BREAST LYMPHATIC DRAIAGE

1.2 LYMPHATICS

There are a large number of lymphatic vessels which drain the skin

and the glandular tissue of the breast.

The  large majority of these vessels drain into three  groups  of

lymph nodes (fig above):

    * The  axillary  route  provides lymphatic  drainage  to  the

      central  and  posterior  part  of  the  breast  and   these

      Lympatics  end  in  PECTORAL and THORACIC  group  of  lymph

      nodes.

      This drainage finally ends in the highest group of axillary

      lymph nodes.

    * Lymphatics  from the medial part of the breast end  in  the

      INTERNAL MAMMARY group of lymph nodes.

    * A  similar and less frequent pathway of lymphatic  drainage

      is via the lymphatic vessels in the RECTUS SHEATH, this  is

      from the lowest and most medial portion of the breast.

      Information  regarding the lymphatics is of  importance  in

      the  treatment  of breast carcinoma since it  dictates  the

      direction  of  flow  of  metastasis and  this  in  turn  is

      dependent on location of the tumour in the breast.

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BREAST ANATOMY BLOOD SUPPLY

ANATOMY

The  functional portion of the breast is a modified  SWEAT  GLAND

gland and is thus an modified appendage of the skin.

It  is  suspended on the anterior chest wall and extends  in  the

female from the SECOND to the SIXTH ribs Fig. 13.1. 

Medially  it  extends to the lateral border of  the  STERNUM  and

laterally upto and ANTERIOR AXILLARY LINE.

1.1 BLOOD SUPPLY

Breast  as an organ is vascular and supplied by  the  perforating

brances  of  the INTERNAL MAMMARY ARTERY from the  first  to  4th

intercostal space.

LATERAL THORACIC ARTERY which is a branch of the axillary artery

The pectoral branch of the ACHROMIO-THORACIC ARTERY also provides

blood supply.

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SKIN DECUBITUS ULCER

DECUBITUS ULCER (Pressure sores)

Met within the surgical and medical patients confined to bed  for

long periods (weeks or months).

 - Common sites are where skin is pressed between bed surface and

   superficial bone of patients as:

   Sacrum                      

   heels

   occiput

The skin in these area becomes red and later ulcerates.

Prophlaxis  is  achieved  by  turning  the  patient  to   prevent

continous  pressure at one point,  and skin care (Keep skin dry,  massage  with

cream).

Have cushions for avoiding injury to the skin.

Surgical treatment with rotation flap may be required

 

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.

Malignant 4 Melanoma treatment

Treatment in most cases is wide surgical excision,prognosis depends on depth of extension
A biopsy gives information on depth of extension .
Clark's classification is shown above Grade 1 spread confined within basal layer gives best results
!00% 5 year survival
Grade 11 Extend to pappilary dermis
Grade 111Extend upto reticular dermis
Grade 1V extend into reticular dermis
Grade V extend into the dermis
All these grades show diminishing survival rates

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MALGNANT SKIN 3 melanomma

MELANOMA

Nearly 50% of melanomas arise in a mole. 

The development of malignancy should be suspected if there is any

one of the following changes observed in a coloured lesion:

   *  Increase in size

   *  A change in the outline of the mole

   *  A change in the colour of the mole

   *  Itching in the mole

   *  Bleeding from the mole

       -  It is believed that exposure to sunlight is responsible

          for these changes to occur

       -  Increased RISK is associated with those of fair skin. 

       -  The other RISK factors are socio-economic status and

          life style.

       -  Lesions in the upper extremity have a better PROGNOSIS

          than the lower extremity. 

       -  The worst PROGNOSIS are those of the

          head and

          neck or

          on the trunk

       -  Ulceration in the lesion is a bad sign. 

       -  Palpable lymph node are also a poor sign.

On  pathological  examination a more accurate  prognosis  can  be

given  on  histological examination since now the  depth  of  the

involvement of the skin can be identified according to the method

of Clark's .

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