. The breast: its anomalies, its diseases, and their treatment . metastatic involvement understood, and all of the tissuesintermediate between the primary focus of disease and the terminal lymph nodes lookedupon as a part of the original tumor and, so far as possible, removed. In addition to the lymphatics of the organ proper, the adjacent lymphatic plexusesmust also be considered, as malignant disease sooner or later transgresses the confines ofone to involve other lymphatic systems. The lymph nodes receiving afferent vessels directly from the breast, comprise thefollowing groups: (a) Axillar
. The breast: its anomalies, its diseases, and their treatment . metastatic involvement understood, and all of the tissuesintermediate between the primary focus of disease and the terminal lymph nodes lookedupon as a part of the original tumor and, so far as possible, removed. In addition to the lymphatics of the organ proper, the adjacent lymphatic plexusesmust also be considered, as malignant disease sooner or later transgresses the confines ofone to involve other lymphatic systems. The lymph nodes receiving afferent vessels directly from the breast, comprise thefollowing groups: (a) Axillary, both sides. (6) Retro-sternal. (c) Retro-pectoral (Rotter). SURGICAL ANATOMY OF THE BREAST 37 {d) Supra-clavicular, deep cervical.(e) Para-mammary (Gerota). The lymph nodes of adjacent systems that frequently become involved in carcinomaof the breast are, in their order of importance: (a) Supra-clavicular, deep cervical. (b) Axillary, opposite side. (c) Diaphragmatic. (d) Hepatic. (e) Supra-xiphoid (Sappey). (f) Upper brachial (g) Intercostal.(b) Fig. i8.—Pectoralis major muscle and pectoralis minor muscle. The cut edges of the pectoralismajor muscle which has been removed show the points of origin and insertion of this muscle; the pectoralisminor muscle is shown intact. The course of the mammary lymphatic vessels passing to these several groupsofnodes is a much disputed question. The anterior parietal lymphatic vessels of the thoraxcomprise the following: Cutaneous of the of the peri-thoracic of the intercostal of the diaphragm. Of these the cutaneous lymphatic plexus is held to be of chief importance and to itthe mammary gland lymphatics are looked upon as tributary. The drainage of the 38 THE BREAST deeper portions of the breast into the lymph channels of the peri-thoracic muscles andtheir fascial coverings is held by Gerota, Poirier, Cuneo and Delamere, and Sappey tobe subsidiary,
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectbreast, bookyear1917
