Breast Surgery Flashcards
Paget’s disease breast/nipple
Features
Dry skin - resembles eczema
Itching
Bloody nipple discharge sometimes
Ulcerated/inverted nipple
Dx investigation of Paget’s disease breast
Punch biopsy
Brown/green/coloured discharge per nipple suspect
Duct ectasia
Hx of trauma to breast with firm round solitary lump
Fat necrosis
20-40 YO w/ bleeding per nipple. +- skin changes
Suspect?
Investigation to be done
Ductal papilloma
Galactogram
Firm, non tender mobile mass in breast of 15-30 YO woman
Suspect
Investigations
Fibroadenoma
US, FNA
Clinical dx
Mastalgia + increased breast size and lumpiness just before period, disappears after
- fibroadenosis
Investigation for suspected breast ca
Core biopsy
Prolonged areolar redness with hx of antibiotic use. Green discharge per nipple +- nipple retraction +- small lump around nipple
Dx?
Periductal mastitis
- young age , smoking is RF
If left untreated - abscess
When should a prophylactic mastectomy be offered?
- Strong FHx of breast ca
- Inherited BRCA 1 BRCA 2- autosomal dominant
- Previous breast ca - in 1 breast
- Biopsy that shows
- lobular ca in situ
- atypical hyperplasia
Mammograms Offered to
All women 50-70 - every 3 years
Strong FHx or BRCA, women 40-70 = every year
Investigation of suspicious breast mass
FNAC +
Core biopsy to confirm dx
Imaging fro breast lump according to age
<35 - US
>36 - mammogram
Breast ca screening - mammogram
50-70 = every 3 years
Strong FHx , BRCA genes aged 40-70 - every year
Commonest form of breast malignancy
Invasive introduction carcinoma
Encapsulate adipocytes within fibrotic stroma
Dx?
Hamartoma (benign)
Proliferation and expansion of the aroma with low cellularity
Fibroadenoma
Duct like epithelium surrounded by fibrous bridging
Fibroadenoma
Cystic formations with mild epithelial hyperplasia
Fibrosis, epitheliosis, cystic formations
Fibroadenosis
Complication of axillary LN clearance during radical mastectomy
Treatment
Upper limb lyphoedema + frozen shoulder
Physio and arm excercise
Most common breast lesion 15-30yo
Fibroadenoma
Most common breast lesion in reproductive age (peak 35-50)
Fibroadenosis
Most common breast mass postmenopausal women
Breast ca
Itching around breast with foul green nipple discharge
Duct ectasia
Intermittent burning/stabbing pain of breast that may radiate to axilla, no palpable masses or lumps
No enlarged LNs
Dx?
Non cyclical mastalgia
If there’s a lump think - breast cyst
Advise for cyclical mastalgia
Advise her to wear better fitting bra during day
Soft support bra at night
Advise to take paracetamol
Offensive yellow discharge from area near nipple
Hx of an abscess in the area previously surgically treated
Dx?
Ductal fistula (mammillary fistula)
Unexplained breast lump in female >30
To be seen in breast clinic within 2 weeks
Breast clinic - 3 assessment
Clinical +imaging + FNAC/core biopsy
As per NICE what is NOT recommended for cyclical mastalgia
Stopping COCP
Reducing caffiene intake
Primrose oil
