open access
The surgical anatomy of the mammary gland. Vascularisation, innervation, lymphatic drainage, the structure of the axillary fossa (part 2.)
- Department of General and Oncological Surgery, K. Marcinkowski University Hospital, Zielona Gora, Poland
- Department of Surgery and Oncology, Collegium Medicum, University of Zielona Gora, Poland
- Department of Radiotherapy, K. Marcinkowski University Hospital, Zielona Gora, Poland
- Department of Urology and Oncological Urology, Collegium Medicum, University of Zielona Gora, Poland
open access
Abstract
Dynamically developing oncoplasty, i.e. the application of plastic surgery methods in oncological breast surgeries, requires excellent knowledge of mammary gland anatomy. This article presents the details of arterial blood supply and venous blood outflow as well as breast innervation with a special focus on the nipple-areolar complex, and the lymphatic system with lymphatic outflow routes. Additionally, it provides an extensive description of the axillary fossa anatomy.
Abstract
Dynamically developing oncoplasty, i.e. the application of plastic surgery methods in oncological breast surgeries, requires excellent knowledge of mammary gland anatomy. This article presents the details of arterial blood supply and venous blood outflow as well as breast innervation with a special focus on the nipple-areolar complex, and the lymphatic system with lymphatic outflow routes. Additionally, it provides an extensive description of the axillary fossa anatomy.
Keywords
anatomy of the mammary gland
Title
The surgical anatomy of the mammary gland. Vascularisation, innervation, lymphatic drainage, the structure of the axillary fossa (part 2.)
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Pages
62-69
Published online
2021-02-05
Page views
1359
Article views/downloads
3839
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2021;71(1):62-69.
Keywords
anatomy of the mammary gland
Authors
Sławomir Cieśla
Mateusz Wichtowski
Róża Poźniak-Balicka
Dawid Murawa
- Deventer Pv, Graewe F. The Blood Supply of the Breast Revisited. Plastic and Reconstructive Surgery. 2016; 137(5): 1388–1397.
- Ho W, Stallard S, Doughty J, et al. Oncological Outcomes and Complications After Volume Replacement Oncoplastic Breast Conservations-The Glasgow Experience. Breast Cancer (Auckl). 2016; 10: 223–228.
- Barros AC, Mori LJo, Nishimura D, et al. Surgical anatomy of the internal thoracic lymph nodes in fresh human cadavers: basis for sentinel node biopsy. World J Surg Oncol. 2016; 14: 135.
- Stone K, Wheeler A. A Review of Anatomy, Physiology, and Benign Pathology of the Nipple. Ann Surg Oncol. 2015; 22(10): 3236–3240.
- Nebril BA, Ramírez SB, Novoa AG, et al. Colgajos por rotación en la cirugía oncológica de la mama. Fundamentos anatómicos y técnicos para su planificación quirúrgica. Cirugía Española. 2016; 94(7): 372–378.
- Hamdi M, De Fr. Pedicled Perforator Flaps in Breast Recon-struction. Seminars in Plastic Surgery. 2006; 20(2): 073–078.
- Sarhadi NS, Shaw Dunn J, Lee FD, et al. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg. 1996; 49(3): 156–164.
- Mota BS, Riera R, Ricci MD, et al. Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database Syst Rev. 2016; 11: CD008932.
- Soumian S, Parmeshwar R, Chandarana M, et al. Chest wall perforator flaps for partial breast reconstruction: Surgical outcomes from a multicenter study. Arch Plast Surg. 2020; 47(2): 153–159.
- Chirappapha P, Petit JY, Rietjens M, et al. Nipple sparing mastectomy: does breast morphological factor related to necrotic complications? Plast Reconstr Surg Glob Open. 2014; 2(1): e99.
- Rendina EA, Ciccone AM. The intercostal space. Thorac Surg Clin. 2007; 17(4): 491–501.
- Youssif S, Hassan Y, Tohamy A, et al. Pedicled local flaps: a reliable reconstructive tool for partial breast defects. Gland Surg. 2019; 8(5): 527–536.
- Würinger E, Mader N, Posch E, et al. Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg. 1998; 101(6): 1486–1493.
- Seitz IA, Nixon AT, Friedewald SM, et al. "NACsomes": A new classification system of the blood supply to the nipple areola complex (NAC) based on diagnostic breast MRI exams. J Plast Reconstr Aesthet Surg. 2015; 68(6): 792–799.
- Losken A, Dugal CS, Styblo TM, et al. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014; 72(2): 145–149.
- Lemaine V, Simmons PS. The Adolescent Female: Breast and Re-productive Embriology and Anatomy. Clin Anat. 2013; 26: 22–28.
- Schlenz I, Kuzbari R, Gruber H, et al. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg. 2000; 105(3): 905–909.
- Macéa J, Fregnani J. Anatomy of the Thoracic Wall, Axilla and Breast. Int J Morphol. 2006; 24(4).
- Sarhadi NS, Shaw Dunn J, Lee FD, et al. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg. 1996; 49(3): 156–164.
- Knackstedt R, Gatherwright J, Cakmakoglu C, et al. Predictable Location of Breast Sensory Nerves for Breast Reinnervation. Plast Reconstr Surg. 2019; 143(2): 393–396.
- Bengtson BP. Sensory nerves in the lower pole of the breast encountered in breast (augmentation) surgery. Plast Reconstr Surg. 2009; 123(1): 32e–33e.
- Bijkerk E, van Kuijk SMJ, Lataster A, et al. Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation. Breast Cancer Res Treat. 2020; 181(3): 599–610.
- Sappey MPC. Anatomie, Physiologie, Pathologie des vaisseaux Lymphatiques consideres chez L’homme at les Vertebres. A Delahaye and E Lecrosnier, Paris 1874.
- Ahmed M, Baker R, Rubio IT. Meta-analysis of aberrant lymphatic drainage in recurrent breast cancer. Br J Surg. 2016; 103(12): 1579–1588.
- Borm KJ, Voppichler J, Düsberg M, et al. FDG/PET-CT-Based Lymph Node Atlas in Breast Cancer Patients. Int J Radiat Oncol Biol Phys. 2019; 103(3): 574–582.
- Kumar A, Puri R, Gadgil PV, et al. Sentinel lymph node biopsy in the management of breast cancer. Indian J Cancer. 2003; 40(2): 60–66.
- Suami H, Heydon-White A, Mackie H, et al. A new indocyanine green fluorescence lymphography protocol for identification of the lymphatic drainage pathway for patients with breast cancer-related lymphoedema. BMC Cancer. 2019; 19(1): 985.
- Rehnke RD, Groening RM, Van Buskirk ER, et al. Anatomy of the Superficial Fascia System of the Breast: A Comprehensive Theory of Breast Fascial Anatomy. Plast Reconstr Surg. 2018; 142(5): 1135–1144.
- Netter FH. Atlas of Human Anatomy. 2014, 6th; Gold 25th Anniver-sary Edition. Elsevier 2014.
- Stecco A, Macchi V, Masiero S, et al. Pectoral and femoral fasciae: common aspects and regional specializations. Surg Radiol Anat. 2009; 31(1): 35–42.
- Lockwood TE. Superficial fascial system (SFS) of the trunk and extremities: a new concept. Plast Reconstr Surg. 1991; 87(6): 1009–1018.
- Stecco A, Masiero S, Macchi V, et al. The pectoral fascia: anatomical and histological study. J Bodyw Mov Ther. 2009; 13(3): 255–261.