PECTORAL REGION

Farrukh Shahzad
BSPT, PPDPT

Isra University,
Islamabad Campus

The pectoral
region

The pectoral region

Pectoral region
The pectoral region consists of structures that connect
the upper limb to the anterolateral chest wall.
surface land marks.
Clavicle
The jugular notch ( interclavicular notch or suprasternal
notch).
The sternal angle or angle of Louis.
The epigastric fossa.
The midclavicular line
The infraclavicular fossa or deltopectoral triangle.
The tip of the coracoid process
The acromion.
The deltoid
The axilla or arm pit
The midaxillary line.

The skin of the pectoral region

Is divided into 2 parts by
a horizontal line passing through
the sternal angle.
The area above this line is supplied by
the supraclavicular nerves.
nerves
The area below the horizontal line

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is divided into 2 parts by

the midclavicular line :
1- The area medial to the midclavicular line:
is supplied by the anterior cutaneous branches of
the second to 6th intercostal nerves
Each anterior cutaneous nerve
supply the skin from the midline to
the midclavicular line.

Cutaneous nerve supply of the pectoral region

Cutaneous nerve supply

- The skin of
the pectoral region is
divided into 2 parts by
a horizontal line
passing through
the sternal angle.
- The area above this

line

is supplied by
the supraclavicular nerves.
nerves

These nerves are branches

from the cervical plexus
(C 3, 4 ventral rami).
The area below
the horizontal line
is divided into 2 parts by
the midclavicular line :

1- The area medial to

the midclavicular
line:
It is supplied by the
anterior cutaneous
branches

of the second to 6th

intercostal nerves
Each anterior cutaneous nerve

divides into

a smaller medial and

larger lateral branches
to supply the skin
from the midline to
the midclavicular line.

2- The area lateral to

the midclavicular line:

is supplied by
the lateral cutaneous branches of
the third to 9th intercostal nerves
Each lateral cutaneous nerve

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divides into 2 branches:

A- An anterior branch:
suppleis the skin from
the midclavicular line to
the midaxillary line

Cutaneous nerve supply of the pectoral region

B- A posterior branch:
suppleis the skin from
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the midaxillary line to

the lateral border of
the erector spinae muscle

Cutaneous nerve supply of the pectoral region

Muscles of the
pectoral region

Clavicle
Scapula
Humerus

Upper ribs and

their costal cartilage
Sternum

Bones of the pectoral region

Upper surface
Tip
Medial border

of

Coracoid process of the scapula

Bones of the pectoral region

Intertubercular or
Bicipital groove
It has
Lateral lip
Floor
Medial lip
Humerus

Bones of the pectoral region

Pectoralis major (6)

1- Sternocostal head:
From half of the breadth of the
anterior surface of the sternum
And upper

6 costal cartilages

2- Clavicular head:

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From the medial half of the

anterior aspect of the clavicle.

Pectoralis minor (3)

from the 3d , 4th and 5th ribs (3)
near their costochondral junctions

Subclavius (1)
from the first costochondral junction (1)

(6, 3, 1)

Origin of the
pectoral muscles

Pectoralis major (largest)

into the lateral lip
of the Bicipital groove of
the humerus
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Pectoralis minor (medium)

into the medial border & upper surface of
the coracoid process of the scapula

Subclavius (Smallest)
into the Subclavius groove.
on the lower surface of
the intermediate third of the clavicle

According to size

Insertion of the
pectoral muscles

Subclavius muscle
Nerve to subclavius from the
upper trunk of the brachial plexus

The pectoralis major

And minor muscles

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Medial and lateral

pectoral nerves
According to the
name of the muscle

The nerve supply of the pectoral muscle

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The pectoralis major muscles

Origin
1- Sternocostal head:
From half of the breadth of the
anterior surface of the sternum
And upper 6 costal cartilages

2- Clavicular head:

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From the medial half of the

anterior aspect of the clavicle.

Insertion
into the lateral lip of the
bicipital groove of the humerus

Nerve supply:
Medial and lateral pectoral nerves

The pectoralis major muscle

Shoulder joint

Action:
1- Adduction and
medial rotation of the arm
with latissimus dorsi and
teres major muscles.
2- Approximation of the trunk to
the abducted arm as in
climbing a tree, swimming
and playing gymnastics.

