الجامعة السورية الخاصة كلية الطب البشري قسم الجـراحـة The Breast M.A.Kubtan,MD-FRCS Lecture 1 M.A.Kubtan

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

Comparative and Surgical Anatomy Human breast is overlying the chest wall between the second to the sixth ribs . It is extending from the lateral border of the sternum to the anterior axillaries line . A thin layer of mammary tissue extend from the clavicle above to the seventh or eighth rib below . From the midline to the edge of the latissmus dorsi muscle poseriorly . 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

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

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

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

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

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

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

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MRI Magnetic resonance imaging M.A.Kubtan

Needle biopsy / cytology M.A.Kubtan

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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

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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

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

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

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

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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

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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

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

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

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Thank You M.A.Kubtan