Surgery. Discussion of benign breast disease for mbbs undergraduates

1. BENIGN
BREAST DISEASE
AKB

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Anatomy
Physiology- ANDI
Clinical examination
Symptomatology
Examination
Evaluation of nipple dge
Breast cysts
Infections
Fibroadenoma
Gynecomastia
Phyllodes tumour
Cancer mimics

3. ANATOMY

4. ANATOMY

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15-20 lobes containing lobules
Lactiferous ducts
Lactiferous sinus
Nipple

7. BLOOD SUPPLY
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Perforating
branches of IMA
70%
Lateral branches of
post intercostal A
Branches from
axillary A
Highest thoracic
Lateral thoracic
Pect br of
thoracoacromial A

8. LYMPHATIC
DRAINAGE

9. LEVELS OF LN
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I=3
Lat, ant, post
II=2
Interpect, central
III=1
Apical

10. PHYSIOLOGY

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Estrogen: ductal dvp
Progesterone: epithelial diff, lobular dvp
Prolactin: lactogenesis

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A. ADOLESCENCE
Changes acc to menstrual cycle
Beginning- increase in size and
density
Menstruation- opp
B. PREGNANCY
Ductal and lobular ep
proliferation
Montogmery glands
Areola darkens
C. LACTATION
Circulating E&P dec
Full exp of lactogenic effect of
PRL
After weaning, pressure in
ducts & alveoli-atrophy of ep
D. SENESCENCE
Replaced by adipose tissue

13. CYCLICAL CHANGES IN BREAST

14. TRUE OR FALSE?
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F.
Breast contains typically 10 lobes
Coopers lig are found only in the upper
quadrant
Tail of spence extends across ant axillary line
Breast receives BS from superior epigastric A
Level IV LN includes internal mammary LN
Progesterone initiates lobular development

15. EVALUATION OF NIPPLE
DGE
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Nipple dge +
Young age vs old age
Unilateral vs bilateral
Single duct or multiple
Blood stained or not??
Whether associated with a mass??

16. D/D
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Milk- Galactorrhoea
Grumous/greenish
Serous / yellow / blood
stained
Single duct
Multiple duct

17. BREAST CYSTS
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From ducts:
Fibroadenosis
Blue domed cyst of
bloodgood
Galactocoele
Serocystic ds of
brodie
Papillary
cystadenoma
Intracystic papillary
carcinoma
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From stroma
Blood cyst
(encapsulation of
hematoma)
Lymphatic cyst
Hydatid cyst
Colloid degen of ca

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30-50% reproductive age women peaks at
premenopause- 30-60yrs
ANDI
Glands & duct secrete fluid even when not
lactating
Duct obstruction!
Large cysts impart blue colour??
h/s flattened columnar ep
Painful if large
Cyclical
Single or multiple, but Unilocular usually
Simple aspiration is the treatment

19. WHEN TO EVALUATE?
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Recurs immediately
Multiple aspirations
Bloody
Mass

20. FIBROADENOMA
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Fibrous + glandular tissue
E: focal area of Estrogen sensitivity
P: 2 varieties
Pericanalicular vs intra canalicular: elastic lamina
Pericanalicular: hard FA
Breast mouse
15-25yrs
Intracanalicular: soft FA, also k/a intraductal
myxoma
Grows larger
30-40yrs

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Giant fibroadenoma? Juvenile fibroadenoma?
Mammogram- little use
USG- often diagnostic
FNAC- confirm diagnosis
Treatment-
Reassurance
Cryoablation
ENUCLEATION

22. INFECTIONS
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Lactational infections
Nonlactaional- central (periductal mastitis) and
peripheral
Lactational
Staph aureus
Cellulitis or frank abscess
Antibiotics/I&D

23. DUCT ECTASIA
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Dialatation of periareolar ducts along with
peri ductal inflammation
Stagnant secretion—loss of ep lining– leak of
dge--- periductal mastitis
Repeated inflammation--- fibrosis, nipple
retraction
Perimenopausal
Sub areolar Mass, dge
Subareolar abscess (unilocular) or mammary
fistula

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Treatment:
No abscess: Abx- cloxacillin+metronidazole
Recurrent: child bearing age– simple
drainage
Hadfield operation
Fistula
Fistulaectomy

25. GYNECOMASTIA
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1.
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Ductal and stromal proliferation
Palpable as a disc of tissue under areola
Physiologic: Neonatal/adolescence/old age-
mechanism??
Pathological:
Drugs: estrogen, other drugs
Metabolic ds. : cirrhosis, alcoholism, renal
failure, thyrotoxicosis
Tumours: teratomas, leydig cell trs,
paraneoplastic s/d, liver tumours
Hypogonadism: UDT, klinefelters

26. Breast enlargement
True enlargement
s/o breast cancer?
Modifiable causes
No causes/persistent
Medical Mx/surgery

27. CANCER MIMICS
FAT NECROSIS
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Elderly
Injury
MONDOR’S DISEASE
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Superficial thrombophlebitis
subcutaneous cord, usually
attached to the skin

29. • Cya..