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Flexion of the arm- 3

.Helps in deep & forced inspiration- 4

The pectoralis major muscle

The pectoralis major muscle

I- Pectoralis major muscle

Origin:

1- Sternocostal head:
From half of the breadth of
the anterior surface of the
sternum.
And upper 6 costal
cartilages.
2- Clavicular head:
From the medial half of the
anterior aspect of the
clavicle.

Insertion:

into the lateral lip of the

bicipital groove of the
humerus

Nerve supply:

Medial and lateral pectoral

nerves.

Action:

1- Adduction and medial

rotation
of the arm (shoulder)
with latissimus dorsi and
teres major muscles.
2- Approximation of the trunk
to the abducted arm
as in climbing a tree,
swimming and
playing gymnastics.
3- Flexion of the arm.
4- Helps in forced inspiration.

The pectoralis minor muscle

Origin

from the 3d , 4th and 5th ribs

near their costochondral junctions

Insertion
into the medial border & upper surface of
the coracoid process of the scapula

Nerve supply:

scapula

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Medial and lateral pectoral nerves

Ribs

Action:
1- Pulls the scapula forwards
(protraction of the shoulder)
shoulder
2- Pull the scapula downwards
(depression of the shoulder)

.with the Serratus anterior muscle

with the lower fibers of the trapezius muscle.

3- Medial (downward) rotation of the scapula: with the levator scapulae muscle
Helps in deep & forced inspiration- 4

The pectoralis minor muscle

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The pectoralis minor muscle

II- Pectoralis minor muscle

Origin:
from the 3d, 4th and 5th
ribs
near their
costochondral junctions

Insertion:
into the medial border &
upper surface of
the coracoid process of
the scapula

Nerve supply:
Medial and lateral
pectoral nerves.

Action:
1- Pulls the scapula
forwards
(protraction of the shoulder)
shoulder
with the Serratus anterior
muscle.
2- Pull the scapula downwards

(depression of the shoulder)

with the lower fibers of
the trapezius muscle.

3- Medial (downward)
rotation of the scapula:
with the levator scapulae muscle.

4- Helps in forced
inspiration.

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The subclavius muscle

The subclavius
muscle
Clavicle

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Rib

Origin

from the first costochondral junction

Insertion

into the Subclavius groove.

Nerve supply

Action:

on the lower surface of

the intermediate third of the clavicle

Nerve to subclavius from the
upper trunk of the brachial plexus

1- Fixation of the clavicle during movements of the shoulder.

2- Helps in inspiration.

III- Subclavius muscle

Origin:

from the first costochondral junction.

Insertion:

into the Subclavius groove.

on the lower surface of
the intermediate third of the clavicle

Nerve supply:

Nerve to subclavius.

Action:

1- Fixation of the clavicle

during movements of the shoulder.

2- Helps in inspiration.

The
clavipectoral
fascia

The clavipectoral fascia

It is a strong sheet of

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fibrous tissue.
- It lies between

the subclavius muscle and

pectoralis minor muscle

The clavipectoral fascia (anterior view)

The clavipectoral fascia

- It is a strong sheet of
fibrous tissue deep to
the clavicular head of
the pectoralis major
muscle.
muscle
- It lies between
the subclavius and
pectoralis minor
muscles.
muscles
- Its upper part splits into
2 layers to enclose
the subclavius muscle and
attaches to the margin of
the subclavius groove.
groove

- Its lower part

splits to enclose
the pectoralis minor muscle
and then extends from
its lower border to attach to
the axillary fascia
forming what is called the
suspensory ligament
of the axilla.
axilla
- Its medial part is attached
to the 1st and 2nd costal
cartilages and
its lateral part is attached
to
the coracoid process.

The costocoracoid membrane

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is pierced by:
1- The cephalic vein.
2- The lymphatics
along the cephalic vein,

3- The thoracoacromial artery.

4- The lateral pectoral nerve.

The clavipectoral fascia

.- The clavipectoral fascia is pierced by:
1- The cephalic vein.
2- The lymphatics along the cephalic vein,
3- The thoracoacromial artery.
4- The lateral pectoral nerve.

