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7- Surgery > Breasts > Flashcards

Breasts Flashcards

(56 cards)

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1
Q

Embryological origin of breasts

A

Ectodermal

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2
Q

Factors deciding of size and shape of breasts

A

Age
race,
genetic
hereditary characteristics,
physiological states like pregnancy and lactation,
unilateral or bilateral disease

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3
Q

Normal borders of the breast

A

Superior - clavicle
Inferior - upper border of recrus sheath
Medial - midline
Lateral - posterior axillary line
Posterior - 2nd to 6th ribs, pectoral is major , serrâtus anterior , upper part of recrus sheath

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4
Q

Structural units of breast

A

Glandular tissue called acinus

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5
Q

Histology of acini

A

Cuboidal epithelium with myoepithelial cell for milk ejection

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6
Q

Type of cells at the bulk of the areola and the nipple

A

Contractile, smooth, muscle fibers, inserted directly to the skin

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7
Q

What are Montgomery glands?

A

Large sebaceous glands in the areola, which become prominent in pregnancy

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8
Q

What are the tissue layers of the breasts?

A

Breast is enveloped between two layers of superficial fascia

Cooper’s ligaments between fascia which separate the lobules

Retromamnary space between the deep layer of superficial fascia and facia covering pectoralis major

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9
Q

why is the retromammary space important

A

Contain important plexus of lymphatics

Influence mobility of the breasts on the chest wall by preservation of loose areolar tissue in the space

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10
Q

blood supply to the breast

A

Main one - Four perforating branches of the internal mammary artery

Axillary artery - pectoral branch of the thoraco-acromial artery, lateral thoracic artery, subscapular artery

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11
Q

Venous drainage of the breasts?

A

Medially- perforating branches of the internal mammary vein

Laterally - axillary vein,

posteriorly - intercostal vein

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12
Q

What is the lymphatic drainage of the breast?

A

Internal mammary chain in the intercostal spaces

axillary group of lymph nodes ( pectoral, central, apical, subscapularis ,lateral)

opposite breasts and axilla

liver via rectus abdominis muscle

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13
Q

Percentage of mammary lymph nodes that drains into the axillary nodes

A

90%

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14
Q

Function of the breast

A

Infant feeding

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15
Q

Presentation of breast change un premenstrual

A

Enlargement of breast due to increased vascularity
Tingling sensation
Feeling of fullness of breast
Mastodynia

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16
Q

Presentation of breast change in pregnancy

A

Increase in size and number of mammary lobules
Increase in areola area and bipolar
Erectile nipple
Prominent sebaceous gkands

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17
Q

Most important factor in maintenance of lactational cycle

A

Infant suckling

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18
Q

What are some true anomalies of the breast?

A

Complete absence - amazia
Multiple breast - polymazia
Accessory nipple - polythelia

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19
Q

What are some common inflammatory breast disease?

A

Bacterial infection leading to Lactational mastitis

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20
Q

What causes bacterial infection in lactational mastitis

A

Cracks on the nipple due to trauma of infant sucking followed by staphylococcus aureus infection

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21
Q

Complication of lactational mastitis is

A

Suppuration , which can lead to breast abscess and chronicity

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22
Q

Rare infection of the breasts

A

Tuberculosis,
parasitic, cyst,
subareolar abscess,
actinomycosis

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23
Q

Treatments of bacterial, mastitis

Study These Flashcards
A

Antibiotics -cloxacillin or flucoxacillin

Abscess drainage

24
Q

What is female pseudo hermaphroditism or congenital adrenal hyperplasia?

