Breast Surgery Flashcards
What should be included in initial assessment of gynaecomastia in men?
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
What are the common antibiotics given for non-lactational mastitis?
Broad spectrum
NICE guidelines recommend:
- Co-amoxiclav
Erythromycin/Clarithromycin plus metronidazole
What is Peau D’Orange caused by and what is it associated with?
Blocked lymphatic drainage
Associated with breast cancer
What specialist medications can you use for cyclical mastalgia?
Danazol
Tamoxifen
What medication can you use for symptom control of Galactorrhoea?
Dopamine agonists (bromocriptine)
What is a risk factor for mammary duct ectasia?
Smoking
What is the usual cause of Lactational mastitis?
Obstruction in the ducts
What is the function of BRCA1 and BRCA2 genes?
Tumour suppressor genes
What are some reconstruction options after mastectomy?
- Synthetic implants
- Latissimus dorsi flaps
- Transverse rectus abdominis flap
- Deep inferior epigastric perforator flap
Describe the features of fibroadenoma?
Common in women under the age of 30 years
Often described as ‘breast mice’ due as they are discrete, non-tender, highly mobile lumps
Describe the features of Fibroadenosis (fibrocystic disease, benign mammary dysplasia)?
Most common in middle-aged women
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
Describe the features of mammary duct ectasia?
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’
Describe the features of duct papilloma?
Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge
Describe the features of fat necrosis?
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
What are the features of breast abscess?
More common in lactating women.
Red hot tender swelling
What is the investigations for Fat necrosis?
Need to do triple assessment to rule out malignancy
What is the management of fat necrosis?
Primarily conservative.
What is a Phyllodes tumour?
It is a rare fibroepithelial neoplasm, typically affecting women in their 40s or 50s.
What is the management for a malignant Phyllodes tumour?
Surgical resection with wide local excision
When is breast screening in the UK?
Every 3 years for women aged between 50 and 71
What histological information may be needing for the planning of breast cancer treatment?
- 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
At what age do you start having mammograms for breast lumps and what is used under this age?
Mammography older than 35 and below use ultrasound scanning (and in men) due to the density of the breast tissue in identifying abnormalities
What is the best method of obtaining histological results from a solid breast mass?
Core biopsy
What are the stages for breast examination?
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
When is the most common time to develop mastitis?
2-3 weeks postpartum
What is the pathophysiology behind lactational mastitis?
Due to Milk stasis due to reduced breastfeeding
What is a common cause of non lactational mastitis and why?
Commonly seen in smokers due to damage to ducts secondary to hypoxia
What are the treatment options for men with gynaecomastia?
Tamoxifen
Surgery
What is Tamoxifen?
A selective oestrogen receptor modulator that reduces the effects of oestrogen on the breast tissue
What is an intraductal papilloma
A warty lesion that grows within one of the ducts in the breast.
It is the result of proliferation of epithelial cells
What is the management of intraductal papilloma?
They require complete surgical exision
