Breast Surgery Lecture Powerpoint Flashcards
Milk is produced in the ___ of the breast and transferred thru the ___
lobules, ducts
Coopers ligaments
Suspensory breast ligaments that may create retraction of skin with underlaying tumor
Lactiferous sinus
Space directly below nipple, attempt needs to be made to preserve if patient wishes to breast feed after surgery
Tail of spence
Tissue of breast that tapers into the axilla
Mammary milk line
Embryological theoretical space extendig from shoulder to thigh where extra breast and nipples may be present
Main blood supply to the breast
Branches of the axillary artery coming off inferior
Borders of the axilla
Superior - axillary vein
Posterior - long thoracic nerve
Lateral - lats muscle
Medial - pec minor muscle
Injury to the long thoracic nerve leads to what condition?
Winged scapula
3 main routes of lymphatic drainage from the breast
- axillary lateral pathway (dominant pathway, into axillary nodes)
- Internal mammary pathway (medial that drains into the parasternal area)
- retromammary pathway (drains deeper portions of breast into the subclavicular plexus)
3 surgical levels of axillary lymphatics
Level 1 (low) lateral to pec minor Level 2 (middle) deep to pec minor Level 3 (high) medial to pec minor
Higher level of lymph node involvement in axillary lymphatics the….
….worse outcome for the cancer patient
Most common cause of mastodynia
Cyclic hormonal variations in menstruating women
Fibrocystic breast changes
General term for benign breast changes that may include lumps and pain but entail poorly defined symptoms and etiology
Fibroadenoma
Common in women 15-35, firm freely mobile solid benign solitary breast mass, 2nd most common tumor in breast after carcinoma
Intraductal papilloma
Benign tumor within the ductal system, relieved by passage of discharge, masses are rare but core needle biopsy determines whether to remove
Most common cause of unilateral bloody nipple discharge
Intraductal papilloma
Possible signs or symptoms of breast cancer (6)
- nontender firm with irregular border fixed to skin or muscle palpable lump
- most nipple discharge is benign
- skin dimpling (peau d’orange)
- nipple retraction
- excoriated nipple
- mammmographic abnormalities
Breast cancer risk factors (6)
- Age
- BRCA 1 and 2
- family history
- early menarche
- nulliparity
- no breastfeeding
Imaging modality for suspected breast cancer (3)
- mammogram (patients over 40)
- ultrasound (under than 30)
- MRI
BIRADS score of 4 of 5 requires a….
….breast biopsy for histologic analysis
2 most common types of breast cancer
- ductal carcinoma (starts in ducts that move milk from breast to nipple)
- lobular carinoma (starts in lobules that produce milk)
Pagets disease
Much less common type of breast cancer that sees scaly raw vesicular and ulcerated breast appearance
Needle localization
Needed when there is not a palpable mass on breast tissue of suspected malignancy, done by radiologist under mammogram assistance to penetrate lesion and hold in place sticking out of skin of breast until procedure
SAVI scout localization
Alternative for needle localization that is less painful, involves infared implantation of reflector prior to surgery that makes audible signal for surgeon to detect with device
