Breast Flashcards
Boundaries of axillary dissection
- Axillary vein (superior)
- Long thoracic nerve (posterior)
- Lat dorsi (lateral)
- Pec minor (medial)
4 nerves of concern in axillary dissection
Talk about each
- Long thoracic nerve (midax line, along serratus anterior, which it innervates)
- Thoracodorsal nerve (courses lat dorsi, which it innervates)
- Medial pectoral nerve (lateral of lateral pec, innervates pec minor and major)
- Lateral pectoral nerve (medial of medial pec, innervates pec major)
Injury to long thoracic nerve results in?
Winged scapula (d/t weakness of serratus anterior)
Cutaneous nerve that traverses axilla?
Intercostobrachial nerve
Lymphatic drainage of the breast?
Lateral: axillary lymph nodes
Medial: parasternal nodes that run with internal mammary artery
Levels of axillary lymph nodes?
I: lateral to pec minor
II: deep to pec minor
III: medial to pec minor
What are Rotter’s nodes?
Nodes in between pec major and minor
Generally not removed
What are suspensory ligaments of the breast called?
Cooper’s ligaments
Mammary milk line?
Embryo line from shoulder to breast where extra nipples can be found
Tail of Spence?
Tail of breast tissue that extends into axilla
Hormone for production vs. expulsion?
Production = prolaction Letdown = oxytocin
Incidence of breast cancer?
12% lifetime risk
(2% occurs in younger than 30)
(33% occurs in older than 70)
Triad of error for misdx (false pos)?
Age <45
Self dx’d mass
Negative mammo
Biggest risk factors for breast CA?
NAACP Nulliparidy Age at menarche (<13) Age at menopause (>55) Cancer of the breast (history) Pregnancy with first child (>30)
Mech of skin retraction?
Tumor involvement of Cooper’s
Best test for mass in woman <30?
Breast ultrasound
Options for bx?
FNA
Core biopsy (bigger needle)
Steriotactic
Open (incisional, excisional)
Spiculated mass with central lucency +/- calcifications on mammo?
Radial scar
Associated with tubular carcinoma
Staging workup?
Bilateral mammo CXR (lung) LFTs (liver) Calcium, alk phos (bone) Neuro eval (brain)
What is a modified radial mastectomy?
Breast, nipple, and I/II axillary nodes removed
Spares pec major and minor
Drains in axilla and chest wall
When do you remove drains?
<30cc per day
Potential complications after MRM?
Ips arm lymphedema
Infection, nerve injury
Skin flap necrosis
hematoma/seroma
Sentinel biopsy?
Blue dye or tech labeled dye to identify primary draining node
Breast reconstruction options?
TRAM flap (transverse rectus abdominus myocutaneous) Lat dorsi flap Implant
Blood supply to breast parenchyma
Internal mammary perforators Thoracoacromial artery Vessels to serratus anterior Lateral thoracic artery 3-8 terminal intercostals
Lumpectomy
Total removal of mass with wide, clear margins
Rel CI: Small breast, large tumor (>5cm), collagen dz
Abs CI: multifocal dz, hx of CA, pregnancy
DCIS
Cancer cells in duct without invasion through BM
Most aggresive subtype?
Comedo
Risk of LN met in DCIS?
<2%
DCIS <1cm tx?
Remove with 1cm margins
XRT
DCIS >1cm tx?
Lumpectomy with 1cm margins with XRT
or
Total mastectomy, no axillary dissection
Diffuse DCIS tx?
Total mastectomy
SN for aggressive cancer
