Lisa Mifsud. Assessment and Management of Surgical Breast Disease

Anatomy

Internal Thoracic artery Lateral thoracic artery and lateral mammary branches

Anatomy

Breast disease Mastalgia Lumps Nipple discharge Cancer

Risk factors Family history Previous neoplastic breast changes Certain breast conditions Oestrogen exposure

Assessment History and Examination Radiography Cytology/histology

Staging TxPrimary tumour cannot be assessed TisCarcinoma in situ T1Tumour size <2cm T2Tumour size 2-5cm T3Tumour size > 5cm T4Any tumour size with fixation to chest wall or skin NxRegional lymph nodes cannot be assessed N0Axillary nodes not involved N1Ipsilateral axillary node metastases (mobile) N2Ipsilateral axillary node metastases (fixed) N3Ipsilateral supraclavicular or internal mammary node mets. MxPresence of distant mets cannot be assessed M0No distant mets M1Distant mets

Treatment Guidelines

Surgical options Breast: –Conservative –Mastectomy Axilla –Sentinal node biopsy –Level 1 dissection –Level 2 dissection –Level 3 dissection

Prognosis Invasive versus insitu Size and grade Histological type Number of lymph nodes involved Lymphovascular invasion Oestrogen/progesterone receptor status HER-2 overexpression

Complications General risks of surgery –Bleeding –Infection Specific risks of breast/axillary surgery –Lymphodema: –Numbness –Seroma –Frozen shoulder –Axillary web syndrome –Skin flap necrosis Anaesthetic risks of GA Risk of immobility