Montgomery Glands
Montgomery’s glands are enlarged sebaceous glands that can secrete milk; It is an intermediate form between the sweat and the mammary glands. The mammary gland is surrounded by fascia tissues extending into the superficial fascia of the abdomen (Kamper fascia). The posterior surface of the mammary gland is adjacent to the deep fascia, which covers the pectoralis major and anterior serratus muscles.
The combination of these two fascial layers forms fibrous bundles (Cooper ligaments), suspending the mammary gland.
The main blood supply to the breast is through the internal and lateral thoracic arteries. About 60% of the mammary gland, mainly the medial and central parts, are supplied by the anterior perforating branches of the internal thoracic artery. About 30% of the mammary gland, mainly the upper outer quadrant, is supplied by the lateral thoracic artery. The subepithelial, or papillary, plexus of the lymphatic vessels of the mammary gland is connected to the subepithelial lymphatic vessels that cover the entire body.
These valveless lymphatic vessels are connected to the subcutaneous lymphatic vessels and fall into the subareolar plexus of Sappaea. In this plexus lymphatic vessels of the nipple and the areola circle, simultaneously connecting with the vertical lymphatic vessels similar to those that connect the subepithelial and subcutaneous plexuses throughout the body. The lymph flows from the superficial to the deep plexus and from the subareolar plexus through the lymphatic vessels accompanying the ducts to the perilobular and deep subcutaneous plexuses.
The flow of lymph from the deep subcutaneous and intramammary lymphatic vessels moves centripetally to the axillary and internal mammary lymph nodes. It is estimated that about 3% of the lymph from the mammary gland flows through the chain of lymphatic vessels accompanying the internal thoracic artery, while 97% go to the axillary lymph nodes. Lymph drainage along the internal mammar chain can be observed after dye injection into any quadrant of the mammary gland.
Axillary lymph nodes can be divided into apical, or subclavian, which are located medially small pectoral muscle; lymph nodes of the axillary vein, accompanying the axillary vein from the pectoral muscle to the lateral wall of the axillary cavity; interthoracic lymph nodes located between the pectoralis major and minor pectoral muscles along the lateral pectoral nerve; scapular group located along the subscapular vessels; central lymph nodes located under the lateral edge of the pectoralis major muscle and under the pectoralis major muscle.
On the other hand, according to the pathways of metastasis, in order to determine the pathological anatomy and metastasis, axillary lymph nodes are divided into conditional levels. Level I lymph nodes are located lateral to the outer edge of the pectoralis major muscle, Level II lymph nodes lie under the small pectoral muscle, Level III lymph nodes are medial to the internal edge of the small pectoral muscle. Before the operation, the position of the lymph nodes of these groups should be accurately marked with a label.