Connection lost. Please refresh the page.
Get help How to study Login Register
Ready to learn?
Pick your favorite study tool

Lymphatic drainage of the breast

Recommended video: Lymphatics of the female breast [09:51]
Lymph vessels and nodes of the female breast.

The lymphatic system plays an essential role in systemic immunity, fluid homeostasis, and returning tissue fluid and macromolecules to the circulation. Lymphatic drainage plays a significant role in the pathology and treatment of breast cancer; globally the most frequently diagnosed malignancy and leading cause of death due to cancer in women.

Malignant cells traveling within the lymphatic system are a common mechanism of tumor metastasis, and examination of lymphatic tissue is essential for cancer prognosis and staging. Advances in lymph node harvesting have improved survival and reduced morbidity from breast cancer treatment. Moreover, lymphatic vessel disruption, a common side effect of breast cancer therapy, can result in significant morbidity.

Key facts about the lymphatic drainage of the breast
Drainage pattern Axillary lymph nodes - they receive 75-90% of the breasts' lymph, which passes through a sentinel lymph node situated at the lateral border of pectoralis major
Parasternal - they receive 10-25% of the breast's lymph
Axillary lymph nodes groups Apical axillary (subclavicular) nodes
Central axillary nodes 
Anterior (pectoral/external mammary) nodes
Lateral (brachial) nodes
Posterior (subscapular/scapular) nodes
[Interpectoral group (Rotter's nodes)]
Other nodes Parasternal (Internal mammary) nodes
Infraclavicular (deltopectoral nodes
Clinical points Breast cancer, lymphedema
  1. Lymphatics
    1. Overview
    2. Lymphatic vessels
    3. Lymph nodes
  2. Lymphatic drainage of the breast
    1. Functional drainage of the breast
    2. Axillary lymph nodes
    3. Other nodes
  3. Clinical notes
    1. Breast cancer
    2. Lymphedema
  4. Sources
+ Show all



The lymphatic system is comprised of:

It is a unidirectional low-pressure network of vessels that run parallel to blood vessels and are found in all regions of the body except the central nervous system and bone marrow.

Like blood plasma, lymph contains interstitial fluid, proteins, clotting factors and leukocytes. Though most of the blood exchanged in a capillary network reenters venous circulation, about 10% is extruded into the interstitial space and must be returned to maintain fluid balance. Lymphatic capillaries contain a single-layer endothelium with loose junctions in the basement membrane that facilitate the entry of cells, macromolecules, and fluid.

Lymphatic vessels

Like veins, lymphatic vessels contain valves and have a smooth muscle endothelial layer which creates a pressure gradient that is further maintained through skeletal muscle contraction, respiratory movement, and gravity. Lymphatic capillaries drain into pre-collectors which sequentially drain into collecting vessels and lymph nodes. Efferents from lymph nodes coalesce into larger vessels and regional lymphatic trunks.

Finally, the right upper torso, including right arm and breast, drain into the right lymphatic duct which empties into the right subclavian vein. The rest of the body, including the left arm and breast, lower extremities, and gastrointestinal tract, drain into the thoracic duct which empties into the left subclavian vein.

Test your knowledge on the lymphatics of the female breast with this quiz.

Lymph nodes

Lymph nodes are encapsulated bean-shaped structures distributed along the lymphatic system that filter lymph of microorganisms and tumor cells. An ideal location for antigen presentation, lymph nodes are essential for cellular immunity. Three paired lymph node basins, the cervical, axillary and inguinal nodes are located at the neck, axillae, and groin respectively.  

Afferent lymphatic collectors drain into sinuses between germinal centers within the node. These germinal centers contain phagocytic cells, such as macrophages, which accumulate foreign material, including the radiolabeled colloids and dyes used to localize lymph nodes during breast cancer treatment.

