intermammary cleft

"Intermammary" ("inter", between + "mamma", breasts + "ry", place[https://www.merriam-webster.com/dictionary/inter inter-], Merriam-Webster[https://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.04.0059:entry=mamma mamma], Charlton T. Lewis and Charles Short (1879), A Latin Dictionary, Oxford: Clarendon Press[https://www.dictionary.com/browse/-ery -ery], Dictionary.com) means something that is located or performed between the breasts (example: intermammary intercourse).[https://www.merriam-webster.com/medical/intermammary intermammary], Merriam-Webster "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).[https://www.perseus.tufts.edu/hopper/resolveform?type=exact&lookup=sulcus&lang=latin sulcus], Charlton T. Lewis and Charles Short (1879), A Latin Dictionary, Oxford: Clarendon Press[https://www.merriam-webster.com/dictionary/sulcus sulcus], Merriam-Webster
[https://dictionary.cambridge.org/dictionary/english/sulcus sulcus], Cambridge Dictionary
[https://www.collinsdictionary.com/dictionary/english/sulcus sulcus], Collins Dictionary 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.John Bostwick, Plastic and Reconstructive Breast Surgery (volume 1), page 21, Quality Medical Pub, 2000, {{ISBN|9781576261040}}Sylvia H. Heywang-Koebrunner, Ingrid Schreer and Susan Barter, Diagnostic Breast Imaging, page 62, Thieme, 2019, {{ISBN|9783131504111}} 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".{{cite book |last1=King |first1=Christopher |last2=Henretig |first2=Fred M. |title=Textbook of Pediatric Emergency Procedures |url=https://books.google.com/books?id=Xi0rlODiFY0C&q=intermammary+line&pg=PA87 |publisher=Lippincott Williams & Wilkins |access-date=19 July 2020 |language=en |date=2008|isbn=9780781753869 }}

{{Annotated image

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{{Annotation|21|7|Deltoid muscle}}

{{Annotation|16|24|Pectoralis major}}

{{Annotation|0|42|Anterior auxiliary fold}}

{{Annotation|49|74|Areola}}

{{Annotation|49|82|Nipple}}

{{Annotation|24|91|Areolar glands}}

{{Annotation|8|102|Serratus anterior}}

{{Annotation|15|117|Inframammary fold}}

{{Annotation|360|7|Manubrium}}

{{Annotation|360|36|Sternum}}

{{Annotation|360|49|Intermammary cleft}}

{{Annotation|360|77|Xyphoid process}}

{{Annotation|360|92|Costal margin}}

{{Annotation|360|106|Polythelia}}

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{{See also|Surface anatomy}}

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.John Blair Deaver, The Breast: its anomalies, its diseases, and their treatment, page 30, P. Blakiston's Son & Company, 1917, {{ISBN|9780266616542}}

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.{{Cite journal|title = Sternalis muscle: a new crossed subtype, classification, and surgical applications|journal = Annals of Plastic Surgery|date = 2011-12-01|issn = 1536-3708|pmid = 21407048|pages = 646–648|volume = 67|issue = 6|doi = 10.1097/SAP.0b013e31820d688b|first1 = Athanasios|last1 = Raikos|first2 = George K.|last2 = Paraskevas|first3 = Faisal|last3 = Yusuf|first4 = Panagiota|last4 = Kordali|first5 = Orestis|last5 = Ioannidis|first6 = Beate|last6 = Brand-Saberi|s2cid = 5303650}}{{Cite journal|title = On the clinical significance of the sternalis muscle|journal = Folia Medica|date = 2009-09-01|issn = 0204-8043|pmid = 19957564|pages = 53–56|volume = 51|issue = 3|first1 = Georgi P.|last1 = Georgiev|first2 = Lazar|last2 = Jelev|first3 = Vladimir A.|last3 = Ovtscharoff}}{{Cite web|title = Anatomy 2008; 2: 67–71 [Case Report]|url = http://www.anatomy.org.tr/issue/200801/fulltext/case_13.asp|website = www.anatomy.org.tr|access-date = 2015-09-05|archive-date = 2016-03-04|archive-url = https://web.archive.org/web/20160304055752/http://www.anatomy.org.tr/issue/200801/fulltext/case_13.asp|url-status = dead}} There is still a great deal of disagreement about its innervation and its embryonic origin. 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.William C. Wood, Charles Staley and John E. Skandalakis, Anatomic Basis of Tumor Surgery, page 140, Springer Science & Business Media, 2010, {{ISBN|9783540741770}} The sternal side is usually more robust and has a fiber orientation that best emulates the downward pull of the subscapularis muscle (armpit muscle).Neal S. Elattrache, Surgical Techniques in Sports Medicine, page 139, Lippincott Williams & Wilkins, 2007, {{ISBN|9780781754279}}

