Breast Surgery

Question 1

Paget’s disease breast/nipple

Features

Answer 1

Dry skin - resembles eczema
Itching
Bloody nipple discharge sometimes
Ulcerated/inverted nipple

Question 2

Dx investigation of Paget’s disease breast

Answer 2

Punch biopsy

Question 3

Brown/green/coloured discharge per nipple suspect

Answer 3

Duct ectasia

Question 4

Hx of trauma to breast with firm round solitary lump

Answer 4

Fat necrosis

Question 5

20-40 YO w/ bleeding per nipple. +- skin changes
Suspect?
Investigation to be done

Answer 5

Ductal papilloma

Galactogram

Question 6

Firm, non tender mobile mass in breast of 15-30 YO woman
Suspect
Investigations

Answer 6

Fibroadenoma
US, FNA
Clinical dx

Question 7

Mastalgia + increased breast size and lumpiness just before period, disappears after

Answer 7

• fibroadenosis

Question 8

Investigation for suspected breast ca

Answer 8

Core biopsy

Question 9

Prolonged areolar redness with hx of antibiotic use. Green discharge per nipple +- nipple retraction +- small lump around nipple
Dx?

Answer 9

Periductal mastitis
- young age , smoking is RF
If left untreated - abscess

Question 10

When should a prophylactic mastectomy be offered?

Answer 10

1. Strong FHx of breast ca
2. Inherited BRCA 1 BRCA 2- autosomal dominant
3. Previous breast ca - in 1 breast
4. Biopsy that shows
   - lobular ca in situ
   - atypical hyperplasia

Question 11

Mammograms Offered to

Answer 11

All women 50-70 - every 3 years

Strong FHx or BRCA, women 40-70 = every year

Question 12

Investigation of suspicious breast mass

Answer 12

FNAC +

Core biopsy to confirm dx

Question 13

Imaging fro breast lump according to age

Answer 13

<35 - US

>36 - mammogram

Question 14

Breast ca screening - mammogram

Answer 14

50-70 = every 3 years

Strong FHx , BRCA genes aged 40-70 - every year

Question 15

Commonest form of breast malignancy

Answer 15

Invasive introduction carcinoma

Question 16

Encapsulate adipocytes within fibrotic stroma

Dx?

Answer 16

Hamartoma (benign)

Question 17

Proliferation and expansion of the aroma with low cellularity

Answer 17

Fibroadenoma

Question 18

Duct like epithelium surrounded by fibrous bridging

Answer 18

Fibroadenoma

Question 19

Cystic formations with mild epithelial hyperplasia

Fibrosis, epitheliosis, cystic formations

Answer 19

Fibroadenosis

Question 20

Complication of axillary LN clearance during radical mastectomy
Treatment

Answer 20

Upper limb lyphoedema + frozen shoulder

Physio and arm excercise

Question 21

Most common breast lesion 15-30yo

Answer 21

Fibroadenoma

Question 22

Most common breast lesion in reproductive age (peak 35-50)

Answer 22

Fibroadenosis

Question 23

Most common breast mass postmenopausal women

Answer 23

Breast ca

Question 24

Itching around breast with foul green nipple discharge

Answer 24

Duct ectasia

Question 25

Intermittent burning/stabbing pain of breast that may radiate to axilla, no palpable masses or lumps
No enlarged LNs
Dx?

Answer 25

Non cyclical mastalgia

If there’s a lump think - breast cyst

Question 26

Advise for cyclical mastalgia

Answer 26

Advise her to wear better fitting bra during day
Soft support bra at night
Advise to take paracetamol

Question 27

Offensive yellow discharge from area near nipple
Hx of an abscess in the area previously surgically treated
Dx?

Answer 27

Ductal fistula (mammillary fistula)

Question 28

Unexplained breast lump in female >30

Answer 28

To be seen in breast clinic within 2 weeks
Breast clinic - 3 assessment
Clinical +imaging + FNAC/core biopsy

Question 29

As per NICE what is NOT recommended for cyclical mastalgia

Answer 29

Stopping COCP
Reducing caffiene intake
Primrose oil