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Anatomy and Diseases of the Breast
1.
2. On pectoral fascia and musculature of
the chest wall
Over upper anterior rib cage 2nd or 3rd to
6th
Fat surrounding
Internal mammary artery & lateral
thoracic artery
Axillary vein, internal mammary veins &
intercostal veins
3. A – Ducts
B – Lobules
C – Lactiferous sinus
D – Nipple
E – Fat
F – Pectoralis major
G – Ribs and intercostal
muscles
A – Duct cells
B – Basement membrane
C – Duct lumen
5. Axillary lymph nodes
defined by pectoralis
minor muscle
› Level 1 – lateral
› Level 2 – posterior
› Level 3 – medial
6.
7. Estrogen
- Development of the breast and
lactiferous ducts
Progesterone
- Together with estrogen causes lobular and
alveolar growth
Prolactin
- Synergizes the effect of estrogen and
progesterone
10. Palpation
Gentle palpation
- quadrant by quadrant
Mass
- number, size, consistency and mobility
Lymph node
- anterior, posterior, lateral, central and apical
Character of the discharge
- Milky, serous, or green-brown discharge
- Bloody discharge
11.
12. 90% of the breast lump are found by
patients themselves.
Encourage female have regular self
breast examination.
20. Abnormalities of Normal Development
and Involution
Most benign disorders are related to
normal process of reproductive life
There is a spectrum that ranges from
normal to aberration and occasionally to
disease
21. These include conditions of well define
etiology
Example: fat necrosis, breast abscess
22. Cyst formation
Fibrosis
Hyperplasia of epithelium in the lining of
the ducts and acini may occur
Papillomatosis
23. Breast lump
Mastalgia – cyclical and non cyclical
Nipple discharge
Infection
24. Normal breast nodularity or cyclical
nodularity
- Upper quad and axillary tail
- Assessment is clinical, supplemented by
USG cytology or core needle histology
- Excisional biopsy if doubt persists
25. Fibroadenoma
- 15-25 yrs
- Firm, smooth or lobulated and extremely mobile
- increase in size during pregnancy
and involutes after parturition
- 5cm is giant fibroadenoma
- Estrogen may play an important
role in its pathogenesis
- If age<25 conservative.
- Excision is done, if age>25, size increases, giant
fibroadenoma and positive family h/o of carcinoma
26. Breast cysts
- 40-50 years
- smooth and tense and easily
palpable against the chest wall
- USG and needle aspiration confirms
- Excisional biopsy is done if residual
mass is present or blood stained fluid is
present
27. Galactocele
- Painless swelling appears in breast
during or after cessation of lactation
- Cyst filled with milky material and
has same character as other cysts
- Mainly found towards areola
- Repeated aspiration
29. Cyclical
- Related to menstrual cycle
- Duration of >1 week per cycle is significant
and called “pronounced” symptoms
- Etiology
1. Hyperprolactenemia
2. Increase level of estrogen after ovulation
3. Abnormality of prostaglandin secondary
to deficient essential fatty acid intake in diet
30. Non Cyclical Mastalgia
- True non cyclical mastalgia
- Chest wall pain
31. Non Medical Measures
- Reassurance
- Breast support
- Dietary measures
Medical Measures
- NSAIDS
- Evening primrose oil
- Danazol
- Tamoxifen
Surgical measures
- subcutaneous mastectomy – the last resort
35. Clinical present
Pain or lump, nipple discharge (15%)
Tense cyst no fluctuant
Cyst may appear rapidly and then maintain
their size or shrink after next menstraual
flow
Most painful in pre-menstraual period
37. Dilation of ducts associated with
periductal inflammation
Presented as nipple discharge, subareolar
mass, abscess, mammary fistula and/or
nipple retraction
To rule out malignancy if lump or nipple
retraction
- if suspicion remain excisional biopsy
- excision of all major ducts
39. 40-50 years old.
6%-8% malignant tendency.
Forming from the epithelial
linings of the main ducts.
Nodule at the areola margin.
Pressure reproduces the bloody
discharge.
40. Types of Intraductal Papilloma
Solitary intraductal papillomas – one lump,
usually near a nipple, causes nipple
discharge
Multiple papillomas – groups of lumps,
farther away from a nipple, usually doesn't
cause discharge, and can't be felt
Treatment
Surgical excision (involved duct or radical
resection if it is proved malignant by frozen
section)
41. Cause
- Lactic stasis
- Bacterial invasion
Clinical present
- Swelling pain
- Painful mass with reddish skin
General features:
Chill, fever, ipsilateral LN enlargement,
bacteriaemia
Abscess formation
42. Thermo therapy
- 25% Magnesium sulfate
Antibiotic therapy
- Local and general administration
Drainage
Prevention
43. After breast surgery or breast injury
Bruised, injured, or dead fatty tissue
Clinical features
- Hard lump
- Tender or painful
- drainage from nipple
- nipple will pull inward
Triple assessment
Management
- NSAIDS
- Vacuum-assisted core needle or lumpectomy