Common breast conditions - teaching Flashcards
Functional unit breasts
- Lobules
- Consists of small alveolar sacs
- Secretion of milk into ducts
What tethers breast onto chest wall?
- Suspensory ligament of cooper
- If cancer invades this, causes puckering of skin
Causes of gynaecomastia
- Liver disease
- Dopamine antagonists
Axillary lymph nodes
- 5 groups
- Lateral - humeral group, along margin of humerus
- Anterior - anterior axillary fold
- Posterior - posterior axillary fold
- Central - centre of axilla
- Apical - apex axillax
Triple assessment - 3 parts
- History and examination
- Imaging - if under 35 - USS, older mammogram, MRI if younger and highly suspicious or maybe ruptured implant
- Tissue diagnosis - FNA cytology or core biopsy
Why do younger people have US rather than mammogram?
In younger women:
* Less fatty tissue
* More fibrous tissue - easier to visualise with USS
Congenital disorders of breast
- Without nipples
- Accessory nipples along milk line
- Benign
Mastitis
- Inflammation of breast
- Presents with painful breasts, discharge, swelling, fever
- Short history - days-weeks
Cyst vs abscess
- Cyst has absent fever, not erythematous unless infected
- And usually affects older women
Operations for abscess
- Incision and drainage
- Hadfields operation - circumareolar incision, open multiple ducts to allow drainage
Duct ectasia?
- Means dilated
- Presents with discharge - variable colours
- Benign
- Smoking is RF
Management duct ectasia
- Smoking cessation
- Conservative
Breasts cysts
- More likely over 50
- Soft, fluctuant breast swelling
- Otherwise systemically well
- Should drain them as chance of malignant transformation
Intraductal papilloma
- Outprojection of duct- benign tumour
- Can shear off and cause bleeding = bloody discharge
*
Fat necrosis
- Following trauma to breasts - firm lumps or lumpy breasts
- Reassure
Fibroadenoma
- Breast mouse, very mobile in all planes
- Young female 18-25
- Firm
- Can become quite large - if >4cm or symptomatic have lumpectomy or quadrantectomy (if small breasts with large lump)
Risk with fibroadenoma
- No risk of malignant transformation to breast cancer
Lobular carcinoma vs ductal
- Lobular more likely to spread distally
Arterial supply to breast
Medial:
* Internal mammary artery
Lateral:
* Lateral thoracic and thoracoacromial (axillary artery origin)
* Lateral mammary branches (intercostal arteries off aorta)
* Mammary branch (anterior intercostal artery)
Lymphatic drainage breast
- Axillary
- Parasternal
- Posterior intercostal
Skin –> axillary, inferior deep cervical and infraclavicular
Nipple and areola –> subareolar lymphatic plexus
Venous drainage breast
Correspond to arteries
Drain into axillary and internal thoracic veins
Factors deciding mastectomy vs WLE
Mastectomy if:
* Multifocal
* Central
* Large lesion in small breast
* DCIS >4cm
* Patient choice
Nottingham prognostic index
Tumour size x 0.2 + lymph node score + grade score
Lymph node score
- 0 nodes = 1
- 1-3 nodes =2
- > 3 nodes = 3
