Breast Surgery Flashcards
What kind of symptoms would you expect in a duct papilloma?
What kind of patient would you expect to see this in?
A clear bloody discharge.
Common in younger patients.
What kind of symptoms would you expect to see in a patient presenting with fibroadenosis?
What kind of patient would you expect to see this condition in?
A clear nipple discharge.
Lumpy painful breasts.
Worsening symptoms prior to menstruation.
Common in middle aged women.
What kind of symptoms would you expect to see in a patient with mammary duct ectasia?
What kind of patients would you expect to see this condition in?
Blood stained/green nipple discharge.
Slit like nipple retraction.
Exacerbated by smoking.
More common in menopausal patients.
Which breast patients should be referred for a two week wait?
Any patient >30 years old with unexplained breast lump or lump in the axilla.
Any patient >50 years old with unexplained nipple changes.
Any patient with skin changes on the breast.
Which patients should be referred to a non-urgent breast clinic for review?
Patients whom are less than 30 years old with an unexplained breast lump.
What is a triple assessment of the breast?
Physical examination
Imaging - USS/Mammogram
Biopsy
What is the most common type of breast cancer?
Invasive ductal carcinoma
What is the pre-operative management of women who are undergoing breast surgery?
Examination for lymphadenopathy.
- Present - axillary clearance in primary surgery
- Absent - axillary USS and if positive then conduct a sentinel node biopsy.
When is radiotherapy offered to women with breast cancer
All women undergoing a wide local excision of the breast.
Women with a T3/T4 breast cancer whom have undergone a mastectomy.
What are the different types of hormonal therapies available?
- SERM - eg. Tamoxifen
- HER2 receptor antagonist - eg. Herceptin
- Aromatase inhibitors - offered to post menopausal women to prevent peripheral oestrogen synthesis.
Which patients is fat necrosis most common?
- Obese patients with large breasts.
* Patients whom have suffered any breast trauma (even minor)
How does fat necrosis present to the GP?
A small round firm lesion that may develop into a hard irregular breast lump.
Always requires review as presents similar to breast cancer.
In what patients are breast abscesses most common?
Patients whom have had mastitis for a while that has remained untreated.
When is surgical excision indicated in a fibroadenoma?
If it is >3cm in size.
What is the most common cause of breast pain in young females?
Cyclical mastalgia.
What are the most common breast conditions that you will encounter in young females?
Cyclical mastalgia Mastitis (lactational) Periductal mastitis (smoking) Duct papilloma Fibroadenosis in middle aged women.
What is the management for cyclical mastalgia?
Supportive bra
Dietary advice
Analgesia
If the breast pain has occurred for >3 months and is affecting the patients quality of life/sleep - refer to specialist.
What is the management for mastitis?
Continue breast feeding
If symptoms do not resolve within 12-24 hours of milk drainage then antibiotics can be prescribed.
Flucloxacillin is drug of choice as infection often due to Staphylococcus. aureus.
What is a complication of mastitis?
If left untreated this can develop into a breast abscess that requires percutaneous drainage and antibiotic treatment.
Necrotic tissue may present and this requires surgical debridement.
How would you diagnose Pagets disease?
Punch biopsy, mammography/USS of the breast.
What is Pagets disease of the breast?
Eczematous changes of the breast that usually start on the nipple and spread to the alveolar tissue (opposite to that of eczema)
Usually indicates the presence of underlying breast disease (malignant)
