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Surgery > Breast Surgery > Flashcards

Breast Surgery Flashcards

Common Breast Condiitons Breast Examination Referal and Diagnostic Pathways Breast Cancer covered more in cancer care block

1
Q

Name some common presenting complaints of the breast

A 
Pain
Lump/lumps
Nipple changes
Asymmetry
Gynaecomastia
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2
Q

How may breast pain present?

A

Cyclic pattern

Unilateral or bilateral

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3
Q

How common is breast pain?

A

Very common, the most common breast complaint

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4
Q

What changes can nipples undergo?

A

Retraction
Skin changes
Discharge

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5
Q

Name the benign breast lump causes

A

Fibrocystic changes
Fibroadenomas
Cysts
Lipomas

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6
Q

What is the peak age for fibroadenomas?

A

20-24 (decrease in incidence over time)

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7
Q

What is the peak age for fibrocystic changes?

A

40-50

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8
Q

What is the peak age for cysts?

A

50-55

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9
Q

What is the pattern of incidence of breast cancer?

A

It increases with age exponentially

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10
Q

What % of premenopausal women get fibrocystic breast changes?

A

20%

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11
Q

What is the relationship between fibrocystic changes and cancer?

A

No increased risk of cancer, but a cyst can mask a cancer

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12
Q

How common is a fibroadenoma?

A

Most common benign breast tumour

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13
Q

How should a fibroadenoma be managed?

A

Excision if growing

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14
Q

What are fibroadenomas also known as?

A

Breast mouse

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15
Q

What is the relationship between fibroadenomas and cancer?

A

No increased risk but can be confused with a cancer (Phylloides tumour)

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16
Q

How are breast cysts managed?

A

Aspiration if large cysts

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17
Q

How are benign and malignant conditions of the breast differentiated?

A

Triple assessment - Clinical examination and hx, imaging, and histology/cytology

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18
Q

What group of people are at risk of low grade infection behind the nipple?

A

Smokers

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19
Q

What are fibrocystic changes usually due to?

A

Hormone changes during the normal cycles

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20
Q

How can discomfort due to hormone cycles be helped? Is this commonly done?

A

Using hormones to help regulate cycles

Rarely requires treatment, but can help relieve symptoms

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21
Q

What is the relationship between breast cycts and cancer?

A

No increased risk of cancer, but could be a sign of cancer presence

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22
Q

What is duct ectasia?

A

Inflammation of a mammary duct due to blockage

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23
Q

What kind of symptoms can duct ectasia cause?

A

Green-yellow discharge from the nipple
Tenderness
Nipple retraction
Lump

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24
Q

What complication of duct ectasia may occur?

A

Fistula formation

inflammation -> abscess -> fistula with periareolar skin

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25
Q

Why is breast cancer such a biiiig ol’ topic? Give me some stats.

A

Most common cancer in women in UK - affects 1 in 8 women.

Over 48,000 cases per year and around 10,000 deaths per year

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26
Q

Who is the UK breast cancer screening programme aimed at?

A

Women aged 47-73

Other specific programmes for more high risk groups eg familial BRCA mutations

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27
Q

How frequently are women called for screening?

A

Every 3 years

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28
Q

What are the common signs and symptoms of breast malignancy?

A 
Lump or breast thickening
Discharge
Bleeding
Size/contour of breast changes
Colour/appearance of areola
Redness/pitting of skin
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29
Q

What are the clinical elements to the triple diagnosis?

A

(Hx) Inspection and palpation

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30
Q

What are the radiological elements to the triple assessment?

A

Mammograms
USS
MRI

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31
Q

What are the pathological elements to the triple diagnosis?

A

Fine needle aspiration cytology
Core biopsy
VACB
Excisional biopsy

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32
Q

What does VACB stand for?

A

Vacuum assisted breast core biopsy

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33
Q

Where anatomically are the breasts located?

A

Anterior thoracic wall, in the pectoral region

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34
Q

What is the main glandular structure in female breast tissue?

A

Mammary glands

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35
Q

What are the mammary glands involved in?

A

Lactation

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36
Q

Where is the lateral border of breast tissue?

A

Mid-axillary line

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37
Q

Where are the superior and inferior borders of the breast tissue?

A

2nd and 6th intercostal cartilages

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38
Q

How many regions are there in a breast?

A

2

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39
Q

Name the regions of the breast

A

Circular body

Axillary tail

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40
Q

What is the nipple composed of mostly?

A

Smooth muscle fibres

41
Q

What is the area surrounding the nipple called?

A

Areola(e)

42
Q

What glands are present in the areolae?

A

Sebaceous glands

43
Q

What is the purpose of the glands of the areolae?

A

Secrete an oily protective lubricant

44
Q

Within the breast tissue, what are th emammary glands surrounded by?

A

Connective tissue stroma

45
Q

What are the structures within a mammary gland?

A

Ducts and secretory lobules (15-20)

46
Q

How do these structures converge on the nipple?

A

Many alveoli drain into one duct, many ducts converge at the nipple like spokes of a wheel

47
Q

What are the 2 main components of the connective tissue strome?

A

Fatty and fibrous tissue

48
Q

What is important about the fibrous stroma of the breast?

A

It condenses to form the Cooper ligaments

49
Q

What do the Cooper ligaments do?

A
  • Attach the breast to the dermis and pectoral fascia

- Separate the secretory lobules of the breast

50
Q

What is the retormammary space?

A

A layer of loose connective tissue between the breast and pectoral fascia

51
Q

What can the retromammary spce be used in?

