Historical review of breast lymphatic studies

The gross anatomy of the lymphatic system is one of the least studied areas of anatomy, primarily because of the technical difficulties encountered in demonstrating this almost invisible yet vast system. Similarly, there have been very few studies of the gross lymphatic anatomy of the adult human breast. Previous studies used young pregnant female cadavers. When mercury was injected into the lactiferous ducts or breast lymphatic channels, these cadavers enabled early anatomists to see the breast lymphatics. Both Cruikshank (1786) and Cooper (1840) located the axillary lymph pathway as well as accessory pathways directly from the breast. Sappey (1874) concluded that all lymphatics arising from the breast drained into the axilla via the subareolar plexus. Current descriptions of the breast lymphatics may be traced back to the diagram made by Poirier and Cuneo (1902). However, it is apparent that this diagram is a composite of adult breast studies by Sappey, their fetal studies and even clinical feedback. This study provides an historical perspective of the methods that have been previously used to study the lymphatics of the breast and introduces an update on current investigative approaches.