UNIVERSIDAD DE GUADALAJARA CENTRO UNIVERSITARIO DE CIENCIAS DE LA SALUD BREAST Brenda de la Torre Aguayo 209340718 MCPA Dr. Benjamín Robles Mariscal Dr. Héctor Manuel Virgen Ayala Clínicas Quirúrgicas
UNIVERSIDAD DE GUADALAJARA CENTRO UNIVERSITARIO DE CIENCIAS DE LA SALUD
BREAST
Brenda de la Torre Aguayo 209340718MCPA
Dr. Benjamín Robles Mariscal Dr. Héctor Manuel Virgen Ayala
Clínicas Quirúrgicas
ANATOMY
The normal breast
A “teardrop” shape
The asymmetry is common
Vascular supply:
medial and central portion:
perforating branches from the internal mammary artery
laterally
lateral thoracic
fascial envelope
Suspensory ligaments of Cooper
Histology Breast tissue
has two histologically distinct tissues: lobular & ductal
The lobule
-is the functional unit of the breast
Alveoli are terminal elongated tubular ducts
Around 10-100 alveoli coalesce to form larger lobular ductal units
BENIGN BREAST DISORDERS
Fibrocystic disease
• Refers to women with severely symptomatic breast
• S&S• Mastodynia • Breast masses • Nipple discharge
Radiographic
Clusstered micricalcifications on MMG
Treatment
Reassurance
Fibroadenoma
It is the most common breast common tumor in adolescents and young women
Patients will have multiple fibroadenomas in 10% -15% of cases
Characteristics
A painless, slow growing mass found on self-breast examination
Several cm.
Changes with mestrual cycle
Well circumscribed
Firm rubbery texture Diagnosis MMG popcorn calcification when degeneration Ultrasound evaluation
Treatment
Based on probability of missing a primary breast CA
-30. observation
Removal if enlarges
+30 FNA
Surgery indicated in changes
Giant fibroadenomas
+ 5 cm
Radial scar
Radial sclerosing lesions
In MMG shows a stellate, irregular spiculated mass lesion
A tissue diagnosis is required to differentiate from cancer
Fat necrosis
Inflamatory necrosis related to trauma
Macrophages laden with fat lobules. Or foreign body giant cells
Treatment
Involves reassurance without excision
Periductal mastitis Uncommon disease
dilated mammary ducts with inspissated secretions and marked periductal inflammation
S&S
include noncyclicla mastodynia; nipple retraction; thick, white creamy nipple discharge; as sterile subareolar abscesses.
History
Difficulty with breast-feeding
Treatment
Reassurance
Surgical incision and drainage
Infectious mastitis
80% are associated with breast-feeding
The most common pathogen is Staphylococcus aureus
Nonlactating women
chronic infections (actinomycosis, tb, syphilis)
autoimmune diseases (lupus erythematosus)
Most infections
begin as skin cellulitis
may be treated with antibiotics safe for feeding the infant
Galactoceles
Are breast cysts that are filled with milk
Almost exclusively seen after breast-feeding and represent silated obstructed breast ducts
Treatment
Ranges from simple aspiration to surgical incision and drainage
Mondor´s disease
Trombophlebitis of superficial veins of the breast
This affects the lower outer quadrant, presents as a pakoable, cord-like mass, burning pain
Treatment
NSAIDs
Intraductal papilloma
Most common cause of bloody nipple discharge
Lesions: small, nonpalpable, close to the nipple
Dx. Ductography
Tx. Subareolar excision
Nipple discharge
Bloody: intraductal papilloma & breast ca
Purulent: subareolar infection
Milky white: galactorrhea
Green/yellow or brown: fibrocystic disease
Mastodynia
2 types
Cyclie mastodynia
Continuous mastodynia
Tx
NSAIDS
Changes in life style