Vessels of the breast

13 Vessels of the breast



13.1 Breast pain and the role of estrogen


Women frequently complain of breast pain in connection with their menstrual cycle, or sometimes more randomly. It is almost always due to hormonal imbalance involving excess estrogens, notably estradiol. Estradiol is the predominant estrogen. It circulates in the blood and is linked to a specific globulin.


Estrogens stimulate breast development during puberty and ensure the proliferation and implantation of subcutaneous fat. They cause renal water and salt retention, which favors cutaneous edema. In addition they contribute to increased osteoblast activity. This is why, after menopause, women can become osteoporotic.


Estrogens also diminish the concentration of low density lipoprotein (LDL) and increase high density lipoprotein (HDL) levels, reducing the incidence of atherosclerosis in premenopausal females. Estrogen thins and softens the skin.


The techniques that we use for the breast do not act on the causes, but on the consequences, of hormone disturbance. However, it often seems to us that the techniques have a central effect, perhaps by way of the vascular and fat system. Remember that fat tissue undoubtedly has a central hormonal role that is still largely being explored. Women who are too thin suffer amenorrhea in large part because of a lack of fat tissue.



13.2 Breast cancer


According to statistics, presently more than one woman in ten has breast cancer, treated by surgery, radiation, and/or chemotherapy. In addition to cancerous lesions, the breasts are subject to numerous mechanical insults due to upright posture, as well as significant variation in hormone production during breastfeeding and menopause.


Surgery and radiation treatment leave traces in all the soft tissues that compose and surround the breast. The surrounding tissues include the skin, adipose tissue, glands, nerves, vascular system, lungs, pleura, heart, mediastinum, and skeletal structure.


Even with the great progress that has been made in radiotherapy, all the soft tissues have a tendency to become fibrotic and the skeleton decalcifies. Promoting renewed circulation of fluid around the breast anatomy helps tissues to rebuild and become less fibrotic.


Should one perform vascular techniques on a breast when cancer is active? This is a frequently asked question. Manipulation of the vascular system does not increase the neoformation. According to a dearly held osteopathic concept, the stimulation of an organism’s defense mechanisms requires good circulatory function. We are confident about one thing: at the end of cancer treatment one must help the circulatory system of the breast. In a general way, various components of the organism always benefit from good circulation. However, we must be very careful after irradiation (X-ray therapy), as this causes the artery walls to be very fragile.



13.3 Anatomy



13.3.1 Container


The breasts, located between the third and seventh ribs, are supported by collagen fibers called the suspensory mammary ligaments (of Astley Cooper) (Fig. 13.1). The ligaments are found between the dermis and the connective tissue of the breast. They can extend towards the axillary fossa, overlying the pectoral muscle. The suspensory ligaments of the breast are comprised of numerous septa, joining the pre- and post-mammary fascia. These fibrous strands of connective tissue are more developed in the upper part of the breast.


image

Fig. 13.1 The container of the breast.


The breast is mobile, thanks to its posterior part which is filled with celluloid adipose tissue that glides on the myofascial planes. Here, in the submammary space behind the breast, we find superficial and deep myofascial layers.



• In the superficial plane, two-thirds of the mammary gland rests on the pectoralis major muscle, and the remaining third on the external oblique and rectus abdominis muscles. The superolateral quadrant is related to the axillary fascia by its lateral process, where it contacts the fifth and sixth digitations of the serratus anterior muscle.


• The deep plane is made up of the subclavian and pectoralis minor muscles, which are ensheathed in the clavipectoral aponeurosis.



13.3.2 Contents


The breast is composed of glandular lobes and adipose tissue surrounded by connective tissue (Fig. 13.2).


image

Fig. 13.2 Contents of the breast.


The adipose tissue makes up the shape and size of the breast. Surrounding the areola are approximately 15 sweat and sebaceous glands. Each lobe has excretory ducts leading to the terminal duct, which is the functional milk secretory component.


With age, the glandular lobes become filled with fat tissue and the suspensory ligaments weaken and lose their ability to support.



13.3.3 Innervation



Intercostal nerves


The breast is innervated by the third to the sixth intercostal nerves (Fig. 13.3). The lateral cutaneous branches innervate the lateral breast, whereas the anterior cutaneous branches pass through the pectoralis major muscle to reach the medial breast.


image

Fig. 13.3 Innervation of the breast.



Nerves of the autonomic system


These nerves derive from the internal and lateral plexus of the internal and lateral thoracic arteries. The plexus of the internal thoracic artery arises from the subclavian plexus, consisting of nerve fibers coming from the stellate ganglion (cervicothoracic ganglion).



Tegumentary innervation


The areola and nipple have a dense nerve plexus, carrying genital corpuscles. These mechanoreceptors are nerve endings in the skin. Once called Golgi and Vater–Pacini corpuscles, these receptors are responsive to pain and especially to gross changes in pressure.



13.3.4 Vascularization


We emphasize again the fact that vascular manipulations will involve the venous system. The breast has a rich venous supply (Fig. 13.4).


image

Fig. 13.4 Vascularization of the breast.



Arteries of the breast


The breasts are essentially supplied by the subclavian artery and its extension, the axillary artery. The areola is the vascular center of the breast.



Subclavian artery (see Chapter 11)


This is an artery of great importance. It supplies, either directly or indirectly, the cerebellum, medulla oblongata, spinal cord, breast, and arm.



Internal thoracic artery



Origin

The internal thoracic artery arises from the anterior surface of the first part of the subclavian artery, opposite the thyrocervical trunk, one fingerwidth lateral to the sternoclavicular joint.



Pathway

Posterior to the sternal end of the clavicle, the internal thoracic artery descends posteriorly to the costal cartilages, close to the lateral sternal border.



Interesting relationship

As it enters the thorax, the phrenic nerve crosses the internal thoracic artery obliquely from its lateral side.



Collaterals



• The anterior intercostal arteries perforate the intercostal muscle and pectoralis major at the third, fourth, and fifth intercostal spaces. These branches then reach the mammary gland, becoming the medial mammary arteries.


• Posterior branches go to the thymus and the pericardium.


• Lateral branches, which form the anterior arteries, are distributed in pairs in each intercostal space.

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Nov 7, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Vessels of the breast

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