- The breast is formed of fibro-fatty tissue, lies in front of the chest wall.
- lt is considered as modified sebaceous gland, so it lies in superficial fascia.
- lt extends from the 2nd to the 6th rib & from the sternum to mid axillary line.
- The axillarv tail of Spence:
. Arises from supero-lateral quadrant of mammary gland.
Passes through a defect in the deep fascia known as foramen of Langer
to the level of the third rib.
It lies close to the axillary vessels.
The Pectoralis maior (%): (see muscles of the shoulder region)
- Origin: sternocostal head, clavicular head.
- lnsertion: lateral lip of bicipital groove,
- Nerve Supply; medial & lateral pectoral nerves (from medial & lateral
cords of the brachial plexus respectively).
- Action: to press her hands against her waist.
- Origin: 8 digitations with the upper I intercostal muscles.
- lnsertion: medial border of the scapula.
- Nerve supply: N. to serratus anterior from roots C5, 6, 7 (=Long
- Action: keeps the stability of scapula with the use of upper limb.
Others are the external oblique & rectus sheath.
. The breast is formed of acini that make up lobules & lobes of the gland which
o Each lobe is drained by a separate duct.
All the collecting ducts (10 -15) open into the nipple. a
The breast is anchored to the overlying skin
& to the pectoral fascia by bands of CT
The lateral thoracic artery, from 2nd part of the axillary artery.
2. tne perforating cutaneous branches of internal mammary artery to the 2nd, 3'd &
4th spaces (medial perforator).
3. Lateral branches of the 2no, 3rd & 4th intercostal arteries (lateral
1. Superficial Veins cross the midline.
2. Deep veins ac@mpany the int. mammary & intercostals arteries.
3. lntercostal veins drain into the azygous system on the Rt. side &
hemiazygous on the Lt. Side, & vertebral veins, so cancer breast
N.B. Phlebitis of the superficial veins is called Mondor's disease (superficial
thrombophlebitis of the breast)
o Skin without nipple & areola ) radial manner.
o Nipple, areola and breast tissue ) axillary LNs (anterior ) medial )
o Deep part of breast ) lymphatics through pectoralis major ) internal
mammary LN ) posterior lntercostal LN.
o Lower medial part ) lymphatics in rectus sheath & falciform ligament )
Lynphoficdralnagr of dllp ptrtcf brlart
The axillarv qroups of lvmph nodes
1. Pectoral group (anterior) ) behind the pectoralis major.
2. Humoral group (lateral) ) along the axillary vein.
3. Sub-scapular group (posterior) ) over the subscapularis muscle.
4. Central group (medial) ) over the floor of the axilla.
5. Apical group (infra-clavicular) ) at the apex of the axilla.
.'.'\;l'-.... ,r I t.. -"",..-cer,tral
Body wall above the level of umbilicus.
lymphalic E Carvico- rirrii-' Right
It is a pyramidat space between upper part of arm & thorax.
. 1't layer: pectoralis major muscle.
- Suspensory ligament of the axilla.
Posterior wall: Subscapularis, teres major &
Upper 4 ribs & serratus anterior muscle
with long thoracic nerve running over it.
Formed by narrow strip of the intertubercular groove of the humerus,
(with the origin of biceps & coracobrachialis muscles).
- Through which the neck (posterior triangle) is connected with the axilla (i.e.:
the nerves & vessels pass through it).
- ln front: middle Ts of lhe clavicle.
- Mediallv: outer border of the 1't rib.
- Behind: upper border of the scapula.
BeSe ] dosed by the axillary fascia.
2. Axillary vessels (cephalic vein
joins axillary vein in the axilla).
situated just below the lateral
The quadrangular space is lateral
to the medial triangular space,
Long head of triceps (medially).
Subscapularis anteriorly & teres minor posteriorly (superiorly).
Surgical neck of humerus laterally.
Contents: axillary nerve & posterior circumflex humeral vessels.
Contents: circumflex scapular artery (from sub-scapular artery).
Contents: radial nerve & profunda brachii artery.
Suprauapr.rlar nerue and artery
The cubital fossa is a triangle space located in front of the
elbow; its base lies above while its apex extends downwards
for a short distance in the forearm.
Above: an imaginary line passing between the 2
Laterallv: the brachioradialis muscle Brachioradialis
Medially: the pronator teres muscle.
. Below: the meeting of lateral & medial borders
forms the apex but brachioradialis overlaps pronator
- Formed by the skin, superficial & deep fascia of
the forearm reinforced on the medial side by the
- The superficial fascia contains parts of @*-
cephalic vein, basilic vein, median cubital vein,
anterior branch of medial cutaneous nerve of the
forearm & lateral cutaneous branch of the
- The deep fascia is pierced by a connection
between the median cubital vein & the deep
Formed by the lower part of the brachialis (on
the medial side) & the anterior part of the
supinator (on the lateral side).
ONTENTS I From medial to lateral, the cubital fossa contains:
2. The end of the brachial a(ery
(palpated here medial to the tendon) &
the origin of radial & ulnar arteries.
4. The radial nerve & the beginning of its
posterior inter-osseous branch (only
seen when brachioradialis is retracted
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