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7- Surgery > Breasts > Flashcards

Breasts Flashcards

1
Q

Embryological origin of breasts

A

Ectodermal

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2
Q

Factors deciding of size and shape of breasts

A

Age
race,
genetic
hereditary characteristics,
physiological states like pregnancy and lactation,
unilateral or bilateral disease

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3
Q

Normal borders of the breast

A

Superior - clavicle
Inferior - upper border of recrus sheath
Medial - midline
Lateral - posterior axillary line
Posterior - 2nd to 6th ribs, pectoral is major , serrâtus anterior , upper part of recrus sheath

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4
Q

Structural units of breast

A

Glandular tissue called acinus

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5
Q

Histology of acini

A

Cuboidal epithelium with myoepithelial cell for milk ejection

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6
Q

Type of cells at the bulk of the areola and the nipple

A

Contractile, smooth, muscle fibers, inserted directly to the skin

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7
Q

What are Montgomery glands?

A

Large sebaceous glands in the areola, which become prominent in pregnancy

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8
Q

What are the tissue layers of the breasts?

A

Breast is enveloped between two layers of superficial fascia

Cooper’s ligaments between fascia which separate the lobules

Retromamnary space between the deep layer of superficial fascia and facia covering pectoralis major

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9
Q

why is the retromammary space important

A

Contain important plexus of lymphatics

Influence mobility of the breasts on the chest wall by preservation of loose areolar tissue in the space

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10
Q

blood supply to the breast

A

Main one - Four perforating branches of the internal mammary artery

Axillary artery - pectoral branch of the thoraco-acromial artery, lateral thoracic artery, subscapular artery

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11
Q

Venous drainage of the breasts?

A

Medially- perforating branches of the internal mammary vein

Laterally - axillary vein,

posteriorly - intercostal vein

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12
Q

What is the lymphatic drainage of the breast?

A

Internal mammary chain in the intercostal spaces

axillary group of lymph nodes ( pectoral, central, apical, subscapularis ,lateral)

opposite breasts and axilla

liver via rectus abdominis muscle

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13
Q

Percentage of mammary lymph nodes that drains into the axillary nodes

A

90%

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14
Q

Function of the breast

A

Infant feeding

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15
Q

Presentation of breast change un premenstrual

A

Enlargement of breast due to increased vascularity
Tingling sensation
Feeling of fullness of breast
Mastodynia

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16
Q

Presentation of breast change in pregnancy

A

Increase in size and number of mammary lobules
Increase in areola area and bipolar
Erectile nipple
Prominent sebaceous gkands

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17
Q

Most important factor in maintenance of lactational cycle

A

Infant suckling

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18
Q

What are some true anomalies of the breast?

A

Complete absence - amazia
Multiple breast - polymazia
Accessory nipple - polythelia

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19
Q

What are some common inflammatory breast disease?

A

Bacterial infection leading to Lactational mastitis

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20
Q

What causes bacterial infection in lactational mastitis

A

Cracks on the nipple due to trauma of infant sucking followed by staphylococcus aureus infection

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21
Q

Complication of lactational mastitis is

A

Suppuration , which can lead to breast abscess and chronicity

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22
Q

Rare infection of the breasts

A

Tuberculosis,
parasitic, cyst,
subareolar abscess,
actinomycosis

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23
Q

Treatments of bacterial, mastitis

A

Antibiotics -cloxacillin or flucoxacillin

Abscess drainage

24
Q

What is female pseudo hermaphroditism or congenital adrenal hyperplasia?

A

Cortisol deficient states of female with excessive ACTH output leading to failure of breast development

25
Q

What are some hypogonadal states which cause failure of breast development?

A

Ovarian dysgenesis with hypoplastic ovaries devoid of germinal follicles

26
Q

Presentation of ovarian dysgenesis

A

No menstruations
no developments of secondary sexual characteristics
can be of normal stature or short

somatic abnormalities like webbed neck, cubitus valgus, hypoplastic nails, coarctation of the aorta ( turner syndrome )

27
Q

What is massive hypertrophy of the breast in pregnancy?

