Breast Mushkies Flashcards
Breast exam components?
- Inspection
- Palpation
- Completion
Breast inspection?
- Positions x 4 = hands by sides, leaning forwards, behind head, pressing hips
- Shape = asymmetry, masses
- Skin = scars, radiotherapy tattoos, eczema, erythema, peau d’orange
- Nipple = inversion, discharge, discoloration, destruction
- Peripheral = axillae, arm, abdomen (DIEP), back (lat dorsi flap harvest)
Breast palpation?
- Breast
- Axillae
- Supraclavicular and cervical nodes
- Lateral chest wall
Breast exam completion?
- Palpate/percuss spine for tenderness, masses
- Examine abdomen for hepatomegaly
- Percuss and auscultate lungs
Axillary lymph nodes?
- Apical
- Anterior
- Posterior
- Medial Lateral
Breast scars?
- Periareolar
2. Submammary
Breast lump Ix?
Triple assessment
- History and Examination
2a. <35 years old = US
2b. >35 years old = US + mammogram - Solid lump = Tru-Cut biopsy, Cystic lump = FNAC
Breast Ca RFs?
BOOBYS
- Bleeding = early menarche <13, late menopause >55
- Oestrogen = OCP, HRT
- Other breast disease = Ca, DCIS, atypia
- Breast feeding = protective
- Young’un = first child >35 y/o
- Sister = FHx
Classification of breast disease?
Benign or Malignant
Malignant breast disease?
- Ductal carcinoma NOS = 70%
- Lobular carcinoma = 20%
- Phylloides tumours
- Other = mucinous, medullary, papillary
Benign Breast disease?
- Stromal = fibroadenomas
- Epithelial = fibroadenosis, cysts, papillomas
- Inflammatory = mastitis, abscess, fat necrosis, duct ectasia
Commonest single breast lumps?
- Fibroadenoma
- Cyst
- Fat necrosis
- Cancer
Features of a malignant breast lump?
- Irregular, nodular surface
- Poorly defined edge
- Hard/scirrhous consistency
- Painless
- Fixation to skin or chest wall
- Nipple involvement
4 indications for mastectomy?
- Multifocal tumour
- Central tumour
- Large lesion in small breast
- DCIS > 4cm
- Pt choice
4 indications for wide local excision?
- Solitary lesion
- Peripheral tumour
- Small lesion in large breast
- DCIS < 4cm
- Pt choice
Drain removal post breast op features?
- Typically 2 drains = axilla and site of surgery
- Left for 3-5 days or until draining <50ml/d
- Pts can go home with drains and district nurse support
2 types of breast reconstruction?
- Implant reconstruction
2. Myocutaneous flap reconstruction
Implant reconstruction features?
- Rounder shape than normal breast
- Breast usually lies higher
- Becker implant may have palpable SC filling port in the axilla
Implant reconstruction advantages?
Simpler technique, can be primary or delayed
Implant reconstruction disadvantages?
- Cosmetic result not as good
- Requires plenty of available skin
- Lies higher than other breast
- Late complications = capsular contracture, implant leakage, infection requiring removal
Myocutaneous flap features?
- Scars extend over back or abdominal wall
- Recess on back where lat dorsi has been removed
- Ask pt to lift head off bed when lying supine to see recess in the rectus muscle
Myocutaneous flaps advantages?
- Useful when little remaining skin.muscle
- Good cosmetic result
- Primary or delayed
Myocutaneous flaps disadvantages?
- Increased blood loss
- Increased op times and complications
- Use of rectus impossible if pt has had abdo surgery
- Late complications = flap necrosis and infection
Types of myocutaneous flap?
- Lat dorsi flap = often augmented w/ an implant
- TRAM flap = transverse rectus abdominis myocutaneous, risk of abdominal hernia, C/I if poor circulation, no implant necessary and combined tummy tuck
- DIEP flap = deep inferior epigastric perforator, may not be possible if small perforators
Gynaecomastia examination?
- Inspection = unilateral/bilateral breast swelling
- Palpation = must feel glandular tissue to differentiate from pseudo
- Completion
Completion of gynaecomastia exam?
- Look for cause = external genitalia, thyroid, CLD, visual fields
- History
- Prescription and recreational drugs
Causes of gynaecomastia?
3Ps
- Physiological
- Pathological
- Potions
Physiological gynaecomastia?
Usually resolves by adulthood
Pathological gynaecomastia?
- Decreased androgen production
2. Increased oestrogen production
Causes of reduced androgen production?
- Hyperprolactinaemia
- Renal failure
- Testicular = atrophy, orchitis, torsion, Klinefelters
Causes of increased oestrogen production?
- Increased production = sex cord stromal tumours, lung Ca
2. Increased peripheral aromatisation = CLD, thyrotoxicosis
Potions that cause gynaecomastia?
- Recreational = Marijuana, Diazepam, Anabolic Steroids
2. Prescription
Prescription drugs that cause gynaecomastia?
- Spironolactone
- Digoxin
- Captopril
- Verapamil
- Ranitidine
Gynaecomastia Ix?
- Testicular Ca = AFP, bHCG
- Hypogonadism = testosterone and LH
- Prolactinoma = PRL
- TFTs
Gynaecomastia suggestive of Ca Fx?
- Older age
- FHx
- Unilateral
- Firm or hard nodules w/in breast tissue
- Axillary LNs