A

Reconstructive plastc surgery

52
Q

How is arterial supply to the breast divided?

A

By medial and lateral aspect supply

53
Q

What artery supplies the medial aspect of the breast?

A

Internal thoracic artery

54
Q

What arterys supplies the lateral aspect of the breast? (4)

A

Mammary branch (of AIA)
Lateral mammary branches (of PIA)
Lateral thoracic and thoracoacromial branches (axillary artery)

55
Q

Which 3 groups of lymph nodes drain the breast tissue?

A

Axillary nodes
Parasternal nodes
Posterior intercostal nodes

56
Q

Which set of nodes recieve the majority of breast lymphatic drainage?

A

Axillary

57
Q

What innervation does the breast receive?

A

Sensory and autonomic nerve fibres

58
Q

What nerves carry these fibres?

A

Anterior and lateral cutaneous branches of 4th to 6th intercostal nerves

59
Q

What regulates the secretion of milk?

A

Prolactin secretion from the anterior pituitary

60
Q

What are the steps of a breast examination?

A
  • Introduction and informed consent
  • Inspection
  • Palpation
  • Axilla
  • Lymph nodes
  • Complete examination
61
Q

Who should be present for a breast examination?

A

The pt, the examiner, and a chaperone.

62
Q

What should you ask the patient before begining?

A

Is there any pain? If so, where?

Where do they feel the lump?

63
Q

For general inspection, how should the patient be positioned?

A

Ask the patient to sit upright, ideally on the side of the bed.

Inspect with arms in 3 different positions.

64
Q

What are we looking for on inspection?

A

Asymmetry, swelling, masses, skin changes, nipple changes

65
Q

What scars may be visible on breasts?

A

Lumpectomy sars
Mastectomy scars
Breast augmentation surgery scars

66
Q

What 3 positions should the arm be in for general inspection?

A

Arms by side
Hands on hips and push inwards
Hands behind/above head

67
Q

What 3 things can cuase nipple retraction?

A
  • Congenital
  • Underlying tumour
  • Duct ectasia
68
Q

What can the pt do to exacerbate any skin dimpling?

A

Lean forwards (with hands above head)

69
Q

What does skin dimpling/puckering suggest?

A

Underlying mass

70
Q

Which breast should be palpated first?

A

The normal/asymptomatic one

71
Q

How should the pt be positioned for palpation?

A

Leaning back on bed at 45 degrees

72
Q

Which part of the hand should you use?

A

The flat of your fingers to compress the breast tissue

73
Q

I mean its completely up to you, but what are some of the ways you can systematically palpate the breast?

A
  • Clock face method (examine each “hour” of the breast)

- Spiral method (start at nipple and work out)

74
Q

Don’t forget to palpate the….

A

Axillary tail!

75
Q

What do you do if a pt has reported nipple discharge?

A

Ask the pt to squeeze the nipple to demonstrate the discharge

76
Q

What does infective discharge look like?

A

Yellow/green

77
Q

What does a bloody discharge suggest?

A

Malignancy e.g. papilloma

78
Q

How do you report the position of a breast lump?

A
  • Which quadrant it lies in/which hour of the clock

- How far it is from the nipple

79
Q

How do you report the size/shape of a breast lump?

A
  • Approx. dimensions of the lump

- Shape of the mass (spherical,elongated, irregular)

80
Q

How do you report the consistency of a breast lump?

A

Smooth, firm, stony, rubbery

81
Q

What else should you report with a lump?

A
  • Overlying skin changes
  • Mobility
  • Fluctuance (a cyst can be squishy)
82
Q

What is the best way to examine the axilla?

A

Supporting the pts arm so they relax their muscles, palpate with the other hand.

Note any lymphadenopathy.

83
Q

Which other lymph nodes should be palpated?

A

Cervical, supraclavicular, infraclavicular, and parasternal

84
Q

After completing examination, what further assessments can be suggested?

A

USS
Mammography
Biopsy

85
Q

If a pt present with an erythematous rash originating in the nipple, and then it spreads to the surrounding areolar area. What do we suspect?

A

Paget’s disease of the nipple

86
Q

What % of all breast cancers are mucinous carcinomas?

A

2-3%

87
Q

What TNM stage is inflammatory breast cancer?

A

T4d

88
Q

What is T1 staging?

A

<2cm

89
Q

What is T2 staging?

A

2-5cm

90
Q

What is T3 staging?

A

5cm +

91
Q

What is T4a staging?

A

Invasion of chest wall

92
Q

What is T4b staging?

A

Invasion of the skin (inc. ulceration or oedema)

93
Q

What is T4c staging?

A

Invasion of chest wall and skin

94
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

95
Q

What features of a breast cancer would indicate that mastectomy is the most appropriate surgical option?

A
  • Multifocal tumour
  • Central tumour
  • Large lesion in a small breast
  • Over 4cm

Most importantly though, its down to the pts choice.

96
Q

What features of a breast cancer would indicate that wide local excision is the most appropriate surgical option?

A
  • Solitary lesion
  • Peripheral tumour
  • Small lesion in large breast
  • Under 4cm

Most importantly though, its down to the pts choice.

97
Q

What is the most likely diagnosis in a pt under 30 with a non-tender, discrete, and mobile lump?

A

Fibroadenoma

98
Q

What is first line advice for managing mastitis?

A

Advise to continue breast feeding if possible.

99
Q

When would abx be prescribed in mastitis?

A

If systemic symptoms are present, or a fissure present, or if symtpoms persist despite 12 hours of effective milk removal.

Surgery (11 decks)

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