The Breast Learning Objectives Appropriate investigation of breast

The Breast Learning Objectives ØAppropriate investigation of breast disease. ØBreast anomalies and complexity of benign breast disease. ØThe in-depth modern management of breast cancer. M. A. Kubtan 2

Comparative and Surgical Anatomy Ø Human breast is overlying the chest wall between the second to the sixth ribs. Ø It is extending from the lateral border of the sternum to the anterior axillaries line. Ø A thin layer of mammary tissue extend from the clavicle above to the seventh or eighth rib below. Ø From the midline to the edge of the latissmus dorsi muscle poseriorly. Ø The axillaries tail of the breast is palpable in some normal subjects , and it may becomes palpable during pre-menstrual or during lactation. M. A. Kubtan 3

Continue Ø Lobule is the basic unit of mammary gland , number varies from 10 – 100 lobules. Ø Lobules empty via ductules into lactiferous duct , their number 15 – 20. Ø Lactiferous ducts are lined by erectile myoepithelial cells with terminal ampulla. M. A. Kubtan 4

Continue Ø The ligaments of Cooper are fibrous tissue filled with breast tissue. Ø Areola contains involuntary muscle arranged in concentric rings. Ø The Areolar epithelium contains numerous sweat glands and sebaceous glands. Ø During pregnancy sebaceous glands serve to lubricate the nipple during lactation ( Montgomery tubercles ). M. A. Kubtan 5

Continue Ø The nipple is covered by thick skin with corrugations. Ø Near its apex lie the orifices of lactiferous ducts. Ø The nipple contains an erectile smooth muscle fibers. M. A. Kubtan 6

Lymphatics of the Breast Ø Lymphatics drains to axillary lymph nodes , and to internal mammory lymph nodes. Ø The axillary lymph nodes receive approximately 85% of the lymphatic fluids. M. A. Kubtan 7

Anatomy of axillary lymph nodes Ø Lateral. Ø Anterior. Ø Posterior. Ø Central. Ø Interpectoral. Ø Apical. M. A. Kubtan 8

Investigation of breast Mammography showing a carcinoma M. A. Kubtan 9

M. A. Kubtan 10

M. A. Kubtan 11

MRI Magnetic resonance imaging M. A. Kubtan 12

Needle biopsy / cytology M. A. Kubtan 13

M. A. Kubtan 14

M. A. Kubtan 15

Benign Breast Disease � 30% of women will suffer from benign breast disorders. �Most common symptoms are Pain , Lumpiness or a lump. �The aim of treatment is to exclude cancer , and then to treat remaining symptoms. M. A. Kubtan 16

M. A. Kubtan 17

M. A. Kubtan 18

M. A. Kubtan 19

Congenital abnormalities �Amazia : congenital absence of breast in one or both breasts. �Polymazia : accessory breasts � ( most frequent site ) groin , buttock and thigh. They function during lactation. M. A. Kubtan 20

Mastitis of infants common in boys as in girls. M. A. Kubtan 21

M. A. Kubtan 22

Injuries of breast �Haematoma >>>> lump >>>> bruises. �Traumatic fat necrosis >>>> acute >>>> or chronic M. A. Kubtan 23

Acute and sub acute inflammation of breast �Bacterial mastitis less common now , mostly caused by Staphylococcus aureus. �Clinical features : classical signs of acute inflammation , if not aborted later an abscess will form. �Treatment in cellulitic stage broad spectrom anti biotics. �If pus formed repeated aspiration pus culture and anti biotic cover , otherwise incision and drainage of breast abscess. M. A. Kubtan 24

M. A. Kubtan 25

Chronic intramammary abscess �Tuberculosis of the breast. �Actinomycosis rare. �Mondor, s disease : thrombophlebitis of the superficial veins of the breast and chest wall , it may be idiopathic , or inflammatory , or of carcinogenic origin. M. A. Kubtan 26

M. A. Kubtan 27

The nipple �Nipple retraction : benign simple in 25% is bilateral. �Recent retraction : may be pathological. �Chronic periductal mastitis. �Circumferential retraction with or without underlying lump may indicate an underlying carcinoma. M. A. Kubtan 28

Discharge from the nipple �A clear serous discharge may be physiological in a parous woman , or may be associated with duct papilloma. �Ablood stained discharge may be caused by duct ectasia, duct papilloma or carcinoma. �A black or green discharge as a result of ductectasia. M. A. Kubtan 29

Duct ectasia / periductal mastitis Ductectasia is dilatation of the breast duct associated with periductal inflammation. M. A. Kubtan 30

M. A. Kubtan 31

M. A. Kubtan 32

Thank You M. A. Kubtan 33