The female breast

The female breast

The basic anatomy of the breast is of considerable
clinical importance because of the frequent
development of cancer in the glands and the
subsequent migration of the malignant cells along the
lymph vessels to
the lymph nodes in the armpit.
armpit

The female breast

The female breast
consists of :
1- The mammary gland.

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2- The superficial fascia

3- The overlying skin.

the stroma of the gland( ).and the surrounding fat

* Shape and position:

- The breast is
conical in shape.

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Its base is circular and has

a constant position.
position
It extends from the sternum
to the midaxillary line

at the level of the 4th rib.

rib

Vertically, it extends from

the 2nd rib to the 6th rib

at the level of the midclavicular line

The female breast

Structure of the breast

* The female
breast
consists of :
1- The mammary
gland.
2- The superficial
fascia
(the stroma of the
gland
and the surrounding
fat).
fat
3- The overlying skin.

* Shape and position:

- The breast is
conical in shape.
- Its base is circular and has
a constant position.
position
- It extends from the sternum
to the midaxillary line
at the level of the 4th rib.
rib
- Vertically, it extends from
the 2nd rib to the 6th rib
at the midclavicular line.
line

The nipple of the breast

is a conical or cylindrical prominence.
prominence
It lies below
the center of the breast
opposite the

1
2
3
4

4th intercostal space

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Cm from 10
the midline

The female breast

Structure of the breast

- A process of the gland
extends from the
upper lateral part
along
the lower border of
the pectoralis major
muscle.
muscle
This process is called
the axillary tail of the
breast.
breast
The axillary tail may pierce
the axillary fascia and
enter the axilla and
becomes in close relation
to
the axillary vessels.
vessels

The nipple of the

breast
- It is a conical or
cylindrical
prominence.
prominence
- It lies below
the center of the breast
opposite the
4th intercostal space
10 Cm from the midline.
midline
Its summit carries
the openings of
the lactiferous ducts of
the mammary gland.
gland

Structure of the breast

- The nipple contains

many smooth myocytes,

myocytes
which are arranged in 2
directions.
Most myocytes are
circularly arranged and
their stimulation (e.g. by suckling)
suckling
leads to erection of the nipple.
nipple
Other myocytes are
longitudinally arranged and
retract the nipple.
nipple

The areola:
areola

- The nipple is surrounded

by
a circular patch of pigmented skin

called the areola.

areola

The areola contains

many sebaceous glands.

glands

- The areola undergoes the

following changes with pregnancy:
pregnancy

1- Its color becomes darker:

darker

This change is permanent and

can be used as a diagnostic sign of
the first pregnancy.
pregnancy
After labour,
labour the color lightens but
never returns to its original state.
state
2- The sebaceous glands enlarge and
their secretions are useful for
lubrication of the nipple
during lactation.
lactation
3- Some small mammary glands
within the areola increase in size and
appear as tubercles known as
Montgomerys tubercles.
tubercles
These tubercles are considered as
a sign of pregnancy.
- The nipple and areola are devoid of
fat.

The upper medial 2/3

Of the base of the breast
lie on
the pectoralis major muscle
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Its lower lateral 1/3

lies on
the serratus anterior muscle
.and external oblique muscle

Relations of the base of the breast

Clavicle

Intercostal muscles

Upper 7 ribs
Subclavius
Pectoralis minor
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Pectoralis major
deep fascia of
the pectoral region
breast
Skin of the breast
Nipple and areola
deep membranous layer
of superficial fascia

The breast

is separated from

The pectoral muscles by

by a layer of
loose connective tissue
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called
the submammary or
retromammary space
This space lies between
deep membranous layer
of superficial fascia
and
deep fascia of the pectoral region

Relations of the breast

Relations:
- The upper medial 2/3
of the breast
lie on
the pectoralis major
muscle.
muscle
Its lower lateral 1/3
lies on
the serratus anterior
muscle
and external oblique
muscle.
muscle

The breast is separated

from
these muscles by a layer of
loose connective tissue
called the submammary or
retromammary space.
This space lies between
the
deep membranous layer of
superficial fascia and
deep fascia of
the pectoral region.
region
The retromammary space
is relatively avascular
but traversed by
lymph vessels and
some blood
vessels.
vessels

