Breast Flashcards
Breast development:
1) Formed from what tissue?
2) Estrogen develops what part?
3) Progesterone develops what part?
4) How does prolactin help?
1) Ectoderm milk streak
2) Estrogen -> Duct development (ED)
3) Progesterone -> Lobular development (PL)
4) Prolactin synergizes E and P
Hormonal cyclic changes:
1) What does E do during the cycle?
2) What does P mature during the cycle?
3) What happens w/ LH/FSH surge?
1) E causes breast swelling; inc glandular tissue
2) P causes maturation of glandular tissue -> menses
3) Release the ovum
(Atrophy of the breast post menopause)
Nerve Anatomy:
1) Innvervates serratus anterior
2) Innvervates lat dorsi
3) Innvervates PECT MAJOR/minor
4) Innvervates only PECT MAJOR
5) Innvervates skin -> sensation to medial arm/axilla
1) Long thoracic -> if cut -> winged scapula
2) Thoracodorsal -> if cut -> weak adduction/pull ups
3) Medial pect
4) Lateral pect
5) Intercostobrachial -> seen during axillary dissection below axillary vein; MC INJURED NERVE DURING MRM AND ALND
Arterial supply to breast:
What are the 4 arteries?
1) Internal thoracic (it is the internal mammary; off of subclavian)
2) Intercostal arteries
3) Thoracoacromial (Trunk off of subclavian)
4) Lateral thoracic (off of axillary)
Lymph node positions relative to PECT MINOR:
Level 1?
Level 2?
Level 3?
Level 1 = Lateral
Level 2 = Posterior
Level 3 = Medial
Where are Rotor’s nodes located?
Between Pect Major and Pect Minor
What is Batson’s plexus, why is it important?
Valveless venous plexus -> allows direct hematogenous spread from breast cancer to spine
Lymph drainage of breast
97% -> Axillary nodes
2% -> Internal mammary nodes (from any quadrant)
If goes to SUPRAclavicular then N3 dz
MC cause of primary axillary adenopathy = lymphoma
What are Cooper’s ligaments?
Suspensory ligaments of breast; skin can dimple if breast CA involeves these ligaments
Benign Breast Dz
1) Abscess
a) MC bug?
b) MC associated with?
c) Presentation?
d) Tx?
e) What to do if doesn’t resolve after 2 wks tx?
a) Staph aureus
b) Breast feeding
c) Painful mass, maybe redness
d) I/D and abx for S. aureus (stop breastfeeding, keep pumping)
e) excisional biopsy including skin for breast CA
Benign Breast Dz 2
1) Infectious Mastitis
a) MC bug?
b) MC associated with?
c) Presentation?
d) Tx?
e) Assciation if not lactating?
a) S. aureus
b) Breast feeding w/in first 12 wks
c) Painful mass in UOQ
d) Abx; continue breast feeding (frequent emptying)]
e) Chronic inflammatory (actinomyces); Autoimmune (SLE)
May also need to biopsy if doesn’t resolve
Benign Breast Dz 3
1) Periductal mastitis (mammary duct ectasia, or plasma cell mastitis)
a) Presentation?
b) RFs?
c) Biopsy results?
d) Tx?
a) Noncyclic mastodynia, erythema, nipple retraction, creamy nipple discharge
b) Smoking, nipple piercing
c) Dilated mammary ducts, inspissated secretions, marked periductal inflammation
d) If just creamy discharge -> abx; resassure; keep breastfeeding; biopsy if no improvement or recurrence (worry is inflammatory CA)
Benign Breast Dz 4
1) Galatocele
a) What is it?
b) Tx?
a) Cyst filled w/ milk; during breastfeeding
b) Aspiration to I/D
Benign Breast Dz 5
1) Galactorrhea
a) Causes?
b) MC associated with?
a) Inc prolactin; OCP, TCAs, reglan, alpha-methyl dopa, reserpine, phenothiazines
b) amennorhea (pituitary adenoma)
Benign Breast Dz 6
1) Gynecomastia - 2 in pinch
a) MC associated with?
b) Tx?
a) cimetidine, spironolactone, marijuana; MC idiopathic
b) Most regress (assurance); surgery if not