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.Elizabeth Hall-Findlay and Gregory Evans, Aesthetic and Reconstructive Surgery of the Breast, Elsevier Health Sciences, 2010, {{ISBN|9780702050091}} 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.Maurice Y Nahabedian and Peter C. Neligan, Plastic Surgery (Volume 5), page 89, Elsevier Health Sciences, 2017, {{ISBN|9780323357104}}Jeffrey Weinzweig, Plastic Surgery Secrets, page 453, Elsevier Health Sciences, 2010, {{ISBN|9780323085908}}

File:Intermammary sulcus anatomy.png

Major blood supply in the area happens through the intermammary artery (also known as the internal thoracic artery) in the thoracic cavity.Ruth A. Lawrence MD and Robert M. Lawrence, MD, Breastfeeding: A Guide for the Medical Profession page 47, Elsevier Health Sciences, 2015, {{ISBN|9780323357760}} Among women, this artery is larger.Rebecca F. Black, The Science of Breastfeeding (Volume 3), page 13, Jones & Bartlett Learning, 1998, {{ISBN|9780763701949}} 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.Theresa Hornstein and Jeri Lynn Schwerin, Biology of Women, page 146, Cengage Learning, 2012, {{ISBN|9781435400337}}

Lymph vessels originating at the base of the nipples can ventrally extend as far as the intermammary cleftCharles Wesley Turner, The mammary gland (vol. 1), page 80, Lucas Bros., 1952 and to the opposite breast. 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.Albert Henry Buck and Thomas Lathrop Stedman, A Reference Handbook of the Medical Sciences (volume 2), W. Wood, 1901

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.Gray's Anatomy of the Human Body, 20th edition (1918), {{Gray's Anatomy link|Page=945}}Henry Albert Reeves, Human Morphology: A Treatise on Practical and Applied Anatomy (Volume 1), page 91, Smith, Elder, & Company, 1882Marios G Lykissas, Ioannis P Kostas-Agnantis, Ananstasios V Korompilias, Marios D Vekris, and Alexandros E Beris, "[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717241/ Use of intercostal nerves for different target neurotization in brachial plexus reconstruction]", World Journal of Orthopedics, 2013 Jul 18; 4(3): 107–111 The nerve supply to sternalis muscles comes from the right third intercostal nerve through its anterior cutaneous branch.Ramachandran Kalpana and Kothandaraman Usha, "[http://eurjanat.com/web/paper.php?id=100016rk Three unilateral recti sternalis muscles – an unusual variation and its clinical significance]", European Journal of Anatomy, 14 (2): 99–103 (2010)

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| image1 = Chest Wall Keloid.JPG

| caption1 = Painful, inflammatory keloid of the chest wall

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| caption2 = Pale coin sized eruptions of tinea versicolor on torso

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| caption3 = Psoriasis across chest

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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.Daphne Merkin, "[https://www.nytimes.com/2005/08/28/style/tmagazine/TW1792179.html?pagewanted=print&_r=0 The Great Divide]", New York Times, August 28, 2005{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}

It is characterized by hypopigmentation, hyperpigmentation, telangiectasias and superficial skin atrophy (occasional itching is reported), is another condition caused by long exposure to sunlight.{{cite book |first1=Murad |last1=Alam |author-link=Murad Alam |first2=Marisa |last2=Pongprutthipan |title=Body Rejuvenation |page=39 |publisher=Springer Science+Business Media |year=2010 |isbn=9781441910936}}American Osteopathic College of Dermatology [http://www.aocd.org/skin/dermatologic_diseases/Poikiloderma-of-Civatte.html "Dermatologic Disease Database"], aocd.org, referenced July 22, 2011. Poikiloderma and dermatoheliosis are treated by desquamation (skin peeling).

