Breast 1 Flashcards
What are the components of breast tissue?
- glandular tissue consisting alveoli and ducts (ACINI) and lactiferous ducts
- fibrofatty tissue - Cooper’s ligament
- Axillary tail of Spencer
What is the attachment of Cooper’s ligament?
from Pectoralis Major to Skin
What is the only part of the female breast present deep to the deep fascia?
Axillary Tail of Spence
What is the medial blood supply of the breast?
- internal thoracic artery from Subclavian
- anterior intercostals from internal thoracic
Which group of lymph nodes should be removed in case of breast cancer?
- level 1 and 2 only
Why don’t we remove level 3?
to not obstruct the upper limb lymphatics
which hormone is responsible for fat deposition in breast? at what age
estrogen at telarche
which hormone is responsible for the development of the duct system in the mammary glands?
progesterone
What is prolactin’s effect on the breast? When is it secreted?
formation of acini and milk formation during pregnancy
Which hormone is responsible for milk ejection?
oxytocin
What is the most important and most commonly used method of breast investigation?
Mammogram
When is mammography used?
In older females due to a lower breast density resulting in a clearer view of a mass
What is the alternative method to use on younger females instead of the Mammogram?
breast ultrasound
What is the best screening method for carcinoma? and why?
- Mammogram
- it can detect micro calcifications before the appearance of a mass
- it can differentiate between malignant (speculated) and benign (smooth) lesions
Which method of investigation can differentiate between cystic and solid lesions?
breast ultrasonography
What are the indications for breast MRI?
- history of surgery inside the breast (scar tissue present)
- detecting recurrence in a previous conservative breast surgery
- only way to screen breast in case of silicon implants
- presence of strong family history
What are the indications for breast MRI?
- history of surgery inside the breast (scar tissue present)
- detecting recurrence in a previous conservative breast surgery patient that removed a mass
- only way to screen breast in case of silicon implants
- presence of strong family history
When should we start the follow ups in case of a strong family history?
5 years prior to the development of your family member’s mass
Which method of investigation can differentiate between recurrence and fibrous tissue?
breast MRI
How many lactiferous ducts do we have in the female breast?
12 - 15 ducts
What is the indication of ductography?
When we find bleeding coming from 1 nipple from 1 duct
what is the method of investigation that differentiates between intraductal papilloma and carcinoma?
ductography
How do we suppress growth of a tumor with hormone receptors?
anti-estrogen
What is the direction of the nipple?
Forward Lateral downward
What is the effect of congenital nipple retraction and how is it treated?
predisposes to lactational breast abscess
- massage and pull it
- Ashfford’s operation
How do we differentiate between acquired or congenital nipple retraction?
the congenital retraction is slit-like
if it’s dating since telarche its congenital if its recent its acquired
What is Poland Syndrome?
- amastia or amazia
- absent sternal pectoralis major
- absent 2nd to 5th rib
- hand and vertebral anomalies
What is the most common site of development of polymastia?
Axilla
What is the cause of benign virginal hypertrophy? How is it treated?
Macromastia: abnormal estrogen receptor response
- reduction mammoplasty
What may simulate malignancy in breast?
Traumatic breast diseases
- breast hematoma due to old clotted hematoma becoming hard and macrocalcified
- traumatic fat necrosis: minor repeated trauma causing rupture of fat cells leading to macrocalcifications
What is the causative organism of acute lactational mastitis?
Staph. Aureus
Wen are the 2 most common times for lactational mastitis?
first week after delivery and during first weaning
What is the best method for localization of breast abscess?
Ultrasound
How can we prevent acute lactational mastitis?
DURING PREGNANCY - good hygiene - nipple massage and frequent pulling AFTER DELIVERY - clean nipple after suckling - treatment of nipple fissuring - pump evacuation if milk engorgement occurs
What is the first line of treatment in a small breast abscess?
aspiration and antibiotics
What is the difference between an acute or chronic abscess?
chronic abscess
- surrounded by extensive fibrosis resembling malignancy
- leads to dimpling and nipple retraction
What is mammary duct ectasia?
dilated inflamed lactiferous ducts
What is the diagnosis of a breast secreting creamy discharge?
mammary duct ectasia
What is the blood supply of the lateral aspect of the breast?
- lateral thoracic artery from axillary artery
- post. intercostals from thoracic aorta
What are the indications for each BIRADS score?
BIRADS 0: additional imagining
BIRADS 1: negative -> routine screening
BIRADS 2: benign -> routine screening
BIRADS 3: probably benign -> short interval follow up (6 months)
BIRADS 4: suspicious -> tissue diagnosis
BIRADS 5: highly suggestive of malignancy -> tissue diagnosis
BIRADS 6: biopsy proven malignancy -> surgical excision
What does FNABC show?
histological signs of malignancy
What does a tru cut biopsy show?
histological & pathological signs of tissues
What’s the difference between amastia & amazia?
amastia is the absence of the breast tissue & nipple with aereola
amazia is the absence of the breast tissue only with presence of nipple
What is athelia?
absence of nipple & aereola only
What is polymastia?
presence of breast tissue along the milk-line
What is polythelia?
extra nipples over milk line
What are the predisposing factors of acute lactational mastitis?
- milk engorgement
- nipple fissuring
- retracted nipple
- bad hygiene
What is the pathogenesis of acute lactational mastitis?
milk engorgement -> acute lactational mastitis -> breast abscess
What is the difference between the clinical pictures of milk engorgement, lactational mastitis, & breast abscess?
MILK ENGORGEMENT LACTATIONAL MASTITIS BREAST ABSCESS
- mild dull aching pain - dull aching pain but more severe - throbbing pain
- mild fever - continuous fever - hectic fever
- enlarged & indurated - signs of inflammation - inflammation not responding to
breast without manifestations treatment of inflammation - +- fluctuation
when should a mother with mastitis wean?
- if there is an abscess due to lactational mastitis -> wean
- if there is only milk engorgement -> continue breast feeding
- if baby is close to weaning age -> wean
what are the types of acute non-lactational mastitis?
- MASTITIS NEONATORUM -> in 3rd day
- MASTITIS OF PUBERTY -> tender enlargement of breast in boys & girls
- PREMAMMARY ABSCESS -> infection of Montgomry sweat gland
- RETROMAMMARY ABSCESS -> deep to pectoral fascia drained by Thomas incision
