Breast

Tesfaye Aga, MD
 Breast
Common Surgical Diseases of the Breast
Objectives
 After completing this session you should be able to know:
 Basics of breast
 Commonly used investigations for breast symptoms
 Common Benign pathologies of the breast
 Breast cancer- epidemiology, risk factors, diagnosis and
treatment principles
 Breast is a pair of glandular organ found on the anterior
chest wall.
 It is mammary tissue main function of which is secretion of
milk.
 It is found overlying the second to the sixth ribs and
extending from the lateral border of the sternum to the
anterior axillary line. A thin layer of mammary tissue
extends considerably further
 Axillary tail
Embryology

 At the fifth or sixth week of fetal development, two

ventral bands of thickened ectoderm (mammary ridges,
milk lines) are evident in the embryo.
 Unlike other mammals, in humans only a pair of gland at
pectoral region persists.
 Polymastia and Polythelia
 Amastia and Athelia
 Arterial supply
 Internal mammary arteries- mainly
 Post. Intercostal arteries
 Branches from axillary artery
 The Veins follow the arteries and drain in to axilla
 Internal thoracic veins
 Post. Intercostal veins
 Tributaries of axillary vein
 Lymphatic drainage
 Axillary nodes (75-85%)
 Internal mammary nodes (posterior third)
 Triple assessment

Clinical Imaging Pathology

Physical
Mammo Ultrason- Core
History examina- FNAC
-graphy graphy cut
tion

PPV = 99.9%
 Current guidelines of the National Comprehensive Cancer
Network suggest that normal-risk women ≥20 years of age
should have a breast examination at least every 3 years.

 Starting at age 40 years, breast examinations should be

performed yearly and a yearly mammogram should be
taken.
BSE
Ultrasound
 Ultrasound is particularly useful in young women with
dense breasts in whom mammograms are difficult to
interpret, and in distinguishing cysts from solid lesions.
 Safe
 Operator-dependent
Biopsy

 FNAC/ Core cut biopsy

Benign diseases of the breast
 Aberrations of Normal Development and Involution/
ANDI/
 (a) Benign breast disorders and diseases are related to the
normal processes of reproductive life and to involution
 (b) There is a spectrum of breast conditions that ranges
from normal to disorder to disease, and
 (c) The ANDI classification encompasses all aspects of the
breast condition, including pathogenesis and the degree of
abnormality .
 Normal Disorder Disease
Early
ANDI reproductive years
classification Lobular
of benign Fibroadenoma
breast disorders Giant fibroadenoma
(age 15–25 y) development
Stromal Adolescent Gigantomastia
development hypertrophy
Nipple eversion Nipple inversion Subareolar abscess
Mammary duct fistula
Later reproductive years Cyclical changes Cyclical mastalgia Incapacitating
(age 25–40 y) of menstruation mastalgia
Epithelial Bloody nipple
hyperplasia of discharge
pregnancy
Involution (age 35–55 y) Lobular Macrocysts
involution Sclerosing lesions

Duct involution
Dilatation Duct ectasia Periductal mastitis/
Sclerosis Nipple retraction fibrosis

Epithelial Epithelial hyperplasia Epithelial hyperplasia

turnover with atypia
 Mastitis
 Infections in the postpartum period remain proportionately
the most common time for breast infections to occur.
 Infections of the breast unrelated to lactation are
proportionately less common
 Intrinsic: secondary to abnormalities in the breast
 Extrinsic: secondary to an infection in an adjacent structure, e.g.,
skin, thoracic cavity
 Staphylococcus aureus and Streptococcus species are the
organisms most frequently recovered from nipple discharge
from an infected breast.
 Others: MTB and fungal infections
Breast abscess
Breast cancer
 Breast cancer is the most common form of cancer in females
 It is the second most common cause of cancer related mortality.
It is second only to lung cancer.
 The most common cause of death in middle-aged women in
Western countries.
 The lifetime risk of breast cancer is 1 in 8 women or 12.2%
 Of those diagnosed with the disease, one-third will die from the
disease.
Risk factors

1. Increased age
2. Being female(only 1% of breast ca occurs in males)
3. Geography
4. Menstrual history: early Menarche & late menopause
5. First child after 30 years of age
6. Family history, first degree Relative (Mother or Sisters)
7. Previous personal Hx of same d/se
8. Previous personal Hx of benign breast lesions like
Atypical hyperplasia
9. Exogenous estrogen
10. Exposure to radiation
11. Diet
Clinical presentations
 Mostly, incidental painless lump
 Nipple discharge
 Nipple retraction
 Ulceration

 Pain
Breast Examination
 Inspection: discharge, ulceration, dimpling, Peau d’orange
appearance
 Hands at sides
 Hands above the head
 Hands pressed against the hips

 Palpation:
 Quadrant by Quadrant with Axillary tails
 Check for:
 Fixation
 Satellite nodes and nodules
 Axillary examination
Diagnosis
 Triple assessment
Spread
 Local
 Lymphatic
 Bloodstream (Hematogenous)
Treatment
 3 modalities of treatment
 Surgery
 Chemotherapy
 Radiation
 Hormonal therapy
Surgery
 Breast conservative surgeries
 MRM
 Radical Mastectomy
Objectives
 Have we met our objectives ?
 Basics of breast
 Commonly used investigations for breast symptoms
 Common Benign pathologies of the breast
 Breast cancer- epidemiology, risk factors, diagnosis and
treatment principles
Any questions ?
Thanks !