Study These Flashcards
A

Cortisol deficient states of female with excessive ACTH output leading to failure of breast development

25
What are some hypogonadal states which cause failure of breast development?
Ovarian dysgenesis with hypoplastic ovaries devoid of germinal follicles
26
Presentation of ovarian dysgenesis
No menstruations no developments of secondary sexual characteristics can be of normal stature or short somatic abnormalities like webbed neck, cubitus valgus, hypoplastic nails, coarctation of the aorta ( turner syndrome )
27
What is massive hypertrophy of the breast in pregnancy?
Massive breast development during pregnancy which regress to normal after parturition there is commonly ulceration and a pre-existing dysplastic breast disease
28
Why is surgery and option in massive hypertrophy of the breast in pregnancy
Cosmetic Establish diagnosis arrest hemorrhage and control sepsis in ulceration
29
Types of tumors of the breast
Epithelial tumors myoepithelial lesions mesenchymal tumors fibroepithelial tumors tumors of the nipple malignant lymphoma metastatic tumor’s tumors of the male breasts
30
what is aberration of normal development and involution
Benign breast dx classified into disorders
31
Types of disorders of aberration of normal development and involution
Disorders of development (fibroadenoma) Disorders due to cyclical hormonal changes ( benign mammary dysplasia) Disorders of involution ( lobular like cyst formation or sclerosing adenosis/ ductal like duct ectasia)
32
Age of incidence of benign mammary dysplasia
20-45yo
33
Pathology of benign mammary dysplasia
Hypersensitivity of breast epithelium to circulating hormones mostly estrogen
34
Gross morphology of benign mammary dysplasia
Localized tissue masses with cysts of variable size with bluish green or clear fluid
35
Microscopy morphology of benign mammary dysplasia
High stromal proliferation Ductal epithelial hyperplasia Cyst formation
36
Clinical features of benign mammary dysplasia
Pain or dull ache in one or both breast worse in lutéal phase , relieved in menstrual phase Lumps Serous or greenish nipple discharge
37
Differential diagnosis of benign mammary dysplasia
Carcinoma Fibroadenoma Duct ectasia
38
Causes of pain originating from breast
Fibroadenosis ( benign mammary dysplasia) Breast cyst Acute mastitis Abscesses acute or chronic Breast engorgement during lactation Galactocele Duct ectasia Mondors disease Pregnancy Previous breast surgery Trauma to breast Heavy pendulous breast Peri menopause
39
Extra mammary causes of breast pain
Tietzes disease Bornholm dx Spondylosis of spine Pleuritic chest pain Lung infection Angina Oesophagitis Herpes zoster Medications - chlorpromazine, diuretics , hormonal treatment , antidepressant, sertraline
40
Treatment of breast pain
Reassurance Well fitting brassiere OCP and hormonal treatment stopped Xanthine containing substances like coffee , tea, chocolate , cola to relieve pain Smoking stopped Topical NSAIDs Evening primrose oil Danazol Tamoxifen Bromocriptine Excision therapy
41
Types of nipple discharge
Clear Purulent Creamy Green Yellow Brown Black Frankly bloodstains
42
Main causes of blood stained or persistent serous discharge
Introduction papilloma Ductal carcinoma Duct ectasia Benign mammary dysplasia Inflammation Atypical Ductal hyperplasia
43
Main cause of clear creamy green brown or black discharge
Benign mammary dysplasia Duct ectasia
44
Main cause of milky nipple discharge
Lactation Galactorhea Duct ectasia
45
Main cause of purulent nipple discharge
Breast abscess Duct ectasia
46
Good differential for nipple discharge with Induration or lump in aerola
Duct ectasia
47
Presentation of sclerosing adenosis
Small mobile mass Area of Breast pain Trigger point pain when pressing affected part
48
Treatment of sclérosing adenosis
Excision of lesion
49
What is Tietze syndrome
Inflammation of costochondral junction and costal cartilage which can be mistaken for breast pain
50
Tietze syndrome presentation
Localized tenderness on palpation No other clinical , radio, pathological abnormality in breast
51
Treatment of Tietze syndrome
Reassurance NSAIDs
52
What is duct ectasia
Dilatation of lactiferous ducts
53
Clinical features of duct ectasia
Recurrent pain especially in subaerolar region Nipple discharge - turbid, yellow, green, brown, black Nipple retraction Swelling under areola
54
Traumatic fat necrosis clinical features
Hard irregular mass May be attached to the skin Irregular surface Edges indefinite
55
Traumatic fat necrosis treatment
Excision therapy
56
Cysts clinical features
Painless lump of short duration during menstrual cycle

7- Surgery (13 decks)

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