Lymphatic drainage

This is of considerable importance in the spread of breast tumours.

The lymph drainage of the breast, as with any other organ, follows the pathway of its blood supply and therefore travels:

1 along tributaries of the axillary vessels to axillary lymph nodes;

2 along the tributaries of the internal thoracic vessels, piercing pectoralis major to traverse each intercostal space to lymph nodes along the internal mammary chain; these also receive lymphatics penetrating along the lateral perforating branches of the intercostal vessels.

Although the lymph vessels lying between the lobules of the breast freely communicate, there is a tendency for the lateral part of the breast to

Axillary nodes

Axillary nodes

Axila Lymphatic Drainage

Internal mammary nodes

Fig. 113 Diagram of the principal pathways of lymphatic drainage of the breast. These follow the venous drainage of the breast—to the axilla and to the internal mammary chain.

Internal mammary nodes

Fig. 113 Diagram of the principal pathways of lymphatic drainage of the breast. These follow the venous drainage of the breast—to the axilla and to the internal mammary chain.

drain towards the axilla and the medial part to the internal mammary chain

A subareolar plexus of lymphatics below the nipple (the plexus of Sappey) and another deep plexus on the pectoral fascia have, in the past, been considered to be the central points to which, respectively, the superficial and deep parts of the breast drain before communicating with main efferent lymphatics. These plexuses appear, however, to be relatively unimportant, the vessels, in the main, passing directly to the regional lymph nodes.

The axillary lymph nodes (some 20-30 in number) drain not only the lymphatics of the breast, but also those of the pectoral region, upper abdominal wall and the upper limb, and are arranged in five groups

1 anterior—lying deep to pectoralis major along the lower border of pec-toralis minor;

2 posterior—along the subscapular vessels;

3 lateral—along the axillary vein;

4 central—in the axillary fat;

5 apical (through which all the other axillary nodes drain)—immediately behind the clavicle at the apex of the axilla above pectoralis minor and along the medial side of the axillary vein.

Clinicians and pathologists often define metastatic axillary node spread simply into three levels:

Posterior Lymph Nodes Clavicle

Apical group

Central group

Anterior group Pectoral is minor Posterior group Lateral group

Axillary vein

Fig. 114 The lymph nodes of the axilla.

Apical group

Central group

Anterior group Pectoral is minor Posterior group Lateral group

Axillary vein

Fig. 114 The lymph nodes of the axilla.

• level I—nodes inferior to pectoralis minor;

• level II—nodes behind pectoralis minor;

• level III—nodes above pectoralis minor.

From the apical nodes emerges the subclavian lymph trunk. On the right, this either drains directly into the subclavian vein or else joins the right jugular trunk; on the left it usually drains directly into the thoracic duct.

Lymphatic spread of a growth of the breast may occur further afield when these normal pathways have become interrupted by malignant deposits, surgery or radiotherapy. Secondaries may then be found in the lymphatics of the opposite breast or in the opposite axillary lymph nodes, the groin lymph nodes (via lymph vessels in the trunk wall), the cervical nodes (as a result of retrograde extension from the blocked thoracic duct or jugular trunk), or in peritoneal lymphatics spreading there in a retrograde manner from the lower internal mammary nodes: this in addition, of course, to spread via the blood stream.

Was this article helpful?

+1 0
How To Get Perfect Abs

How To Get Perfect Abs

The Complete Guide To How to Get Perfect Abs is Here. While other books gear you towards buying a product or a service, this book actually tells you exactly what you need to do to get the abs of your dreams. Getting a six pack and looking good is easier than ever if you follow the instructions in this book. This book does not just tell you what workout machines to use, but how to think, what to eat, what not to eat and how to exercise to get the six pack abs that you have longed for but never thought that you would get.

Get My Free Ebook


Responses

  • Osvaldo
    What is the principal lymphatic drainage of the right breast?
    3 years ago

Post a comment