A Three-Dimensional Analysis of the Lymphatics of a Bilateral Breast Specimen: A Human Cadaveric Study

Background: There is an increasing clinical need for evaluation of the lymphatic anatomy of the breast. Because of tissue putrefaction, previous studies have not been able to achieve radiographic analyses of bilateral breasts in cadaver specimens. The use of improved preservation techniques with computed tomographic lymphangiography (CT; CTL) has now allowed this analysis to be undertaken. Materials and Methods: The bilateral breasts and anterior-upper torso from a female unembalmed human cadaver was studied over an 8-week period. Using microsurgical techniques, lymphatic vessels were identified with hydrogen peroxide, injected with lead oxide mixture, and radiographed to demonstrate lymphatic vessels in both breasts. Multiple frozen domestic ice bricks were used to cover the contralateral side of tissues to keep them partially frozen during this lengthy process. The specimen was radiographed, CT scanned, cross-sectioned, and radiographed again, with images digitalized for analysis. Results: A three-dimensional analysis of lymph collecting vessels in the breasts, anterior upper torso and the internal mammary vascular bundles was achieved using both plain radiography and CTL. The lymphatics of the breast and anterior upper torso drain radially into the axillary lymph nodes. A predominance of superficial lymphatics are noted. Importantly, lymphatic vessel patterns of the breast are asymmetric between breasts of each side. Conclusion: Three-dimensional images of the lymphatic drainage of the breasts using advanced imaging technologies, are described, with lymphangiography achieved in bilateral cadaveric breasts and anterior upper torso for the first time. This has significant future application for clinical practice.