Topic Overview

Breast – Dissection

Step 1: Skin Incisions

• Make a circular skin incision around the breast, including the nipple and areola.

• Reflect the skin carefully to expose the superficial fascia.

• Observe the areola with Montgomery’s glands and nipple with lactiferous ducts openings.

Step 2: Superficial Fascia

• Breast lies entirely within the superficial fascia of the anterior chest wall.

• Note:

  • Glandular tissue → arranged in 15–20 lobes.

  • Lactiferous ducts → each lobe drains into one duct, which opens on nipple.

  • Fatty tissue → fills space around lobes, especially in periphery.

  • Suspensory ligaments of Cooper → fibrous bands connecting skin to deep fascia, maintain breast contour.

Step 3: Retromammary Space

• Identify the loose areolar tissue plane between breast and deep pectoral fascia.

• Allows mobility of breast over chest wall.

• Clinical: Infiltration in carcinoma causes fixation of breast.

Step 4: Vascular Supply

• Expose arteries:

  • Internal thoracic artery (perforating branches).

  • Lateral thoracic artery.

  • Thoracoacromial artery.

  • Posterior intercostal arteries.

• Veins accompany arteries and drain mainly into axillary vein and internal thoracic vein.

Step 5: Nerve Supply

• Cutaneous nerves encountered:

  • Anterior and lateral cutaneous branches of 4th–6th intercostal nerves.

  • Carry sensory fibers to skin and nipple, sympathetic fibers to vessels and smooth muscle.

Step 6: Lymphatic Drainage

• Expose and trace lymphatic channels:

  • Axillary lymph nodes (75%) → mainly anterior/pectoral group.

  • Parasternal nodes → along internal thoracic vessels.

  • Posterior intercostal nodes → along intercostal spaces.

  • Subdiaphragmatic nodes → communicate with abdominal lymphatics.

• Identify subareolar plexus of Sappey around areola → drains nipple and areola.

Step 7: Relations

• Breast lies over:

  • Pectoralis major (2/3).

  • Serratus anterior (1/3).

• Note extension of axillary tail of Spence into axilla.

Step 8: Clinical Demonstrations in Dissection

• Carcinoma of breast:

  • Skin dimpling (fibrosis of Cooper’s ligaments).

  • Peau d’orange (lymphatic obstruction).

  • Nipple retraction (fibrosis of lactiferous ducts).

  • Fixation to chest wall (retromammary space infiltration).

• Gynecomastia: seen in male breast.

• Polymastia / Polythelia: accessory breast or nipples along milk line