The document describes the anatomy and physiology of the breast as well as common breast conditions. It discusses the structure of the breast including lobes, lobules, ducts, and surrounding tissues. It then covers common benign and malignant breast diseases like fibroadenomas, cysts, mastitis, and ductal carcinoma in situ. The document concludes with descriptions of clinical exam findings, imaging tests, biopsy procedures, and management of various breast abnormalities.

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

4. Cooper’s ligament

5.  Axillary lymph nodes
defined by pectoralis
minor muscle
› Level 1 – lateral
› Level 2 – posterior
› Level 3 – medial

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

8. Inspection
 Overall inspection
- symmetry, size, shape, skin color,
venous pattern, lump, local dimpling
 Nipple
- excoriation, inversion, discharge,
edema and redness
 Skin
- redness, edema, Peau d’orange

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

12.  90% of the breast lump are found by
patients themselves.
 Encourage female have regular self
breast examination.

13. In Front a Mirror

14. In The Shower

15. Lying Down

16.  Mammography
 Ultrasound
 Magnetic Resonance (MR)
 Computed tomography (CT)
 Positron Emission Tomography (PET)

17. Mammographic screening is key to the early detection of breast cancer

18.  Fine needle aspiration
- Cytology
 Core biopsy
- Image guided
- Stereotactic
 Excisional biopsy
- Needle localization

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

28. Galactocele

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

32.  Discharge from single duct
- Blood stained
1. Intraductal carcinoma
2. Intraductal papilloma
3. Duct ectasia
- Serous
1. Fibrocystic disease
2. Duct ectasia
3. Carcinoma

33.  Discharge from more than one duct
- Blood Stained
1. Carcinoma
2. Duct ectasia
- Grumous
1. Duct ectasia
- Purulent
1. Infection
- Serous
1. Duct ectasia
2. Fibrocystic disease
3. Carcinoma

34. Cause
 Hormonal imbalance
 Excessive estrogen production

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

36.  Diagnosis
- Pain or lump
- FNA
 Management
- Hormonal therapy
- Mastectomy

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

38.  Bacterial mastitis
- cellulitic stage
- abscess form
 Tuberculosis
 Actinomycosis
 Syphilis

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

44. THE END