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CLINICAL EXAMINATION
LAB. TESTS
IMAGISTIC INVESTIGATIONS
TREATMENT MODALITIES
SURGERY - CLASIC OR
MINIMALLY INVASIVE (LAPAROSCOPIC)
MEDICAL- COMORBIDITIES, DEFFICITS
CORRECTION: SEVERE ANEMIA,
HYPOVOLEMIA, DISELECTROLYTEMIA,
ANTIBIOTICS, ANTICOAGULANTS
ADJUVANT, NEOADJUVANT:
RADIOTHERAPY, CHEMOTHERAPY
SURGICAL TREATMENT
THE RIGHT OPERATION PERFORMED WELL
THE RIGHT OPERATION PERFORMED BADLY
THE WRONG OPERATION PERFORMED WELL
THE WRONG OPERATION PERFORMED BADLY
In only one case the patient will have the best result
Surgery is the branch of medicine that treats
diseases, injuries, and deformities by manual or
operative methods.
Mammary glands-specialized
accessory glands of the skin
Gland tissue, milk ducts, fibrous tissue,
fat, areola/nipple, lymphatic ducts, skin
Between the deep fascia and breast is an area called
the retromammary space.
The breast may move freely over the pectoralis
muscle but is firmly attached to the deep fascia via
suspensory ligaments.
How does the breast produce milk?
As the woman ages, the fat content of the breast tissue will
increase. This explains the overall aspect of the breast, as it
will begin to droop.
Peau d'Orange: From the French term, orange skin, this identifies a malignant
obstruction of the superficial lymphatic channels.
Look with her arms at her sides and with her arms above her head.
Is a lump visible?
Do the breasts look symmetrical? Slight asymmetry is quite normal.
Is there an inverted nipple and if so is it unilateral or bilateral?
Is there puckering of the skin or peau d’orange (orange peel)
Breast lump
The next stage is palpation and a systematic search pattern
improves the rate of detection.
Ask the patient to lie supine with her hands above her head.
Remember the axillary tail of breast tissue.
Examine the axilla for palpable lymphadenopathy.
Palpation with the flat of one hand is usual, but it may be more
appropriate to examine large breasts between two hands.
Sensitivity of 90-98%, depending largely on the skill and experience of the cytologist.
False-negative findings are caused by inadequate sampling, improper specimen
processing, or the inability of the cytologist to make the definite diagnosis.
Needle aspiration can differentiate between solid and cystic lesions.
If the lesion is cystic, the fluid is aspirated and, providing it is not bloodstained, discarded.
Aspiration of solid lesions requires skill to obtain sufficient cells for cytological analysis and
expertise is needed to interpret the smears.
The needle is introduced into the lesion and suction applied by withdrawing the plunger
The plunger is then released and the material spread on to microscope slides.
Core biopsy
Core biopsy either with a cutting needle or
special device is a useful technique for large,
palpable, solid masses.
It is performed under local anesthesia.
Several cores are removed from a mass.
Estrogen and progesterone receptors are
assessed by immunocytochemistry
Any breast lump must be investigated
by FNAC/CB even if the mammography
is negative
FNAC- cytologic investigation
Core biopsy-immunocytichemistry
RE/ RPg, HER2/neu
Ki-67 ,angiogenetic markers.
Open biopsy
Juvenile hypertrophy
Fibroadenoma
Juvenile hypertophy
Uncontrolled overgrowth of breast tissue occurs
occasionally in adolescent girls.
These changes are usually bilateral, but may be limited
to one breast or part of one breast.
There is an increase in the amount of stromal tissue
rather than in the number of lobules and ducts.
These excessive growth is an aberration rather than a
true disease.
Simptoms: pain in the shoulder, neck and back due to
large breasts
Treatment: reduction mammoplasty
Virginal breast hypertrophy (VBH) is the common name for the
medical condition juvenile macromastia and juvenile gigantomastia
This condition causes a
woman's breasts to grow
rapidly to an excessive weight
during puberty. The main
symptom is pain in the
breasts.
Cyclical mastalgia
Nodularity
Cyclical mastalgia
Cyclic breast pain often is described as a heaviness or
tenderness.
Many patients will experience symptomatic relief by reducing
the caffeine content of their diet and by ingesting vitamin E,
400-800 units/day, although there is no scientific proof that
these methods are valuable.
More than 85% of cyclical breast pain is of minor degree and
no specific treatment is required.
Treatment should be considered for women who have
moderate to severe pain.
Cyclical mastalgia
Antibiotics, vitamin B6, progestogens, diuretics are not effective.
Evening primrose oil-EPO- two 500-mg. capsules three times a day. EPO is
an essential fatty acid supplement containing cis-linoleic acid and gamma-
linoleic acid. It is believed to act by increasing synthesis of prostaglandin
E1,which inhibits the action of prolactin peripherally
Pain killers: Some women gain relief by taking simple painkillers, such as
paracetamol or ibuprofen but they are generally only of value in milder
cases.
Danazol ( a derivative of 17 ethinyl testosterone) is used in a dose of
100/day PO for 2-3 months.705 of patients will respond.
Side effects are: hirsutism, weight gain, irregular period
Bromocriptine is rarely used because of its side-effects.
Nodularity
Lumpiness and nodularity in the breast can be diffuse or
focal. Diffuse nodularity is normal, particularly
premenstrually. Diffuse nodularity is not associated with any
underlying pathological abnormality.
Breast cysts
Sclerosis
Duct ectasia
Epithelial hyperplasia
Breast cysts
Approximately 7% of women develop a palpable breast cyst
at some time in their life.