Breast Surgery

Question 1

What kind of symptoms would you expect in a duct papilloma?

What kind of patient would you expect to see this in?

Answer 1

A clear bloody discharge.

Common in younger patients.

Question 2

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?

Answer 2

A clear nipple discharge.

Lumpy painful breasts.

Worsening symptoms prior to menstruation.

Common in middle aged women.

Question 3

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?

Answer 3

Blood stained/green nipple discharge.

Slit like nipple retraction.

Exacerbated by smoking.

More common in menopausal patients.

Question 4

Which breast patients should be referred for a two week wait?

Answer 4

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.

Question 5

Which patients should be referred to a non-urgent breast clinic for review?

Answer 5

Patients whom are less than 30 years old with an unexplained breast lump.

Question 6

What is a triple assessment of the breast?

Answer 6

Physical examination

Imaging - USS/Mammogram

Biopsy

Question 7

What is the most common type of breast cancer?

Answer 7

Invasive ductal carcinoma

Question 8

What is the pre-operative management of women who are undergoing breast surgery?

Answer 8

Examination for lymphadenopathy.

• Present - axillary clearance in primary surgery
• Absent - axillary USS and if positive then conduct a sentinel node biopsy.

Question 9

When is radiotherapy offered to women with breast cancer

Answer 9

All women undergoing a wide local excision of the breast.

Women with a T3/T4 breast cancer whom have undergone a mastectomy.

Question 10

What are the different types of hormonal therapies available?

Answer 10

• SERM - eg. Tamoxifen
• HER2 receptor antagonist - eg. Herceptin
• Aromatase inhibitors - offered to post menopausal women to prevent peripheral oestrogen synthesis.

Question 11

Which patients is fat necrosis most common?

Answer 11

• Obese patients with large breasts.

* Patients whom have suffered any breast trauma (even minor)

Question 12

How does fat necrosis present to the GP?

Answer 12

A small round firm lesion that may develop into a hard irregular breast lump.

Always requires review as presents similar to breast cancer.

Question 13

In what patients are breast abscesses most common?

Answer 13

Patients whom have had mastitis for a while that has remained untreated.

Question 14

When is surgical excision indicated in a fibroadenoma?

Answer 14

If it is >3cm in size.

Question 15

What is the most common cause of breast pain in young females?

Answer 15

Cyclical mastalgia.

Question 16

What are the most common breast conditions that you will encounter in young females?

Answer 16

Cyclical mastalgia
Mastitis (lactational)
Periductal mastitis (smoking)
Duct papilloma 
Fibroadenosis in middle aged women.

Question 17

What is the management for cyclical mastalgia?

Answer 17

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.

Question 18

What is the management for mastitis?

Answer 18

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.

Question 19

What is a complication of mastitis?

Answer 19

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.

Question 20

How would you diagnose Pagets disease?

Answer 20

Punch biopsy, mammography/USS of the breast.

Question 21

What is Pagets disease of the breast?

Answer 21

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)