Intermammary cleft

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search
Intermammary cleft
Details
Identifiers
Latinsulcus intermammarius
TA98Lua error in Module:Wikidata at line 746: attempt to index field 'wikibase' (a nil value).
TH{{#property:P1694}}
TE{{#property:P1693}}
FMA{{#property:P1402}}
Anatomical terminology
[[[d:Lua error in Module:Wikidata at line 865: attempt to index field 'wikibase' (a nil value).|edit on Wikidata]]]

The intermammary cleft, intermammary sulcus, or sulcus intermammarius is a surface feature of males and females that marks the division of the two breasts with the sternum (breastbone) in the middle.[1][2][3][4][5] The International Federation of Associations of Anatomists (IFAA) uses the terms "sulcus intermammarius" or "intermammary cleft" when referring to the area between the breasts.[6][7][8]

Etymology

[edit | edit source]

"Intermammary" ("inter", between + "mamma", breasts + "ry", place[9][10][11]) means something that is located or performed between the breasts (example: intermammary intercourse).[12] "Sulcus" is a Latin word that means a furrow or groove, commonly used to mean a fold, fissure or furrow of the brain (example: lateral sulcus).[13][14] In popular usage the area is commonly referred to as a cleavage of breasts. In surgical parlance, the cleavage or intermammary cleft is also known as the "medial definition" or "medial fold" of breasts.[15][16] An imaginary line between the nipples that crosses the intermammary cleft, serving as a landmark for some CPR procedures, is known as the "intermammary line".[17]

Anatomy

[edit | edit source]
Superficial anatomy of human female breast
See also: Surface anatomy

Skin

[edit | edit source]

At the midline of the breast—the intermammary cleft—a deep layer of superficial fascia (lowermost layer of the skin) is firmly attached to the pectoral fascia (outer side of chest muscles) and the periosteum (bone membrane) of the sternum. It forms a shelving edge that supports the breasts.[18]

Muscles

[edit | edit source]

The sternalis muscle is an anatomical variation that lies in front of the sternal end of the pectoralis major runs along the anterior aspect of the body of the sternum. The sternalis muscle often originates from the upper part of the sternum and can display varying insertions such as the pectoral fascia, lower ribs, costal cartilages, rectus sheath, aponeurosis of the abdominal external oblique muscle.[19][20][21] There is still a great deal of disagreement about its innervation and its embryonic origin.[19] The sternal side (towards the breastbone) of the pectoralis major is distinct from the clavicular side (towards the collarbone), and the two are separated by a fascial interval.[22] The sternal side is usually more robust and has a fiber orientation that best emulates the downward pull of the subscapularis muscle (armpit muscle).[23]

Ligaments

[edit | edit source]

A dense structure of Cooper's ligaments is medially inserted into the skin overlying the sternum, determining the shape of the breasts and intermammary sulcus.[24] These ligaments helpful in supporting the breasts in an youthful disposition; loss of elasticity or attenuation of these ligaments results in ptosis (sagging) of breasts.[25][26]

File:Intermammary sulcus anatomy.png
Anatomy of the cleavage, the red outlined area being the intermammary cleft

Arteries

[edit | edit source]

Major blood supply in the area happens through the intermammary artery (also known as the internal thoracic artery) in the thoracic cavity.[27] Among women, this artery is larger.[28] From which anterior perforating branches carry blood into the circummammary arterial plexus, a vascular network formed by branches between minute arteries around the breasts, with lateral mammary branches curving around the lateral border of the pectoralis major.[27][28][29]

Lymphs

[edit | edit source]

Lymph vessels originating at the base of the nipples can ventrally extend as far as the intermammary cleft[30] and to the opposite breast.[1] The intermammary lymphatics begin as a bunch of small channels consisting of a single layer of epithelium that is supported by stroma tissues. Each mesh of this network surrounds one or more of the ultimate lobules of the glands and receives its lymph from the interacinous spaces between the acini of glands.[31]

Nerves

[edit | edit source]

The first intercostal nerve, a tiny branch (ramus) of the anterior division of the first thoracic nerve, runs along the first intercostal space (the lower margin of the first rib), travels towards the sternum to innervate the skin near the midline, and, as the first anterior cutaneous (skin) branch of the thorax, ends on the front of the chest.[32][33][34] The nerve supply to sternalis muscles comes from the right third intercostal nerve through its anterior cutaneous branch.[35]