If you want to learn more details about the lymphatic system, take a look at the following:

Lymphatic drainage of the breast

Functional drainage of the breast

Most (75-90%) of the lymphatic drainage of the breast is to the ipsilateral (same side) axillary nodes. Nearly all lymphatics of the breast drain along a subdermal plane into the axillae, typically collecting in a single sentinel lymph node at the lateral border of the pectoralis major muscle.

Did you know that active recall is the most effective and time efficient way to learn? Discover the importance of using active recall to revise the lymphatic drainage of the breast! 

Superficial lymphatics of the nipple and areola collect in a dense network of pre-collectors known as the subareolar plexus (of Sappey). Lymphatics in the breast parenchyma originate in the interlobular tissue and within the walls of the lactiferous ducts.

A variable degree of deep breast tissue, particularly of the medial breast, may collect into lymphatic vessels that perforate the deep fascia to drain into parasternal nodes (a.k.a. internal mammary nodes) . Lymphatics may also pass through tiny interval nodes within the breast parenchyma. Sporadic drainage to the subscapular, subclavicular, supraclavicular, or contralateral parasternal nodes can occur.  

Axillary lymph nodes

The axillary lymph node chain may be divided into six groups:

Apical axillary nodes

Also known as the subclavicular group, they contain 8-12 nodes between the superior border of the pectoralis minor muscle and the clavicle, lateral to the first rib. This group receives drainage from all other levels of axillary nodes and drains into the subclavian trunk, which flows into the thoracic duct on the left and the right lymphatic trunk on the right side of the body.

Lateral (brachial) axillary nodes 

Also known as the axillary vein or humeral group, they consist of 4-6 nodes medial and posterior to the axillary vein and receive the majority of drainage from the upper extremity and drains into the apical axillary group.

Central axillary nodes

Lying deep to the pectoralis minor muscle within adipose tissue of the axilla, they contain about 4-5 nodes and receive drainage from the breast, the brachial group, the pectoral group, and the subscapular group.    

Posterior (subscapular) axillary nodes

Also known as the scapular group, they consist of 5-7 nodes on the lateral edge of the scapula, anterior to the subscapularis muscle; they receive drainage from the posterior neck, shoulder, and trunk.

Anterior axillary nodes

Also known as the pectoral or external mammary group, they contain 5-6 nodes along the lateral thoracic vessels at the inferior border of the pectoralis minor and superior border of the pectoralis major. They receive drainage from the lateral aspect of the breast and abdominal wall, and drain into the central group.    

Interpectoral nodes

Also known as Rotter’s nodes, they consist of 1-4 nodes between the pectoralis major and minor muscles and receive lymph drainage directly from the breast, draining into the apical axillary and pectoral group. They are classified as axillary lymph nodes in some sources. However, it is noteworthy to mention that the interpectoral nodes are not part of the axillary node group.

Other nodes

Infraclavicular nodes

Also known as the deltopectoral nodes, while not part of the axillary chain, lie in the region bordered by the clavicle, deltoid and pectoralis major muscles. Surrounding the cephalic vein, this group receives drainage from the forearm and hand.  

Parasternal nodes

Also known as the internal mammary nodes, these nodes travel along the internal thoracic artery and vein within the intercostal spaces and deep to the parietal pleura. Perforating lymphatics accompany perforating branches of the internal thoracic artery through the deep fascia and pectoralis muscles. Variations in blood supply to the breast via these perforators explain why, in all quadrants of the breast, cancer has the potential to metastasize via parasternal lymphatics, especially in the deep medial aspect of the breast.

Do you want to test your newly acquired knowledge about the lymphatics of the breast? Then tackle the following study unit and custom quiz:

Lymphatic drainage of the breast: want to learn more about it?

Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster.

What do you prefer to learn with?

“I would honestly say that Kenhub cut my study time in half.” – Read more.

Kim Bengochea Kim Bengochea, Regis University, Denver
© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by German and international copyright laws. All rights reserved.

Register now and grab your free ultimate anatomy study guide!