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Finals - Surgery > Breast Surgery > Flashcards

Breast Surgery Flashcards

1
Q

What are the components of a Triple Assessment

A
  1. Breast examination
  2. Radiology: ultrasound + mammography
  3. Pathology: fine needle aspiration + core biopsy
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2
Q

Mastitis - definition

A

Inflammation of the breast tissue

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3
Q

Mastitis - causes

A
  • Most commonly infection: s. areus

- Can be granulomatous

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4
Q

Mastitis - classification

A
  1. Lactational Mastitis
    - usually first 3 months of breastfeeding
    - associated with cracked nipple + milk stasis
  2. Non-Lactational Mastitis
    - usually in women with other breast conditions (e.g duct ectasia)
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5
Q

What is a significant risk factor for Mastitis

A

Smoking - causes damage to sub-areolar duct walls

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6
Q

Mastitis - Clinical features

A
  • Tenderness
  • Swelling
  • Erythema
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7
Q

Mastitis - Management

A
  • General: antibiotics + analgesia
  • Lactational: continue to breastfeed/express
  • Severe lactational: Cabergoline to stop lactation
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8
Q

What is the key complication of Mastitis

A

Breast abscess

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9
Q

Breast abscess - definition

A

Collection of pus, lined with granulation tissue, in breast

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10
Q

Breast abscess - clinical features

A
  1. Systemic
    - fever
    - malaise
  2. Lump
    - tender, fluctuant + erythematous
    - has a punctum
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11
Q

Breast Abscess - investigations

A

Clinical diagnosis

- can use USS if unsure

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12
Q

Breast Abscess - Management

A
  1. Non-surgical: antibiotics + needle aspiration

2. Surgical: incision + drainage (complicated abscess)

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13
Q

Breast Abscess - Complications

A

Mammary duct fistula

  • fistula between duct + skin
  • requires surgical correction + antibiotics
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14
Q

Breast Cyst - Definition

A

Epithelial-lined fluid cavity, in breast

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15
Q

Breast Cyst - Cause

A
  • Blockage leads to distention of lobule

- Commonly peri-menopausal women

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16
Q

Breast Cyst - Features

A

Smooth, distinct mass

  • can be tender
  • can be multiple
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17
Q

Breast Cyst - Investigations

A
  • Ultrasound: diagnostic
  • Mammogram: characteristic ‘halo shape’
  • Needle aspiration: if suspecting cancer
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18
Q

How does a needle aspirate exclude cancer with breast cyst

A
  • Absence of blood in aspirate fluid

- Disappearance of lump once drained

19
Q

Breast Cyst - Management

A
  • Conservative: will resolve on its own

- Non-surgical: needle aspiration (for large cysts)

20
Q

Breast Cyst - Complications

A
  1. Cancer: increases risk, ~1% will present with cancer

2. Fibroadenomas, multiple small cysts cause fibrosis

21
Q

Duct Ectasia - Definition

A

Dilatation + shortening of major lactiferous ducts

22
Q

Duct Ectasia - Clinical features

A
  • Yellow/green coloured nipple discharge
    (if blood present need triple assessment)
  • Palpable mass
  • Nipple retraction
23
Q

Duct Ectasia - Investigation

A
  • Mammogram: dilated, calcified duct

- Biopsy: typically shows multiple plasma cells

24
Q

Duct Ectasia - Management

A
  1. Conservative: will resolve on its own

2. Surgical: duct excision to stop nipple discharge

25
Fat Necrosis - Definition
Ischaemic necrosis of fat lobule
26
Fat Necrosis - Cause
Due to inflammation - Blunt trauma = 40% - Surgery + radiological interventions = 60%
27
Fat Necrosis - Clinical features
- Usually asymptomatic + a lump - Nipple discharge/inversion - Skin dimpling - Pain ``` Chronic fibrosis (due to persistent inflammation) - large, irregular lump ```
28
Fat Necrosis - Investigations
- Trauma history - USS: hyper-echoic mass - Core biopsy: if suspect cancer
29
Fat Necrosis - Management
Conservative - self resolves - analgesia + reassurance
30
What are the different benign breast tumours
1. Fibroadenoma - ductal (stroma + epithelial) tumour 2. Adenoma - glandular tumour 3. Papilloma - sub areolar tumour 4. Lipoma - adipose tumour 5. Phyllodes tumour - fibro-epithelial tumour
31
What age groups does each type of benign tumour typically affect
- Any age: Lipoma - Reproductive age: Fibroadenoma - 40-50yrs: Papilloma - Older women: Adenoma + Phyllodes
32
Benign tumours - examination findings
- Fibroadenoma: rubbery + highly-mobile - Adenoma: nodular - Papilloma: only large ones present as lump - Lipoma: soft + highly-mobile - Phyllodes: typically larger + fast growing
33
How to papilloma's typically present?
Nipple discharge (clear or bloody)
34
Benign tumours - malignancy potential
- Fibroadenoma: low - Adenoma - Papilloma: high if multi-ductal - Lipoma: low - Phyllodes: 1/3 are high
35
Benign tumours - investigation
Triple assessment - malignancy suspected
36
How are benign tumours managed
- Mostly conservatively: with follow-up - If cancer can't be ruled out: excision - Phyllodes: wide excision
37
Gynaecomastia - Definition
Development of breast tissue in males due to imbalance of oestrogen:androgen ratio
38
Gynaecomastia - Physiological Causes
1. In adolescence (common) - delayed testosterone surge 2. In older men - decline in testosterone
39
Gynaecomastia - Pathological Causes
1. Lack of testosterone - e.g. klinefelters, testicular/renal disease 2. Increase in Oestrogen - e.g. liver disease, obesity 3. Drugs - e.g. spironolactone, digoxin, 4. Idiopathic - 25% of cases
40
Gynaecomastia - Clinical features
- Insidious onset - Firm/rubbery mass >2cm - Mass starts deep to nipple and expands outwards
41
Gynaecomastia - important things to assess
- Breast lumps: underlying malignancy | - Testicles: esp in younger patients
42
Gynaecomastia - Investigations
- Only if cause unknown - LFTs + U+Es first - Only do hormone screen if other tests are normal - Triple assessment if suspect malignancy
43
How do serum hormone levels indicate the cause of gynaecomastia
1. LH high, testosterone low: testicular failure 2. LH low, testosterone low: increased oestrogen 3. LH high, testosterone high: androgen insensitivity - or malignancy
44
Gynaecomastia - Management
- Treat (reversible) underlying cause - Conservative: reassurance - Medical: tamoxifen for tenderness - Surgical: for later stages of fibrosis

Finals - Surgery (5 decks)

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