Clinical conditions

[edit | edit source]
File:Chest Wall Keloid.JPG
Painful, inflammatory keloid of the chest wall
File:Tinea versicolor1.jpg
Pale coin sized eruptions of tinea versicolor on torso
File:Psoriasis en gouttes enfant 4.jpg
Psoriasis across chest

Poikiloderma of Civatte

[edit | edit source]

Poikiloderma of Civatte, a condition of dilated blood vessels and red to red-brown spots, is common to upper part of the cleavage, especially for those who wear sports bras or push-up bras for prolonged periods, and commonly affects fair skinned middle-aged to elderly women.[36][37] It is characterized by hypopigmentation, hyperpigmentation, telangiectasias and superficial skin atrophy (occasional itching is reported), is another condition caused by long exposure to sunlight.[38][39] Poikiloderma and dermatoheliosis are treated by desquamation (skin peeling).[36][38]

Hidradenitis suppurativa

[edit | edit source]

Hidradenitis suppurativa (HS) is a non-contagious chronic skin disease affects intertriginous skin of apocrine sweat gland bearing areas like inframammary fold, and intermammary sulcus. It is characterized by clusters of abscesses, epidermoid cysts, sebaceous cysts, pilonidal cysts.[40][41] There is no single effective treatment for HS. The recommended treatments include antibiotics, antiandrogens, corticosteroids, ciclosporins, and TNF inhibitors.[41]

Tinea versicolor

[edit | edit source]

Tinea versicolor is a condition characterized by pinhead to coin sized eruptions on the body trunk and proximal extremities, often affecting the breast cleavage as a narrow band of lesions.[42][43] The majority of tinea versicolor is caused by the fungus Malassezia globosa, although Malassezia furfur is responsible for a small number of cases.[44][45] Topical antifungal medications containing selenium sulfide are often recommended to treat tinea versicolor.[46]

Psoriasis

[edit | edit source]

Intermammary cleft can get attacked by plaque type psoriasis, which can in turn can cause erythematosus.[47] Prurigo pigmentosa is a rare skin condition of unknown cause that affects depressed places on chest and back like the intermammary area. It is characterized by the sudden onset of erythematous papules that leave a reticulated hyperpigmentation when they heal.[48][49] Confluent and reticulated papillomatosis, characterized by asymptomatic, small, red to brown, slightly verrucous papules occurs on upper torso, the cleavage area and back.[50] Granular parakeratosis, though mostly an ailment of the armpit area, is also found on the cleavage.[51]

Hirsutism

[edit | edit source]

Most women have an increase of hair as they grow older, but some gets more hair on their cleavage, face and elsewhere because of hirsutism, often as a result of polycystic ovary syndrome. The hair on the cleavage is upsetting for many women. There are two ways to remove the hair — temporary (i.e. shaving, waxing, plucking, hair removal creams or bleaching) and permanent (electrolysis or laser hair removal. Contraceptive pills also help.[52][53]

Symmastia

[edit | edit source]

Symmastia is a condition defined as a confluence of the breast tissue of both breasts across the intermammary cleft that normally divides them. It can be surgically corrected by a plastic surgeon through symmastia revision.[54] Symmastia can either be a congenital anomaly or iatrogenic.[55] Congenital symmastia is a rare condition with few published cases. Iatrogenic symmastia may occur following breast augmentation, forming what is also colloquially referred to as a "uniboob" or "breadloafing" as a result of the release of skin and muscle tissue around the sternum due to over-dissection.[56]

In alternative medicine

[edit | edit source]
File:Chakra4.svg
The mandala (diagram) for anahata chakra, the yogic heart that lies at the depression on the sternum between the nipples[57]
See also: Alternative medicine

The cleavage area is special in Ayurvedic and Yogic philosophy as the fourth chakra' or anahata chakra (अनाहत meaning "unstruck" in Sanskrit, the heart chakra) supposedly lies at the level of the depression in the sternum.[58][57] The astral anahata chakra supposedly lies between the breasts, just inside the front of the chest level with the nipples.[59][60][61] According to Yogashikha Upanishad, the sacred text on yoga, 101 nadis (energy channels) connect the anahata chakra with the rest of the body, including ida, pingala and shushumna, the three major nadis.[62]

According to yoga philosophy, the kundalini shakti (the feminine energy) rises from the muladhara chakra (root chakra) in the pelvic area to reach the cleavage area, a fundamental center for growth of a human being,[63] where at the anahata chakra it is expressed as love, hate and fear.[64] In the cleavage area, according to yoga philosophy, lies the yogic heart of a person, not the heart of flesh,[57] that serves as the bridge between the three lower chakras and the three higher chakras,[65] and when the kundalini remains in the Anahata Chakra, a person is inclined to good and noble desires, thoughts and acts.[66]

