Breast Lymphatics

Excerpt

Breast cancer is the most commonly seen cancer diagnosis in women worldwide. Lymph node involvement is one of the most important prognostic factors in breast cancer and is important in determining the management of a breast cancer diagnosis. Lymphatic channels collect under the areola to form Sappey’s plexus. The axillary lymph nodes that drain the breast tissue about 75% of the time have been divided into three levels depending on their relationship with the pectoralis major muscle. Level one lymph nodes are lateral to the pectoralis major, level two lymph nodes are posterior to the pectoralis major, and level three lymph nodes are medial to the pectoralis major. Of note, the lymph node between the pectoralis major and minor muscles is also referred to as Rotter’s node. The internal mammary lymph node located beneath the sternum will be the predominant draining node about 5% of the time. In the other 25% of the time, drainage occurs into a combination of the axillary and internal mammary lymph nodes.