ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

ANATOMY OF THE BREAST:FROM EMBRYOLOGY TO ONCOPLASTIC PERSPECTIVES

Taner Kıvılcım1 Abut Kebudi2

1Okan University, Faculty of Medicine, Department of General Surgery, İstanbul, Türkiye
2Okan University, Faculty of Medicine, Department of General Surgery, İstanbul, Türkiye

Kıvılcım T, Kebudi A. Anatomy of the Breast: From Embryology to Oncoplastic Perspectives. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.3-12.

ABSTRACT

This chapter provides a comprehensive overview of the breast’s anatomy, from embryologic development to its relevance in modern oncoplastic surgery. Breast development begins hormonally independent, with mammary ridges forming during the 5th–6th fetal weeks. Subsequent morphologic changes, influenced by estrogen and progesterone, shape the breast through puberty, pregnancy, lactation, and menopause. Histologically, the progression from type 1 to type 4 lobules corresponds to reproductive stages, with type 4 lobules seen in lactation. These developmental patterns are not only biologically significant but also serve as a foundation for understanding pathological alterations in breast tissue.

Topographically, the adult female breast spans from the 2nd to 6th ribs and is anchored by fascial structures like Cooper’s ligaments and Wuringer’s septum. Understanding these elements is essential in procedures such as nipple-sparing mastectomies. Vascularization is mainly supplied by internal mammary and lateral thoracic arteries, while lymphatic drainage primarily involves axillary and internal mammary nodes. Innervation of the nipple–areola complex is predominantly through the fourth intercostal nerve. Detailed knowledge of these anatomical structures enables surgeons to perform safe dissections, preserve critical neurovascular supply, and design reconstructive strategies that optimize both oncological and cosmetic outcomes.

In the context of oncoplastic breast surgery, these anatomic insights provide a vital framework for surgical decision-making. The relationship between glandular tissue, supporting fascial structures, and vascular supply must be carefully considered when planning resections or reconstructions. A thorough grasp of arterial supply ensures preservation of flap viability, while lymphatic mapping remains crucial for oncologic staging and sentinel lymph node biopsy. Furthermore, the topographic and histological features of the breast directly influence choices regarding incision placement, flap design, and techniques for achieving breast symmetry. By linking embryologic development, structural anatomy, and clinical applications, this chapter underscores the inseparable connection between basic science and surgical innovation. Such integration ensures that modern breast surgery not only achieves oncological safety but also enhances functional preservation, aesthetic outcomes, and patient quality of life.

Keywords: Breast anatomy; Embryology; Arterial supply; Lymphatic drainage

Referanslar

  1. Javed A, Lteif A. Development of the human breast. Semin Plast Surg. 2013;27(1):5-12. [Crossref]  [PubMed]  [PMC]
  2. Parker C, Damodaran S, Bland KI, Hunt KK. The breast. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Kao LS, Hunter JG, Matthews JB, Pollock RE, eds. Schwartz's Principles of Surgery. 11th ed. McGraw-Hill Education; 2019.
  3. Dixon JM, Barber MD, Paterson-Brown S, Garden OJ. Breast Surgery E-Book. Elsevier; 2023. ISBN: 9780702084805, 0702084808.
  4. Emmanuel M, Bokor BR. Tanner Stages. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Updated December 11, 2022.
  5. Harigopal M, Singh K. Breast development and morphology. UpToDate. Updated March 26, 2024.
  6. Sun SX, Bostanci Z, Kass RB, Mancino AT, Rosenbloom AL, Klimberg VS, Bland KI. Breast physiology: normal and abnormal development and function. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast. 5th ed. Elsevier; 2018:37-56. [Crossref]
  7. Bazira PJ, Ellis H, Mahadevan V. Anatomy and physiology of the breast. Surgery (UK). 2022;40(2). [Crossref]
  8. Paavolainen O, Peurla M, Koskinen LM, et al. Volumetric analysis of the terminal ductal lobular unit architecture and cell phenotypes in the human breast. Cell Rep. 2024;43(10). [Crossref]  [PubMed]
  9. Würinger E, Mader N, Posch E, Holle J. Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg. 1998;101(6):1486-1493. [Crossref]  [PubMed]
  10. Wueringer E, Tschabitscher M. New aspects of the topographical anatomy of the mammary gland regarding its neurovascular supply along a regular ligamentous suspension. Eur J Morphol. 2002;40(3):181-189. [Crossref]  [PubMed]
  11. Maillard GF, Garey LJ. An improved technique for immediate retropectoral reconstruction after subcutaneous mastectomy. Plast Reconstr Surg. 1987;80(3):396-408. [Crossref]  [PubMed]
  12. Bayati S, Seckel BR. Inframammary crease ligament. Plast Reconstr Surg. 1995;95(3):501-508. [Crossref]  [PubMed]
  13. van Straalen WR, Hage JJ, Bloemena E. The inframammary ligament: myth or reality? Ann Plast Surg. 1995;35(3). [Crossref]  [PubMed]
  14. Muntan CD, Sundine MJ, Rink RD, Acland RD. Inframammary fold: a histologic reappraisal. Plast Reconstr Surg. 2000;105(2):549-557. [Crossref]  [PubMed]
  15. Anderson E, Clarke RB. Steroid receptors and cell cycle in normal mammary epithelium. J Mammary Gland Biol Neoplasia. 2004;9(1):3-13. [Crossref]  [PubMed]
  16. Qiao Q, Zhou G, Ling Y. Breast volume measurement in young Chinese women and clinical applications. Aesthetic Plast Surg. 1997;21(5):362-368. [Crossref]  [PubMed]
  17. Regnault P. Breast ptosis: definition and treatment. Clin Plast Surg. 1976;3(2):193-203. [Crossref]  [PubMed]
  18. Cunningham L. The anatomy of the arteries and veins of the breast. J Surg Oncol. 1977;9(1):71-85. [Crossref]  [PubMed]
  19. Nakajima H, Imanishi N, Aiso S. Arterial anatomy of the nipple-areola complex. Plast Reconstr Surg. 1995;96(4):843845. [Crossref]  [PubMed]
  20. Thekkinkattil D. Oncoplastic and reconstructive anatomy of breast. In: Deo SVS, ed. Breast Oncoplasty and Reconstruction: Principles and Practice. Springer Nature Singapore; 2023:1-8. [Crossref]
  21. Jo J, Schiff D. Metastatic disease and the nervous system. In: Aminoff MJ, Josephson SA, eds. Aminoff's Neurology and General Medicine. 5th ed. Academic Press; 2014:539-562. [Crossref]  [PMC]
  22. Smeele HP, Bijkerk E, van Kuijk SMJ, Lataster A, van der Hulst RRWJ, Tuinder SMH. Innervation of the female breast and nipple: a systematic review and meta-analysis of anatomical dissection studies. Plast Reconstr Surg. 2022;150(2):243-255. [Crossref]  [PubMed]