According to Traditional Chinese medicine (TCM), shan zhong (Ren-17, 膻中; dan jung, 단중 in Korean) is the acupoint that lies at the intersection of the mid sternal line and a line connecting the nipples. The name shan zhong refers to its location at the center of the chest, seated on an "altar" (i.e. the sternum ) or a "place of worship".[67] It was described by Lingshu Jing, the Divine Pivot as the location of the pericardium. It also is the focal point for regulate the flow of qi, the vital force of any living entity, in the entire body, especially in the chest and breasts.[68][69] It also helps to provide emotional relief and calm the spirit.[69]

See also

[edit | edit source]

References

[edit | edit source]
  1. ^ a b Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  2. ^ Dr. Ted Eisenberg and Joyce K. Eisenberg, The Scoop on Breasts: A Plastic Surgeon Busts the Myths, Incompra Press, 2012, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  3. ^ Heide Schatten and Gheorghe M. Constantinescu, Comparative Reproductive Biology, page 17, John Wiley & Sons, 2008, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  4. ^ Genaro Andres Contreras, The Use of Tylosin to Treat Intramammary Infections , page 22, ProQuest, 2008, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  5. ^ Olufunmilayo I. Olopade and Carla I. Falkson, Breast Cancer in Women of African Descent, page 125, Springer Science & Business Media, 2010, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  6. ^ TA A16.0.02.002
  7. ^ Keith L. Moore, Anne M.R. Agur and Arthur F. Daley, Essential Clinical Anatomy (4th edition), page 49, Lippincott Williams and Wilkins, 2010, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  8. ^ Muhammad Adil Abbas Khan, Ammar Asrar Javed and Nigel Mercer, Cleavage classification: categorizing a vital feminine aesthetic landmark, Plastic and Aesthetic Research (PAR), 016-01-15
  9. ^ inter-, Merriam-Webster
  10. ^ mamma, Charlton T. Lewis and Charles Short (1879), A Latin Dictionary, Oxford: Clarendon Press
  11. ^ -ery, Dictionary.com
  12. ^ intermammary, Merriam-Webster
  13. ^ sulcus, Charlton T. Lewis and Charles Short (1879), A Latin Dictionary, Oxford: Clarendon Press
  14. ^ sulcus, Merriam-Webster
    sulcus, Cambridge Dictionary
    sulcus, Collins Dictionary
  15. ^ John Bostwick, Plastic and Reconstructive Breast Surgery (volume 1), page 21, Quality Medical Pub, 2000, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  16. ^ Sylvia H. Heywang-Koebrunner, Ingrid Schreer and Susan Barter, Diagnostic Breast Imaging, page 62, Thieme, 2019, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  17. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  18. ^ John Blair Deaver, The Breast: its anomalies, its diseases, and their treatment, page 30, P. Blakiston's Son & Company, 1917, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  19. ^ a b Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  20. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  21. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  22. ^ William C. Wood, Charles Staley and John E. Skandalakis, Anatomic Basis of Tumor Surgery, page 140, Springer Science & Business Media, 2010, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  23. ^ Neal S. Elattrache, Surgical Techniques in Sports Medicine, page 139, Lippincott Williams & Wilkins, 2007, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  24. ^ Elizabeth Hall-Findlay and Gregory Evans, Aesthetic and Reconstructive Surgery of the Breast, Elsevier Health Sciences, 2010, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  25. ^ Maurice Y Nahabedian and Peter C. Neligan, Plastic Surgery (Volume 5), page 89, Elsevier Health Sciences, 2017, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  26. ^ Jeffrey Weinzweig, Plastic Surgery Secrets, page 453, Elsevier Health Sciences, 2010, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  27. ^ a b Ruth A. Lawrence MD and Robert M. Lawrence, MD, Breastfeeding: A Guide for the Medical Profession page 47, Elsevier Health Sciences, 2015, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  28. ^ a b Rebecca F. Black, The Science of Breastfeeding (Volume 3), page 13, Jones & Bartlett Learning, 1998, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  29. ^ Theresa Hornstein and Jeri Lynn Schwerin, Biology of Women, page 146, Cengage Learning, 2012, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  30. ^ Charles Wesley Turner, The mammary gland (vol. 1), page 80, Lucas Bros., 1952
  31. ^ Albert Henry Buck and Thomas Lathrop Stedman, A Reference Handbook of the Medical Sciences (volume 2), W. Wood, 1901
  32. ^ Gray's Anatomy of the Human Body, 20th edition (1918), p. 945
  33. ^ Henry Albert Reeves, Human Morphology: A Treatise on Practical and Applied Anatomy (Volume 1), page 91, Smith, Elder, & Company, 1882
