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Flashcards in Women's health: breast Deck (63)
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1

The Breast Ducts are influenced by:
the lobes are influenced by:

Ducts:Estrogen
Lobes: Progesterone

2

Nerves to:
Seratus anteriour
Lat Dorsi
sensory nerve to medial arm and axilla

SA: Long thoracic
LD: Thoracodorsal n
intercostobrachial nerve

3

Vessels
Seratus anteriour
Breast:

thoracodorsal artery – latissimus dorsi

Internal thoracic artery (superior epigastric), intercostal arteries, thoracoacromial artery, lateral thoracic artery all supply the breast

4

Lymphatic drainage of the breast:

97% goes to the axillary nodes, 1-2 % go to the internal mammary nodes.

5

Any quadrant can drain into the internal mammary nods, but what is most common?

Usually the lower inner Quadrent

6

If supraclavicular nodes are + what are you thinking?

it is from a metastic disease

7

if there is primary axillary lymphadenopathy what are you thinking?

it is usually lymphoma not BC

8

Gail Model
What is it:
what does it consider?

Tool to assess risk for breast cancer (cannot use if patient has had breast cancer or LCIS/DCIS)

– Age
– Age at menarche
– Age at first live birth
– Number of first degree relatives with breast cancer – Number of previous breast biopsies
– Atypical hyperplasia
– Race

9

Gail Model
** if greater than 1.66%, the patient should be considered for

tamoxifen therapy to reduce the risk of breast cancer

10

*If you do not feel a discrete mass but feel something that is coarsely nodular (bag of peanuts) what do you need to do?

note whether or not it is symmetrical bilaterally. If it is not symmetrical, evaluate further with imaging

11

US
• Great for _____
• Much more sensitive than:...... esp.....
• Cannot be used for
• When you order an ultrasound, specify the

US
• Great for cysts!!
• Much more sensitive than mammogram,
especially in the dense breast
• Cannot be used for screening
• When you order an ultrasound, specify the area of the breast to be examined (UOQ, etc.)

12

Mammogram
• Best for
• Only about 85% sensitive for:
• If you have a patient with a mass and a negative mammogram, that patient still needs

Mammogram
• Best for screening!!
• Only about 85% sensitive for breast cancer
• If you have a patient with a mass and a negative mammogram, that patient still needs a biopsy!!!***

13

BIRADS classification: 0-6 –

• 0- needs additional imaging
• 1- negative, re-mamm in 1 year
• 2-benign finding, re-mamm in 1 year
• 3-probably benign ~1% malignant, re-mamm in 6 months
• 4-posssibly malignant ~10-50% malignant, biopsy
• 5-probably malignant ~90-97% malignant, biopsy
• 6-knownmalignancy

14

Galactogram/ductogram
- Used to evaluate
• A catheter is placed into the
• This shows the
• Filling defects in the duct are
• The duct must be actively

Used to evaluate nipple discharge from a single duct
• A catheter is placed into the draining duct and contrast is injected, a mammogram is taken
• This shows the shape of the duct
• Filling defects in the duct are suspicious for
malignancy
• The duct must be actively draining in order for this test to be done

15

MRI
• Very
• Indications:
– To assess for
– Following
– To screen for
– Evaluating
– Evaluating

MRI
• Very expensive, so do not use as a general screening tool
• Indications:
– To assess for extent of disease in newly diagnosed
breast cancer
– Following neoadjuvant chemotherapy to plan surgery
– To screen for cancer in young patients with extensive family history of pre-menopausal breast cancer
– Evaluating breast implants
– Evaluating lumpectomy sites for recurrence (after a year)

16

Lipoma

– benign fatty tumor
– treatment is surgical – don’t diagnose this clinically – biopsy is necessary

17

Fat necrosis –

– benign
– lump occurring following trauma
– common in breast reduction

18

Mondor’s disease
• Superficial
• Feels
• Often
• Associated with
• Usually occurs in the
• Treat with

• Superficial thrombophlebitis of the breast
• Feels cordlike
• Often painful
• Associated with trauma or strenuous exercise
• Usually occurs in the lower outer quadrant
• Treat with NSAIDs

19

Fibroadenoma
– Benign tumor of the
– Most common lesion in
– Painless,
– Can change in size with
– NEED
– Core biopsy
– Therefor, often treated
– Can be confused with
– Can have large coarse

Fibroadenoma
– Benign tumor of the fibrous stroma (compresses epithelial cells on pathology)
– Most common lesion in adolescents and young women
– Painless, slow-growing, well circumscribed, firm, rubbery,
very mobile
– Can change in size with menses and grow in pregnancy
– NEED BIOPSY
– Core biopsy can be useful in establishing diagnosis but the lump is not removed
– Therefor, often treated surgically
– Can be confused with phylloides tumor on ultrasound
– Can have large coarse (popcorn) calcifications on mammogram

20

Juvenile hypertrophy or prepubertal gynecomastia
– Symmetrical enlargement
– Can be treated

– Symmetrical enlargement of breast tissue before age 12
– Can be treated surgically if severe

21

Poland’s syndrome
• hypoplasia of
• Surgical

• hypoplasia of the chest wall, amastia, hypoplastic shoulder, no pectoralis muscle
• Surgical reconstruction of the breast after puberty

22

Polythelia

Accessory nipples – most common anomaly

23

Cyclical Mastalgia
• Pain usually occurs
• No differences in
• Women with Cyclical Mastalgia may have

• Pain usually occurs prior to the start of menses each month, suggesting a hormonal link
• No differences in hormone levels between women with mastalgia and women with no pain
• Women with Cyclical Mastalgia may have breast tissue that is more sensitive to hormones

24

Treating Cyclical Mastalgia
• Properly
•)




• Properly fitting bra
• Caffeine cessation (not reduction)
• Vitamin E supplementation (400 IU/day)
• Oil of Evening Primrose
• Change in any exogenous or endogenous hormones
• NSAIDs
• Tamoxifen 10mg/day for six weeks – Aspirin daily while on this medication

25

Mastodynia
what is it:
cause is:
-
-
-
-
-

Constant severe breast pain unrelated to the menstrual cycle

• Cause is unknown
– Periductal mastitis or adenosis
– Can be musculoskeletal
– Tietze’s syndrome is costochondritis causing breast pain
– Consultation with a pain specialist for injection
– OMM consultation for manipulation

26

treatment of mastodynia?

Standard therapies for cyclical mastalgia are sometimes ineffective but should be tried
• As a last resort, mastectomy can be utilized for treatment and is generally effective for treating breast pain, provided that the pain is actually from the breast

27

Mastitis and Abscess
• Frequently associated with
• ________ are effective in most cases of mastitis
• Persistent symptoms necessitate


• Frequently associated with nursing
• Antibiotics are effective in most cases of mastitis
• Persistent symptoms necessitate ultrasound to look for an abscess
• Abscess needs to be drained for antibiotics to be effective
• I&D of an abscess in a lactating breast can lead to milk fistula so needle aspiration is preferred

28

Mastitis and Abscess Beware of:

Beware of inflammatory breast cancer!! If it does not get better with antibiotics, do an ultrasound. If the ultrasound does not show an abscess, then biopsy is necessary.

29

Galactocele
• Associated with


• Treated with:

• Associated with pregnancy/nursing
• Milk-filled cyst
• Smooth mass
• Treated with drainage/I&D

30

Breast Cysts
Affect ____% of women in Western countries
• Represent ____% of discrete breast lumps
• More common in women in their

Affect 7% of women in Western countries
• Represent 15% of discrete breast lumps
• More common in women in their 40s and 50s