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.{{cite journal|last1=Alikhan|first1=Ali|author2=Lynch, Eisen|title=Hidradenitis suppurativa: a comprehensive review|journal=J Am Acad Dermatol|year=2009|volume=60|issue=4|pages=539–561|doi=10.1016/j.jaad.2008.11.911|pmid=19293006}}Faye Lyons, [https://books.google.com/books?id=bkv4AwAAQBAJ&dq=dermatology+intermammary&pg=PA120 Dermatology for the Advanced Practice Nurse], pages 118–121, Springer Publishing Company, 2014, {{ISBN|9780826136435}} There is no single effective treatment for HS. The recommended treatments include antibiotics, antiandrogens, corticosteroids, ciclosporins, and TNF inhibitors.

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.{{cite book |author=Rapini, Ronald P |author2=Bolognia, Jean L |author3=Jorizzo, Joseph L |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St Louis |year=2007 |pages=Chapter 76 |isbn=978-1-4160-2999-1}}James Nevins Hyde, A Practical treatise on diseases of the skin, pages 625-626, Lea Bros. & Company, 1888 The majority of tinea versicolor is caused by the fungus Malassezia globosa, although Malassezia furfur is responsible for a small number of cases.{{cite journal |author=Morishita N |author2=Sei Y. |title=Microreview of pityriasis versicolor and Malassezia species |journal=Mycopathologia |date=December 2006 |volume=162 |issue=6 |pages=373–76 |doi=10.1007/s11046-006-0081-2|pmid=17146580 |s2cid=30397515 }}{{cite journal |author=Prohic A |author2=Ozegovic L. |title=Malassezia species isolated from lesional and non-lesional skin in patients with pityriasis versicolor |journal=Mycoses |date=January 2007 |volume=50 |issue=1 |pages=58–63 |doi=10.1111/j.1439-0507.2006.01310.x|pmid=17302750|s2cid=25493290 }} Topical antifungal medications containing selenium sulfide are often recommended to treat tinea versicolor.{{cite journal|last1=Likness|first1=LP|title=Common dermatologic infections in athletes and return-to-play guidelines.|journal=The Journal of the American Osteopathic Association|date=June 2011|volume=111|issue=6|pages=373–379|pmid=21771922|doi=10.7556/jaoa.2011.111.6.373|doi-access=free}}

Intermammary cleft can get attacked by plaque type psoriasis, which can in turn can cause erythematosus.Alan Menter and Benjamin Stoff, Psoriasis, page 25, CRC Press, 2010, {{ISBN|9781840765908}} 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.James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). page 57, Saunders. {{ISBN|0-7216-2921-0}}.Q Ashton Acton, Issues in Dermatology and Cosmetic Medicine (2013 Edition), page 432, Scholarly Editions, 2013, {{ISBN|9781490109114}} Confluent and reticulated papillomatosis, characterized by asymptomatic, small, red to brown, slightly verrucous papules occurs on upper torso, the cleavage area and back.David Weedon, Weedon's Skin Pathology, page 505, Elsevier Health Sciences, 2009, {{ISBN|9780702047749}} Granular parakeratosis, though mostly an ailment of the armpit area, is also found on the cleavage.J Lazar and Phillip H. McKee, Pathology of the Skin, page 96, Elsevier Health Sciences, 2011, {{ISBN|9780723437185}}

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.[https://www.nhs.uk/conditions/hirsutism/ Condition: Hirsutism], NHSRachel Lapidos, [https://www.wellandgood.com/how-to-remove-chest-hair/ What's the Best Way to Get Rid of Cleavage Hair?], Well+Good, 2019-10-17