  34. ^ Marios G Lykissas, Ioannis P Kostas-Agnantis, Ananstasios V Korompilias, Marios D Vekris, and Alexandros E Beris, "Use of intercostal nerves for different target neurotization in brachial plexus reconstruction", World Journal of Orthopedics, 2013 Jul 18; 4(3): 107–111
  35. ^ Ramachandran Kalpana and Kothandaraman Usha, "Three unilateral recti sternalis muscles – an unusual variation and its clinical significance", European Journal of Anatomy, 14 (2): 99–103 (2010)
  36. ^ a b Daphne Merkin, "The Great Divide", New York Times, August 28, 2005
  37. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  38. ^ a b Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  39. ^ American Osteopathic College of Dermatology "Dermatologic Disease Database", aocd.org, referenced July 22, 2011.
  40. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  41. ^ a b Faye Lyons, Dermatology for the Advanced Practice Nurse, pages 118–121, Springer Publishing Company, 2014, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  42. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  43. ^ James Nevins Hyde, A Practical treatise on diseases of the skin, pages 625-626, Lea Bros. & Company, 1888
  44. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  45. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  46. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  47. ^ Alan Menter and Benjamin Stoff, Psoriasis, page 25, CRC Press, 2010, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  48. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). page 57, Saunders. Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value)..
  49. ^ Q Ashton Acton, Issues in Dermatology and Cosmetic Medicine (2013 Edition), page 432, Scholarly Editions, 2013, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  50. ^ David Weedon, Weedon's Skin Pathology, page 505, Elsevier Health Sciences, 2009, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  51. ^ J Lazar and Phillip H. McKee, Pathology of the Skin, page 96, Elsevier Health Sciences, 2011, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  52. ^ Condition: Hirsutism, NHS
  53. ^ Rachel Lapidos, What's the Best Way to Get Rid of Cleavage Hair?, Well+Good, 2019-10-17
  54. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  55. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  56. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  57. ^ a b c Swami Rama, The Royal Path: Practical Lessons on Yoga, page 82, Himalayan Institute Press, 1998, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  58. ^ Vimala McClure, A Woman's Guide to Tantra Yoga, page 46, New World Library, 2012, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
    Annelise Hagen, 12 Yoga Poses to Boost Breast Health, Yoga Journal, 2017-11-01
    Ravi Ratan and Minoo Ratan, Journey Through Chakras, page 5, Institute of Holistic Sciences, 2007, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  59. ^ Swami Satyananda Saraswati, Meditations from the Tantras, page 37, Bihar School of Yoga, 1974, OCLC 2188780
  60. ^ Jonn Mumford, A Chakra & Kundalini Workbook, page 184, Llewellyn Worldwide, 1994, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  61. ^ Swami Rama, OM the Eternal Witness, page 181, Lotus Press, 2008, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  62. ^ Harish Johari, Chakras: Energy Centers of Transformation, page 44, Simon and Schuster, 2000, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  63. ^ Christine Horner, Waking the Warrior Goddess, page 204, Basic Health Publications, 2005, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  64. ^ Sri Sri Ravishankar, Shiva Sutras, page 119, Aslan Business Solutions, 2018, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  65. ^ Hilary H. Carter, The Chakras Made Easy, page 18, John Hunt Publishing, 2012, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  66. ^ Swami Narayanananda, The Primal Power in Man: The Kundalini Shakti, page 108, Health Research Books, 1960, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  67. ^ Arnie Lade, Acupuncture Points: Images & Functions page 268, Eastland Press, 1989, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  68. ^ Ji Zhang, Baixiao Zhao and Lixing Lao, Acupuncture and Moxibustion, page 252, PMPH-USA, 2014, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  69. ^ a b Honora Lee Wolfe, Bob Flaws, Better Breast Health Naturally with Chinese Medicine page 120, Blue Poppy Enterprises, Inc., 1998, Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).

Lua error in Module:Authority_control at line 153: attempt to index field 'wikibase' (a nil value).

Retrieved from "http://70.231.62.181/index.php?title=Intermammary_cleft&oldid=9511576"