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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
Q

Fat Necrosis - Definition

A

Ischaemic necrosis of fat lobule

26
Q

Fat Necrosis - Cause

A

Due to inflammation

  • Blunt trauma = 40%
  • Surgery + radiological interventions = 60%
27
Q

Fat Necrosis - Clinical features

A
  • Usually asymptomatic + a lump
  • Nipple discharge/inversion
  • Skin dimpling
  • Pain
Chronic fibrosis (due to persistent inflammation)
- large, irregular lump
28
Q

Fat Necrosis - Investigations

A
  • Trauma history
  • USS: hyper-echoic mass
  • Core biopsy: if suspect cancer
29
Q

Fat Necrosis - Management

A

Conservative

  • self resolves
  • analgesia + reassurance
30
Q

What are the different benign breast tumours

A
  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
Q

What age groups does each type of benign tumour typically affect

A
  • Any age: Lipoma
  • Reproductive age: Fibroadenoma
  • 40-50yrs: Papilloma
  • Older women: Adenoma + Phyllodes
32
Q

Benign tumours - examination findings

A
  • Fibroadenoma: rubbery + highly-mobile
  • Adenoma: nodular
  • Papilloma: only large ones present as lump
  • Lipoma: soft + highly-mobile
  • Phyllodes: typically larger + fast growing
33
Q

How to papilloma’s typically present?

A

Nipple discharge (clear or bloody)

34
Q

Benign tumours - malignancy potential

A
  • Fibroadenoma: low
  • Adenoma
  • Papilloma: high if multi-ductal
  • Lipoma: low
  • Phyllodes: 1/3 are high
35
Q

Benign tumours - investigation

A

Triple assessment - malignancy suspected

36
Q

How are benign tumours managed

A
  • Mostly conservatively: with follow-up
  • If cancer can’t be ruled out: excision
  • Phyllodes: wide excision
37
Q

Gynaecomastia - Definition

A

Development of breast tissue in males due to imbalance of oestrogen:androgen ratio

38
Q

Gynaecomastia - Physiological Causes

A
  1. In adolescence (common)
    - delayed testosterone surge
  2. In older men
    - decline in testosterone
39
Q

Gynaecomastia - Pathological Causes

A
  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
Q

Gynaecomastia - Clinical features

A
  • Insidious onset
  • Firm/rubbery mass >2cm
  • Mass starts deep to nipple and expands outwards
41
Q

Gynaecomastia - important things to assess

A
  • Breast lumps: underlying malignancy

- Testicles: esp in younger patients

42
Q

Gynaecomastia - Investigations

A
  • Only if cause unknown
  • LFTs + U+Es first
  • Only do hormone screen if other tests are normal
  • Triple assessment if suspect malignancy
43
Q

How do serum hormone levels indicate the cause of gynaecomastia

A
  1. LH high, testosterone low: testicular failure
  2. LH low, testosterone low: increased oestrogen
  3. LH high, testosterone high: androgen insensitivity
    - or malignancy
44
Q

Gynaecomastia - Management

A
  • Treat (reversible) underlying cause
  • Conservative: reassurance
  • Medical: tamoxifen for tenderness
  • Surgical: for later stages of fibrosis

Finals - Surgery (5 decks)

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