Breast Surgery

Question 1

What should be included in initial assessment of gynaecomastia in men?

Answer 1

They should have a testicular examination. There is a link between gynaecomastia and Leydig cell testicular tumours. About 2% of patients presenting with gynaecomastia have a testicular tumour

Question 2

What are the common antibiotics given for non-lactational mastitis?

Answer 2

Broad spectrum
NICE guidelines recommend:
- Co-amoxiclav
Erythromycin/Clarithromycin plus metronidazole

Question 3

What is Peau D’Orange caused by and what is it associated with?

Answer 3

Blocked lymphatic drainage
Associated with breast cancer

Question 4

What specialist medications can you use for cyclical mastalgia?

Answer 4

Danazol
Tamoxifen

Question 5

What medication can you use for symptom control of Galactorrhoea?

Answer 5

Dopamine agonists (bromocriptine)

Question 6

What is a risk factor for mammary duct ectasia?

Answer 6

Smoking

Question 7

What is the usual cause of Lactational mastitis?

Answer 7

Obstruction in the ducts

Question 8

What is the function of BRCA1 and BRCA2 genes?

Answer 8

Tumour suppressor genes

Question 9

What are some reconstruction options after mastectomy?

Answer 9

• Synthetic implants
• Latissimus dorsi flaps
• Transverse rectus abdominis flap
• Deep inferior epigastric perforator flap

Question 10

Describe the features of fibroadenoma?

Answer 10

Common in women under the age of 30 years
Often described as ‘breast mice’ due as they are discrete, non-tender, highly mobile lumps

Question 11

Describe the features of Fibroadenosis (fibrocystic disease, benign mammary dysplasia)?

Answer 11

Most common in middle-aged women
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation

Question 12

Describe the features of mammary duct ectasia?

Answer 12

Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’

Question 13

Describe the features of duct papilloma?

Answer 13

Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge

Question 14

Describe the features of fat necrosis?

Answer 14

More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted

Question 15

What are the features of breast abscess?

Answer 15

More common in lactating women.
Red hot tender swelling

Question 16

What is the investigations for Fat necrosis?

Answer 16

Need to do triple assessment to rule out malignancy

Question 17

What is the management of fat necrosis?

Answer 17

Primarily conservative.

Question 18

What is a Phyllodes tumour?

Answer 18

It is a rare fibroepithelial neoplasm, typically affecting women in their 40s or 50s.

Question 19

What is the management for a malignant Phyllodes tumour?

Answer 19

Surgical resection with wide local excision

Question 20

When is breast screening in the UK?

Answer 20

Every 3 years for women aged between 50 and 71

Question 21

What histological information may be needing for the planning of breast cancer treatment?

Answer 21

• Tumour size
• Tumour grade
• Lymph node involvement
• Completeness of excision/ If the margins are clear
• Vascular invasion
• Oestrogen receptor status
• Progesterone receptor status
• Steroid receptor status
• HER2 status

Question 22

At what age do you start having mammograms for breast lumps and what is used under this age?

Answer 22

Mammography older than 35 and below use ultrasound scanning (and in men) due to the density of the breast tissue in identifying abnormalities

Question 23

What is the best method of obtaining histological results from a solid breast mass?

Answer 23

Core biopsy

Question 24

What are the stages for breast examination?

Answer 24

Inspection - General then hands pushing into hips and arms above head whilst leaning forward

Palpation- Start with asymptomatic breast first. Then symptomatic then axillary tail

Nipple-areolar complex

Lymph nodes

Question 25

When is the most common time to develop mastitis?

Answer 25

2-3 weeks postpartum

Question 26

What is the pathophysiology behind lactational mastitis?

Answer 26

Due to Milk stasis due to reduced breastfeeding

Question 27

What is a common cause of non lactational mastitis and why?

Answer 27

Commonly seen in smokers due to damage to ducts secondary to hypoxia

Question 28

What are the treatment options for men with gynaecomastia?

Answer 28

Tamoxifen
Surgery

Question 29

What is Tamoxifen?

Answer 29

A selective oestrogen receptor modulator that reduces the effects of oestrogen on the breast tissue

Question 30

What is an intraductal papilloma

Answer 30

A warty lesion that grows within one of the ducts in the breast.

It is the result of proliferation of epithelial cells

Question 31

What is the management of intraductal papilloma?

Answer 31

They require complete surgical exision