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1、CHAPTER36DISEASESOFTHEBREASTKellyK.Hunt,MarjorieC.Green,andThomasA.Buchholzsubclavicularnodesmedialtothepectoralisminormuscle.TheanatomylevelIIInodesareeasiertovisualizeandremovewhenthepec-microscopicanatomytoralisminormuscleisdivided.Theapexoftheaxillaisdefinedbreastdev
2、elopmentandphysiologybythecostoclavicularligament(Halsted’sligament),atwhichdiagnosisofbreastdiseasepointtheaxillaryveinpassesintothethoraxandbecomesthebreastimagingsubclavianvein.Lymphnodesinthespacebetweenthepecto-identificationandmanagementofhigh-riskpatientsralismajo
3、randminormusclesaretermedtheinterpectoralgroup,benignbreasttumorsandrelateddiseasesorRotter’snodes,asdescribedbyGrossmanandRotter.Unlessepidemiologyandpathologyofbreastcancerthisgroupisspecificallyexposed,theyarenotencompassedinstagingofbreastcancersurgicalproceduresthat
4、preservethepectoralmuscles.Lymphaticchannelsareabundantinthebreastparenchymasurgicaltreatmentofbreastcanceranddermis.Specializedlymphaticchannelscollectunderthetreatmentofductalcarcinomainsitu(intraductalnippleandareolaandformSappey’splexus,namedforthecarcinoma)anatomist
5、whodescribedthemin1885.Lymphflowsfromradiationtherapyforbreastcancertheskintothesubareolarplexusandthenintotheinterlobularsystemictherapyforbreastcancerlymphaticsofthebreastparenchyma.Appreciationoflymphatictreatmentoflocallyadvancedandinflammatorybreastflowisimportantfo
6、rperformingsuccessfulsentinellymphnodecancersurgery(seelater).Oflymphaticflowfromthebreast,75%istreatmentofspecialconditionsdirectedintotheaxillarylymphnodes.Aminoramountgoesinterpretingresultsofclinicaltrialsthroughthepectoralismuscleandintomoremediallymphnodegroups,ass
7、howninFigure36-2.Lymphaticdrainagealsooccursthroughtheinternalmammarylymphnodesasthepredominantdrainageinupto5%ofpatientsandasasecondaryrouteinANATOMYcombinationwithaxillarydrainageinapproximately20%.AThebreastliesbetweenthesubdermallayerofadiposetissueandmajorrouteofbre
8、astcancermetastasisisthroughlymphaticthesuperficialpectoralfascia(Fig.36-1).Thebreastparenchymachannels