A

Massive breast development during pregnancy which regress to normal after parturition

there is commonly ulceration and a pre-existing dysplastic breast disease

28
Q

Why is surgery and option in massive hypertrophy of the breast in pregnancy

A

Cosmetic
Establish diagnosis
arrest hemorrhage and control sepsis in ulceration

29
Q

Types of tumors of the breast

A

Epithelial tumors
myoepithelial lesions
mesenchymal tumors
fibroepithelial tumors
tumors of the nipple
malignant lymphoma
metastatic tumor’s
tumors of the male breasts

30
Q

what is aberration of normal development and involution

A

Benign breast dx classified into disorders

31
Q

Types of disorders of aberration of normal development and involution

A

Disorders of development (fibroadenoma)

Disorders due to cyclical hormonal changes ( benign mammary dysplasia)

Disorders of involution ( lobular like cyst formation or sclerosing adenosis/ ductal like duct ectasia)

32
Q

Age of incidence of benign mammary dysplasia

A

20-45yo

33
Q

Pathology of benign mammary dysplasia

A

Hypersensitivity of breast epithelium to circulating hormones mostly estrogen

34
Q

Gross morphology of benign mammary dysplasia

A

Localized tissue masses with cysts of variable size with bluish green or clear fluid

35
Q

Microscopy morphology of benign mammary dysplasia

A

High stromal proliferation
Ductal epithelial hyperplasia
Cyst formation

36
Q

Clinical features of benign mammary dysplasia

A

Pain or dull ache in one or both breast worse in lutéal phase , relieved in menstrual phase

Lumps

Serous or greenish nipple discharge

37
Q

Differential diagnosis of benign mammary dysplasia

A

Carcinoma
Fibroadenoma
Duct ectasia

38
Q

Causes of pain originating from breast

A

Fibroadenosis ( benign mammary dysplasia)
Breast cyst
Acute mastitis
Abscesses acute or chronic
Breast engorgement during lactation
Galactocele
Duct ectasia
Mondors disease
Pregnancy
Previous breast surgery
Trauma to breast
Heavy pendulous breast
Peri menopause

39
Q

Extra mammary causes of breast pain

A

Tietzes disease
Bornholm dx
Spondylosis of spine
Pleuritic chest pain
Lung infection
Angina
Oesophagitis
Herpes zoster
Medications - chlorpromazine, diuretics , hormonal treatment , antidepressant, sertraline

40
Q

Treatment of breast pain

A

Reassurance
Well fitting brassiere
OCP and hormonal treatment stopped
Xanthine containing substances like coffee , tea, chocolate , cola to relieve pain
Smoking stopped

Topical NSAIDs
Evening primrose oil
Danazol
Tamoxifen
Bromocriptine
Excision therapy

41
Q

Types of nipple discharge

A

Clear
Purulent
Creamy
Green
Yellow
Brown
Black
Frankly bloodstains

42
Q

Main causes of blood stained or persistent serous discharge

A

Introduction papilloma
Ductal carcinoma
Duct ectasia
Benign mammary dysplasia
Inflammation
Atypical Ductal hyperplasia

43
Q

Main cause of clear creamy green brown or black discharge

A

Benign mammary dysplasia
Duct ectasia

44
Q

Main cause of milky nipple discharge

A

Lactation
Galactorhea
Duct ectasia

45
Q

Main cause of purulent nipple discharge

A

Breast abscess
Duct ectasia

46
Q

Good differential for nipple discharge with Induration or lump in aerola

A

Duct ectasia

47
Q

Presentation of sclerosing adenosis

A

Small mobile mass
Area of Breast pain
Trigger point pain when pressing affected part

48
Q

Treatment of sclérosing adenosis

A

Excision of lesion

49
Q

What is Tietze syndrome

A

Inflammation of costochondral junction and costal cartilage which can be mistaken for breast pain

50
Q

Tietze syndrome presentation

A

Localized tenderness on palpation
No other clinical , radio, pathological abnormality in breast

51
Q

Treatment of Tietze syndrome

A

Reassurance
NSAIDs

52
Q

What is duct ectasia

A

Dilatation of lactiferous ducts

53
Q

Clinical features of duct ectasia

A

Recurrent pain especially in subaerolar region
Nipple discharge - turbid, yellow, green, brown, black
Nipple retraction
Swelling under areola

54
Q

Traumatic fat necrosis clinical features

A

Hard irregular mass
May be attached to the skin
Irregular surface
Edges indefinite

55
Q

Traumatic fat necrosis treatment

A

Excision therapy

56
Q

Cysts clinical features

A

Painless lump of short duration during menstrual cycle

7- Surgery (13 decks)

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