Page 1156 - TNFlipTest

PL34 Plastic Surgery
Breast
Toronto Notes 2019
Breast
Anatomy
Vascular Supply
Thoracoacromial artery Axillary artery
Lateral thoracic artery Thoracodorsal artery
Anterolateral intercostal perforators
Figure 31. Breast vasculature
Innervation
Subclavian artery
Internal thoracic artery
Internal thoracic perforating branches Medial intercostal perforators
©Midori Nediger 2016
• innervatedinadermatomalpatternfrombranchesofthethoracicintercostalnerves(T3-6) ■ medially innervated from anterior cutaneous branches of I-VI intercostal nerves
■ lateral innervated from lateral cutaneous nerve branches of II-VII intercostal nerves
• lateralandupperportionsofthebreastinnervatedbylowerfibresofthecervicalplexus(C3,C4) • nippleareolarcomplex
■ supplied by anterior and lateral cutaneous branches of intercostal nerve IV
■ additional innervation by cutaneous branches of intercostal nerves III and VI
Intercostobrachial nerve
Cervical plexus
3 3 Anteromedial
Anterolateral 4 intercostal 5 nerves 6
Figure 32. Innervation of the breast
Breast Reduction
Indications
4 intercosal 5 nerves
© Ruth Chang 2016
• symptomatic(generalsymptoms)
■ musculoskeletal pain (back, strap, neck), chronic headache, paresthesia in upper limb, rashes under
the breast, breast discomfort, and physical impairment
• breastreductionmethodscanbeclassifiedbasedonpedicle(i.e.bloodsupplytothenipple/areolar
complex) and skin resection pattern (i.e. the resultant scar)