The breast disease



The adult female breast lies between the 2-nd and 6-th ribs and
extend from the sternal edge to the medaxillary line
Breast tissue extends into the axillx as axillary tail of spence.
Poteriorly rest on the fascia of pectoralis major M. and
inferolaterally on the fascia of the serratus anterior M.

Coopers lig. –fibrous tissue bands support the breast and extend
from the pectoralis fascia and the dermis.

BREAST ---Composed of skin –subcutaneous tissue –and
breast tissue. breast consist of 15 to 20 lobs of glandular tissue
Subdivided into lobules which-branched into—tubuloalveolar
glands

Each lobe ends in a lactiferous duct, 2 to 4 mm in diameter. Beneath the
areola, the lactiferous ducts dilate into lactiferous sinuses and then open
through a constricted orifice onto the nipple

Blood supply—2—3—and the 4-th perforaters of the internal mammary
artery plus lateral thoracic artery








Physical breast examination –pt-position –insemisetting position and her hand put on her weist then
putting her hands abovethe head.
Mammogram-is apopular program for screening breast
cancer.
Uses a low dose –film 0,1 rad per study.
Decrease sensitivity of the mammogram in---labular
carcenoma in situ and in dense breast.
--early detection of an occult cancer before it reaches
5mm.
--define the abnormality.
--detect multicentric disease.
--identify the synchronous cancer.







Positive mammographic signs of malignancy.
--parenchymal tissue distortion.
--poorly defined mass lesion.
--branching or linear microcalcefication.
--stellate opacities.
Women initiate breast self-examination at the age of 20
yrs.
Base line mammographic examination at the age of 35
yrs









Breast ultrasound—to diffirentiate solid from cystic mass .used
esp. in young Pt.
-in dense breast tissue.
-for guide needle biopsy.
BIOPSY technique for solid masses.
1-F.N.A—high accuracy rate.
False neg.—10% and false positive-1%.
Core needle biopsy—tissue obtained for histologic examination.
Excisional biopsy –give definitive therapy for a benign mass.
Incisional biopsy –in large breast mass.
Figure 50.3
Ultrasound of
the breast
showing a cyst
(arrow).


Figure 50.6
Corecut
biopsy of
breast.









Triple assessment.
-clinical assessment.
-tissue biopsy.
-radiological imaging.
-give accuracy of diagnosis---99,9%
Breast pain-Mastalgia or Mastodynia.
50% of pt seen in the clinic.
2-groups of pt.
-a-cyclical –related to menstrual cycle.




-b-non-ctclical –occurs in both pre. And post
menopausal women—a-musculoskeletal pain.
b-sclerosing adenosis
C-post –operative
d-cervical root pain






Aetoilogy of cyclical mastalgia.
1-hormonal abnormality—increased oestrogen
secretion or decreased progesterone
production.
2-abnormal prolactin secretion .
3-water retention in the breast .
4-excessive caffeine ingestion 0r inadequate
essentional fatty acid intake
5-psychoneurosis.





80% 0f pt in the clinic with mastalgia req. no
treatment --- just reassurance.
1-anti-oestrogen drug as tamoxifin 10 mg tablet
dialy.
2-anti-gonadotrophin drug as danazol –400mg
dtaly.
3-prolactin-antigonist—bromocriptin.
4-primrose oil—unsaturated fatty acid.






Breast lump.-about 40% of pt present in the
clinic .
History; 1-lump duration.
2-pain . 3-change in size. 4-relation to mensis.
Fibro-adenoma.—derived from the breast
lobule.
Originated from –connective tissue and
epithelium
-its size -3cm but gaint fibroadenoma-5cm.





In 10% of pt have multiple fibroadenomas.
Dx by FNA .Mammogram is of little value.
Gaint fibroadenoma – 5 up to 10cm .
Occur in extremes of reproductive age .
14---18yr and the45—50 yr age.






Commonly –typical hypocellular stromal and epithelial
component.
Phy llodes tumour.(phyllodes sarcoma or cystosarcoma.
Has much more cellularity ,pleomorphism and mitotic
activity plus atypia.
-age of the pt –30 –50yr but rare in young pt.
Axillary L.N.enlargment is rare.
Treatmen-wider exceion with safety margine –1cm even
mastectomy may be done






Galactocele-occur during lactation or when
recently stopped breast feeding.
Aspiration—will resolve the problem.
Sclerosing adenosis-peri-neural tissue invasion-.
-trigor- spot zone causing mastalgia.
Fat necrosis—due to trauma . May confused
with cancer Dx by FNA.
Lipoma –fat tissue in the breast.




Breast cyst –are frequently confused with
cyclical nodularity.
Most cyst size about 2—3mm due to aberation
of normal lobular physiology.
Pt compl. Of pain that may relate to menstrual
cycle.
Treatment-by aspiration surgical excesion –cyst
recurrence or blood stained aspiration




Bacterial breast infection (Br. Abscess).
Staph. Aureus and strep. Species –are the most
micro-organism are present in nipple discharge
from an infected breast.
Symptoms- piont of tenderness, erythema,
hyperthermia.
Related to lactation, and occur within the few
weeks of breast-feeding.








Classification.
-subcutaneous.
-subareolar
-interlobullar.
-retromammary abscess.
Also into—1-unicentric 2-multicentric.
Pre-oper. Ultrasound—may be requered
Surgical treat. –Circumareolar incision or incision
paralleling Langers lines.





Staph aureus infection---more localized and
deep in the breast.
Strep. Infection-usually more superficial.
In chronic breast infection –requered cultures
for 1-acid-fast bacilli
2-anaerobic and 3-aerobic bacteria 4-fungi.
Biopsy is req.during drainage to rule out
underlying breast Cancer.