Breast Surgery Flashcards
Describe breast anatomy
Most of breast is adipose tissue
Nipple, with areola surrounding it
Behind the nipple = ducts lead into lobules
Lobules secrete milk, go through ducts and through openings of the nipple
What does triple assessment refer to?
Clinical examination
Imaging - US or mammography
Histology - fine needle aspiration or ore biopsy
What is a firbroadenoma? What are its features?
Common benign tumour of stromal/epithelial breast duct tissue
- painless
- smooth
- round
- well circumscribed
- mobile
- usually up to 3cm in diameter
Breast cyst features
Small
Mobile
Well-circumscribed
Possibly fluctuant
What is far necrosis and what are its features?
Benign lump caused by localised degeneration and scarring of fat tissue in the breast
Commonly triggered by localised trauma, radiotherapy or surgery causing an inflammatory response that results in fibrosis and necrosis
- painless
- firm
- irregular
- fixed in local structures
- may be skin dimpling or nipple inversion
What is a lipoma? Its features?
Benign tumour of fat tissue, can occur anywhere in the body, including the breast
- soft
- painless
- mobile
- do not cause skin changes
Typically managed conservatively
What is a galactocele? Features?
Occur in women who are lactating
Often stop after breast feeding
Breast milk filled cysts that occur when the lactiferous duct is blocked preventing the gland from draining milk
- firm
- mobile
- painless lump - usually beneath the areola
What is a phyllodes tumour? Features?
Rare tumours of the connective tissue (stroma) of the breast
Most commonly occur in 40-50 year old
Large and fast-growing
Can be benign or malignant
Treatment - surgical removal (wide excision)
What is mammary duct ectasia? Features?
Ectasia = dilation
Dilation with the large ducts of the breast, they can become clogged and inflamed leading to intermittent discharge from the nipple (green, grey, white). Occurs in postmenopausal women usually.
Can also have nipple retraction or inversion
What is an intraductal papilloma? Typical presentation?
Warty lesion that grows in one of the ducts
Proliferation of epithelial cells
Benign tumours but can be associated with breast cancer
Typically clear or blood-stained nipple discharge Most commonly 34-55 years old Often asymptomatic Tenderness Palpable lump
Most common type of breast cancer
Invasive ductal carcinoma
Re-named no specific type
Risk factors for breast cancer
Female obviously Increased oestrogen expsorue - early periods, late menopause COCP - small risk but stops 10 years after taking it Obesity Smoking More dense breast tissue Family history - first-degree HRT - especially combined
Describe hormonal therapy of breast cancer
Anti-Oestrogen therapy - tamoxifen (given to those who have cancers that are oestrogen sensitive)
Post-menopausal = aromatase inhibitors (anastrozole)
Biological therapy - tratuzumab - (herceptin) if HER2 sensitive
Can fibroadenomas be surgically removed?
Yes if >3cm (or causing discomfort etc.)
Via excision biopsy
If <3 cm then it could be observation and simple advice be enough.
Are young women usually given mammograms
No, as ineffective due to dense breasts
What is given after wide local excision of breast cancer?
Radiotherapy to prevent recurrence
Breast cancer with clinically palapable lymphadenopathy, management
US-guided biopsy with Axillary node clearance at primary surgery
Who does mastitis commonly affect?
Breastfeeding women
Management of mastitis
Continue breast feeding
If not improving within 24 hours, symptoms not resolving or if culture indicates infection
Flucloxacillin for 10-14 days
If untreated - may develop into abscess
What is letrozole?
An aromatase inhibitor, used in oestrogen receptor sensitive cancer in post menopausal women
Tender breast lump in a 32 year old breast feeding woman
Breast abscess (likely at risk of mastitis, leading to abscess if not treated)
Creamy nipple discharge originating from multiple ducts in a 53 year old associated with nipple inversion
Duct ectasia
When does duct ectasia occur?
During menopausal period
As ducts shorten they may contain insipiated material
52 year old lady with an episode of nipple discharge, usually clear, from a single duct. Contains some blood.
Also a young woman with blood stained nipple discharge. Not usually a palpable mass
Intraductal papilloma
What is the commonest cause of blood stained nipple discharge in younger women?
Intraductal papilloma
Differentiating between pagets disease of the nipple and eczema of the nipple
Pagets- involves nipple, spreads to areola later. Opposite in eczema
What is fibroadenosis?
Most common in middle aged women
Lumpy breasts that may be painful
Syptoms worsen prior to menstruation
Describe breast cancer screening
Mammogram every 3 years to women aged 50-70 years
Inflammatory breast cancer presentation
Atypical appearance - progressive erythema oedema in the absence of infection signs like fever, discharge or elevated WCC and CRP
Elevated CA 15-3
Duct ectasia vs intraductal papilloma presentation
Ectasia - older
pap - younger
Ectasia = Green, brown discharge, smokers
Pap = blood stained discharge, no palpable lump
Side effects of aromatase inhibitors
Osteoporosis
Hot flushes
Insomnia
Arthralgia
Tamoxifen side effects
Vaginally bleeding, amenorrhoea
Hot flushes
VTE
Endometrial cancer
Halo sign on mammogram is associated with what?
Breast cyst
