Breast Surgery Lecture Powerpoint

Question 1

Milk is produced in the ___ of the breast and transferred thru the ___

Answer 1

lobules, ducts

Question 2

Coopers ligaments

Answer 2

Suspensory breast ligaments that may create retraction of skin with underlaying tumor

Question 3

Lactiferous sinus

Answer 3

Space directly below nipple, attempt needs to be made to preserve if patient wishes to breast feed after surgery

Question 4

Tail of spence

Answer 4

Tissue of breast that tapers into the axilla

Question 5

Mammary milk line

Answer 5

Embryological theoretical space extendig from shoulder to thigh where extra breast and nipples may be present

Question 6

Main blood supply to the breast

Answer 6

Branches of the axillary artery coming off inferior

Question 7

Borders of the axilla

Answer 7

Superior - axillary vein
Posterior - long thoracic nerve
Lateral - lats muscle
Medial - pec minor muscle

Question 8

Injury to the long thoracic nerve leads to what condition?

Answer 8

Winged scapula

Question 9

3 main routes of lymphatic drainage from the breast

Answer 9

• 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)

Question 10

3 surgical levels of axillary lymphatics

Answer 10

Level 1 (low) lateral to pec minor
Level 2 (middle) deep to pec minor
Level 3 (high) medial to pec minor

Question 11

Higher level of lymph node involvement in axillary lymphatics the….

Answer 11

….worse outcome for the cancer patient

Question 12

Most common cause of mastodynia

Answer 12

Cyclic hormonal variations in menstruating women

Question 13

Fibrocystic breast changes

Answer 13

General term for benign breast changes that may include lumps and pain but entail poorly defined symptoms and etiology

Question 14

Fibroadenoma

Answer 14

Common in women 15-35, firm freely mobile solid benign solitary breast mass, 2nd most common tumor in breast after carcinoma

Question 15

Intraductal papilloma

Answer 15

Benign tumor within the ductal system, relieved by passage of discharge, masses are rare but core needle biopsy determines whether to remove

Question 16

Most common cause of unilateral bloody nipple discharge

Answer 16

Intraductal papilloma

Question 17

Possible signs or symptoms of breast cancer (6)

Answer 17

• 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

Question 18

Breast cancer risk factors (6)

Answer 18

• Age
• BRCA 1 and 2
• family history
• early menarche
• nulliparity
• no breastfeeding

Question 19

Imaging modality for suspected breast cancer (3)

Answer 19

• mammogram (patients over 40)
• ultrasound (under than 30)
• MRI

Question 20

BIRADS score of 4 of 5 requires a….

Answer 20

….breast biopsy for histologic analysis

Question 21

2 most common types of breast cancer

Answer 21

• ductal carcinoma (starts in ducts that move milk from breast to nipple)
• lobular carinoma (starts in lobules that produce milk)

Question 22

Pagets disease

Answer 22

Much less common type of breast cancer that sees scaly raw vesicular and ulcerated breast appearance

Question 23

Needle localization

Answer 23

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

Question 24

SAVI scout localization

Answer 24

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

Question 25

Lumpectomy/partial mastectomy

Answer 25

Removal of breast malignancy with clear or negative margins, incision periareolar for cosmetics, after removed tumor is inked to understand orientation of tissue removed to ensure that margins are clear and what direction there may have been not full clearing in for surgeons future procedure

Question 26

Mastectomy

Answer 26

Removal of all of breast tissue, either simple with dissection of all of breast tissue, modified radical form includes removal of level 1 and 2 axillary nodes in addition for biopsy proven lymph node involvement

Question 27

Sentinal lymph node biopsy

Answer 27

Often done in conjunction with mastectomy, injection of radioactive dye into tumor site of breast that probe can sense tracer located at the nearby lymph nodes (sentinal ones), once located, incision is made and node or multiple nodes are removed and sent to pathology, helps determine staging based on how far cancer has spread

Question 28

A patient will need axillary lymph node dissection AFTER sentinal lymph node biopsy if these 4 conditions are met

Answer 28

• 3 or more positive nodes on patient with small tumor
• any # of positive lymph nodes in patients with large tumor
• any # of positive lymph nodes found with extranodal extension of tumor cells
• any # of positive nodes in patients who will not receive breast irradiation because they undergo mastectomy, or refusal of radiation

Question 29

Breast flaps surgery (DIEP, TRAM, TDAP)

Answer 29

Chunk of tissue (skin, fat, muscle) reimplanted including vasculature and perfusion over site of mastectomy, for example TDap (removal of part of latismus dorsi muscle) TRAM (transverse rectus abdominus muscle), or DIEP (deep inferior epigastric perforator artery)