Cutaneous and subcutaneous lymphatic drainage of the breast

The aim of this study was to topographically map the superficial lymphatic drainage ofthe breast. The study was performed on 24 female cadavers. Patent blue dye wasadministered intradermally and subcutaneously. After visualization and dissection of thelymphatics, a schematic record of their routes was made on a transparency folio of thebreast map. Afterwards, a summation was performed of all schematic records, and a map ofthe lymphatic vessels of the breast was derived. The natural dominant drainage for theoutflow of lymph from the superficial areas of the breast is to the axillary nodes. Thispathway plays a primary role in the initial stages of breast cancer. This observation doesnot exclude other pathways of lymph drainage, which probably play a secondary roleexcept in cases where flow is limited in the primary lymphatic pathway. Although eachquadrant is dominantly drained by one or two of its own collectors, it is also interconnectedvia the subareolar plexus with the other quadrants of the breast, and lymph collectors ofthe upper medial quadrant pass to the lower medial quadrant and vice versa. Lymphaticcollectors from the medial quadrants followed the medial, cranial and caudal margins ofthe breast and afterwards ran into the axilla. The common interconnections of theindividual quadrants of the breast with one or two collectors, which circumscribe thebreast, but run outside the subareolar plexus, further increase the risk of developinglocoregional recurrences. In some cases, the marginal lymphatic collectors of the breastmay even run beyond the anatomical boundaries of the breast–particularly apparent in thesubmammary region