Redefined Lymphatic Anatomy of the Breast with Clinical Implications

Abstract

Detailed gross anatomical information about the lymphatic system is essential for predicting accurate distant metastatic sites in solid cancers. Current anatomical knowledge of the lymphatic drainage of the breast is derived from studies by Sappey, Poirier, and Cuneo one century ago. The authors have developed a new radiographic protocol for delineating the lymphatic system in human cadavers; firstly using hydrogen peroxide to identify lymphatic vessels in the soft tissues, then injecting a radioopaque lead oxide mixture directly into these vessels and recording their findings on radiographs. We found that the lymph vessel drainage patterns of the breast and upper torso showed no significant difference between male and female specimens. Some lymph vessels that originated at or below the costal margin of the chest, coursed through the breast tissue to reach the axilla. Other lymph vessels coursed beside the perforating branches of the internal mammary blood vessels to reach the internal mammary lymphatics. These findings are discordant with our basic knowledge of breast lymphatic drainage, thereby initiating our anatomical review of the lymphatics of this region.