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Flashcards in Breast surgery Deck (23):
1

Benign breast disorders 

  • fibroadenoma 
  • cyst 
  • breast abscess
  • fibrocystic changes 
  • fat necrosis 
  • mastalgia 

2

Mastalgia 

Mastalgia (breast pain) 

  • experienced by most women 
  • changes are cyclical then due to cyclical hormonal effects 

Management 

  • cyclical more likely to respond to treatment 
  • evening primrose oil 
  • reduce caffeine intake 
  • danazol (suppresses the production of gonadotropins)  and bromocriptine
  • if pain is non cyclical then MSK! 

3

Types of breast infections

  • Postpartum abscess
  • periductal mastitis 

4

Postpartum abscess - Acute mastitis 

  • assoc to breastfeeding 
  • staph infecion 
  • treated with antibiotics 
  • abscess develops then drain 

Skin is red and hot

5

Periductal mastitis 

  • Smokers 
  • episodes of periductal sepsis with anaerobes (metronidazole) 
  • resolve or abscess 

Total duct excision and fistulectomy f recurrent bouts of infection 

6

Nipple discharge 

  • cloudy white colour= galactorrhea
  • clear or light white - pregnancy 
  • red- blood- breast infection or intraductal papilloma but can be breast cancer 
  • white- yellow or green - PUS!! infection 

7

Fibroadenoma 

  • arises from the Lobules 
  • 15-25 
  • smooth, well defined and mobile "breast mouse" 

Diagnose with 

  • clinical exam 
  • characteristic ultrasound appearance 
  • benign cells on FNAC 

Benign and does not necessarily need removal 

8

Phyllodes 

  • similar appearance to fibroadenoma 
  • older women 
  • larger (3-4cm) 
  • it has malignant potential (may develop into sarcoma) 

 

9

breast cysts 

  • women ove 35 years (when involutional changes occur)  
  • microcysts form as the stroma involutes and some of these may coalesce to form macrocysts
  • palpable lump
  • cysts may be single or multiple and affect both breasts 
  • appear suddenly 
  • o/e- well defined smooth mass that is not mobile

Investifations 

  • seen on mammograms as well as well defined smooth elsions and on ultrasounds 

treatment - aspiration to extinction 

 

 

10

Galactocele 

retention cyst containing milk or a milky substance that is usually located in the mammary glands. It is caused by a protein plug that blocks off the outlet

 

Lactaring women 

11

Fat necrosis 

  • common sequela to trauma 

12

Inflammatory lesions 

  • acute mastitis 
  • periductal mastitis 
  • mammary duct ectasia 
  • fat necrosis 
  • lymphocytic mastopathy 
  • granulomatous mastitis 

 

13

mammary duct ectasia 

  • means dilated duct disease (old females prsent with mass or nipple discharge) 

14

Lymphocytic mastopathy -

diabetics 

15

Granulomatous mastitis 

sarcoid, TB 

16

17

fibrocystic changes

  • very common and may almost be considered as normal 
  • occur in pre-menopausal women and has a cyclical pattern 
  • diffuse lumpiness in upper outer quadrant with breast pain 

18

Fat necrosis 

  • previous trauma 
  • bruising 
  • beningn and resolves with time 
  • firm and irregular and can be clinically supsicious of a breast cancer 

19

Causes of breast pain 

  1. normal pre-menstrual cyclical pain 
  2. fibrocystic changes 
  3. breast trauma 
  4. infection 
  5. MSk 

20

Causes of nipple discharge 

  1. pregnancy/previous breast feeding- physiological 
  2. duct extasia 
  3. intra-duct papilloma 
  4. breast cancer 
  5. gallactorrhoea 

 

21

Intra-ductal papilloma 

  • women over 40 
  • close to nipple 
  • discharge common 
  • both breasts at the same time 
  • no increase in risk of breast cancer unless atypical 

Diagnosis

  • routine breast screening 
  • triple assesment 
  • FNAC

treatment 

  • may need excision biopsy 

 

22

causes of gynaecomastia 

  • physiolgical 
  • chronic liver disease 
  • testicular failure -usually old age 
  • drugs - bendofluazide, digoxin, spirnolactone 
  • adrenal tumour 

23

treatment ofgynaecomastia 

  • physiolgocial type often resolve spontaneosly 
  • surgical