in feeding patterns and those mothers with lower storage capacity will breastfeed more frequently than those with higher storage capacity, thus supporting the argument for responsive feeding.
Oncological safety of therapeutic ‘nipple-sparing mastectomy’ followed by reconstruction: a systematic review
Published in Acta Chirurgica Belgica, 2021
Seven [15,16,23–27] out of fourteen included articles detailed their method for dissection and removal of the glandular tissue. Alsharif et al. [26] used electrocautery to perform a sharp subcutaneous dissection of the subdermal and subareolar tissue. Kim et al. [16] solely used knives to perform a sharp dissection at subcutaneous level, electrocautery was only used for bleeding control. Balci et al. [24] used hydrodissection by injecting 2.5 μg/mL of adrenaline into the deep subareolar dermis and the subdermal plane. Munhoz et al. [15] performed a subcutaneous dissection, preserving the ductal tissue in the nipple area. Sakamoto et al. [23] performed a subcutaneous dissection and removed major ducts in the nipple when indicated by a suspicious preoperative MRI or frozen-section biopsy of the base of the nipple. Stanec et al. [27] performed a dissection at the level of Cooper ligaments. Wu et al. [25] defined the dissection as leaving 1–2 mm of intact dermis.
Ex-vivo mechanical characterisation of the breast Cooper’s ligaments
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
N. Briot, G. Chagnon, C. Masri, E. Girard, Y. Payan
The first point (Table 1) is the high values for the equivalent Young modulus of Cooper’s ligaments (2–3 magnitude order stiffer than most breast tissue) but still less stiff than other ligaments such as knee ligament. The other point is the data dispersion (high standard deviations) observed on the experimental curves. This can be explained in several ways: the freshness of the tissue (the cadaver conserved in formalin), errors in section measurements (samples sectioned by hand) or the various location of the tissue.