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.{{Cite journal | last1 = Wong | first1 = M. T. | last2 = Cheong | first2 = E. C. | last3 = Lim | first3 = J. | last4 = Lim | first4 = T. C. | title = Creation of an intermammary sulcus in congenital synmastia | journal = Singapore Medical Journal | volume = 48 | issue = 1 | pages = e29–e31 | year = 2007 | pmid = 17245502}} Symmastia can either be a congenital anomaly or iatrogenic.{{Cite journal | last1 = Sillesen | first1 = N. H. | last2 = Hölmich | first2 = L. R. | last3 = Siersen | first3 = H. E. | last4 = Bonde | first4 = C. | title = Congenital symmastia revisited | doi = 10.1016/j.bjps.2012.08.008 | journal = Journal of Plastic, Reconstructive & Aesthetic Surgery | year = 2012 | pmid = 23026472 | volume=65 | issue=12 | pages=1607–13}} 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.{{cite web |url=http://www.justbreastimplants.com/risks/symmastia.htm |title=Symmastia |access-date=2020-10-11 |archive-date=2014-10-17 |archive-url=https://web.archive.org/web/20141017211131/http://www.justbreastimplants.com/risks/symmastia.htm |url-status=dead }}

File:Chakra4.svg (diagram) for anahata chakra, the yogic heart that lies at the depression on the sternum between the nipples]]

{{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.Vimala McClure, A Woman's Guide to Tantra Yoga, page 46, New World Library, 2012, {{ISBN|9781577312765}}
Annelise Hagen, [https://www.yogajournal.com/lifestyle/12-yoga-poses-to-boost-breast-health 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, {{ISBN|9788120832404}}Swami Rama, The Royal Path: Practical Lessons on Yoga, page 82, Himalayan Institute Press, 1998, {{ISBN|9780893891527}} The astral anahata chakra supposedly lies between the breasts, just inside the front of the chest level with the nipples.Swami Satyananda Saraswati, Meditations from the Tantras, page 37, Bihar School of Yoga, 1974, {{OCLC|2188780}}Jonn Mumford, A Chakra & Kundalini Workbook, page 184, Llewellyn Worldwide, 1994, {{ISBN|9781567184730}}Swami Rama, OM the Eternal Witness, page 181, Lotus Press, 2008, {{ISBN|9788188157433}} 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.Harish Johari, Chakras: Energy Centers of Transformation, page 44, Simon and Schuster, 2000, {{ISBN|9781594779091}}

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,Christine Horner, Waking the Warrior Goddess, page 204, Basic Health Publications, 2005, {{ISBN|9781591201557}} where at the anahata chakra it is expressed as love, hate and fear.Sri Sri Ravishankar, Shiva Sutras, page 119, Aslan Business Solutions, 2018, {{ISBN|9789385898198}} In the cleavage area, according to yoga philosophy, lies the yogic heart of a person, not the heart of flesh, that serves as the bridge between the three lower chakras and the three higher chakras,Hilary H. Carter, The Chakras Made Easy, page 18, John Hunt Publishing, 2012, {{ISBN|9781780995168}} and when the kundalini remains in the Anahata Chakra, a person is inclined to good and noble desires, thoughts and acts.Swami Narayanananda, The Primal Power in Man: The Kundalini Shakti, page 108, Health Research Books, 1960, {{ISBN|9780787306311}}

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".Arnie Lade, Acupuncture Points: Images & Functions page 268, Eastland Press, 1989, {{ISBN|9780939616084}} 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.Ji Zhang, Baixiao Zhao and Lixing Lao, Acupuncture and Moxibustion, page 252, PMPH-USA, 2014, {{ISBN|9787117193283}}Honora Lee Wolfe, Bob Flaws, Better Breast Health Naturally with Chinese Medicine page 120, Blue Poppy Enterprises, Inc., 1998, {{ISBN|9780936185903}} It also helps to provide emotional relief and calm the spirit.

• Gynecomastia

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Category:Breast

Category:Human appearance