Breast surgery Flashcards
Benign breast disorders
- fibroadenoma
- cyst
- breast abscess
- fibrocystic changes
- fat necrosis
- mastalgia
Mastalgia
Mastalgia (breast pain)
- experienced by most women
- changes are cyclical then due to cyclical hormonal effects
Management
- cyclical more likely to respond to treatment
- evening primrose oil
- reduce caffeine intake
- danazol (suppresses the production of gonadotropins) and bromocriptine
- if pain is non cyclical then MSK!
Types of breast infections
- Postpartum abscess
- periductal mastitis
Postpartum abscess - Acute mastitis
- assoc to breastfeeding
- staph infecion
- treated with antibiotics
- abscess develops then drain
Skin is red and hot
Periductal mastitis
- Smokers
- episodes of periductal sepsis with anaerobes (metronidazole)
- resolve or abscess
Total duct excision and fistulectomy f recurrent bouts of infection
Nipple discharge
- cloudy white colour= galactorrhea
- clear or light white - pregnancy
- red- blood- breast infection or intraductal papilloma but can be breast cancer
- white- yellow or green - PUS!! infection
Fibroadenoma
- arises from the Lobules
- 15-25
- smooth, well defined and mobile “breast mouse”
Diagnose with
- clinical exam
- characteristic ultrasound appearance
- benign cells on FNAC
Benign and does not necessarily need removal
Phyllodes
- similar appearance to fibroadenoma
- older women
- larger (3-4cm)
- it has malignant potential (may develop into sarcoma)
breast cysts
- women ove 35 years (when involutional changes occur)
- microcysts form as the stroma involutes and some of these may coalesce to form macrocysts
- palpable lump
- cysts may be single or multiple and affect both breasts
- appear suddenly
- o/e- well defined smooth mass that is not mobile
Investifations
- seen on mammograms as well as well defined smooth elsions and on ultrasounds
treatment - aspiration to extinction
Galactocele
retention cyst containing milk or a milky substance that is usually located in the mammary glands. It is caused by a protein plug that blocks off the outlet
Lactaring women
Fat necrosis
- common sequela to trauma
Inflammatory lesions
- acute mastitis
- periductal mastitis
- mammary duct ectasia
- fat necrosis
- lymphocytic mastopathy
- granulomatous mastitis
mammary duct ectasia
- means dilated duct disease (old females prsent with mass or nipple discharge)
Lymphocytic mastopathy -
diabetics
Granulomatous mastitis
sarcoid, TB
fibrocystic changes
- very common and may almost be considered as normal
- occur in pre-menopausal women and has a cyclical pattern
- diffuse lumpiness in upper outer quadrant with breast pain
Fat necrosis
- previous trauma
- bruising
- beningn and resolves with time
- firm and irregular and can be clinically supsicious of a breast cancer
Causes of breast pain
- normal pre-menstrual cyclical pain
- fibrocystic changes
- breast trauma
- infection
- MSk
Causes of nipple discharge
- pregnancy/previous breast feeding- physiological
- duct extasia
- intra-duct papilloma
- breast cancer
- gallactorrhoea
Intra-ductal papilloma
- women over 40
- close to nipple
- discharge common
- both breasts at the same time
- no increase in risk of breast cancer unless atypical
Diagnosis
- routine breast screening
- triple assesment
- FNAC
treatment
- may need excision biopsy
causes of gynaecomastia
- physiolgical
- chronic liver disease
- testicular failure -usually old age
- drugs - bendofluazide, digoxin, spirnolactone
- adrenal tumour
treatment ofgynaecomastia
- physiolgocial type often resolve spontaneosly
- surgical