Relations of the breast

The retromammary space
is important because:
1- It may be the site of
an abscess.
abscess
2- The breast prostheses
are usually inserted
into this space.
space
3- It permits
free movements
of the breast
over the
muscles.
muscles

4- It is the space
(line of cleavage)
cleavage
where the breast
is separated from
the underlying
muscles
during
simple mastectomy.
mastectomy
5- It is the site of the
deep lymphatic
plexus
of the breast.
breast

Structure of the mammary gland

- The gland is
a modified sweat
gland.
gland
- It consists of
parenchyma and
stroma.
stroma
- The parenchyma
consists of
15 20 lobes.
Each lobe consists of
several lobules.
lobules

- Each lobule has a ductule.

ductule
The ductules within each
lobe unite with each other
to form a single duct
for the lobe.
lobe
This duct is called
the lactiferous duct.
duct
- The lactiferous ducts (15 20)

converge towards the

nipple.
nipple
Each duct dilates under
the areola to form
lactiferous sinus which
narrows again and open
separately on the
summit of the nipple.
nipple

The breast is supplied by

1- Perforating branches of
the internal mammary artery
in the 2nd, 3d and 4th intercostal spaces

).main arterial supply(

Mammary branches of- 2
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the lateral thoracic artery

and pectoral branch of

the thoraco-acromial artery

3- Perforating branches from

.the 2nd, 3d and 4th posterior intercostal arteries

Arterial supply of the breast

Blood supply of the breast

I- Arterial supply of the breast :
The breast is supplied by the following arteries:
arteries
1- Perforating branches of
the internal mammary artery
in the 2nd, 3d and 4th intercostal spaces
(main arterial supply).
supply
2- Mammary branches of the lateral thoracic artery
and pectoral branch of the thoraco-acromial artery
(branch from the 2nd part of the axillary artery).
artery
3- Perforating branches from
the 2nd, 3d and 4th posterior intercostal arteries.

The venous blood of the

The breast
Is drained into adjacent veins
1- The internal mammary vein
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The posterior intercostal veins- 3

Axillary vein- 2
through

the lateral thoracic vein

This is the main

venous drainage

Venous drainage of the breast

the intercostal nerves

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4
The breast
is supplied by

5
6

the anterior cutaneous branches and

the lateral cutaneous branches of
the 4th, 5th and 6th intercostal nerves

Nerve supply of the breast

Nerve supply of the breast

The breast is supplied by
the anterior and lateral
cutaneous branches of
the 4th, 5th and 6th
intercostal nerves.
nerves

Lymphatic drainage of
breast

The lymphatics from the breast

radiate into many directions

The central and lateral- 1

parts of the gland
drain into

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the anterior (pectoral) group

.of axillary lymph nodes

The tail of the breast- 2

drain into
the subscapular group

The upper part of the gland- 3

drains into
the apical group of axillary lymph nodes and

lower deep cervical lymph nodes

The medial part of the gland- 4 drains into

the parasternal lymph nodes

Lymphatic drainage of the breast

The lymphatics from the skin of- 5

the medial part of the breast
cross the midline and
anastomose with
the lymphatics of

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the other breast

Lymphatic drainage of the breast

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6- The lymphatics from the skin of

the infero-medial part of the breast
anastomose with the lymphatics of
the anterior wall of the rectus sheath

Lymphatic drainage of the breast

7- The lymphatics from

the inferomedial part of the gland
anastomose with
the subdiaphragmatic plexus

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and then through the diaphragm

to the medistinal lymph nodes

Lymphatic drainage of the breast

Lymphatic drainage of the breast

- Through the lymphatics,
lymphatics
cancer breast may spread to:
1- The axillary lymph nodes.
nodes
2- The other breast and parasternal lymph
nodes.
nodes
3- The lower deep cervical lymph nodes.
nodes
4- The rectus sheath and then to the liver
through the falciform ligament.
ligament
5- The subdiaphragmatic plexus and then
through the diaphragm to the mediastinal
lymph nodes.
nodes

Thank you
& good luck