1. الجامعة السورية الخاصة كلية الطب البشري قسم الجـراحـة
The Breast
M.A.Kubtan,MD-FRCS
Lecture 1
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2. 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 .
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3. 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 .
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4. 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 .
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5. 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 ) .
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6. 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.
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7. 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 .
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8. Anatomy of axillary lymph nodes
Lateral.
Anterior .
Posterior .
Central .
Interpectoral.
Apical.
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9. Investigation of breast
Mammography .
Mammography showing a carcinoma
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12. MRI Magnetic resonance imaging
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13. Needle biopsy / cytology
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16. 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 .
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20. 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 .
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21. Mastitis of infants common
in boys as in girls .
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23. Injuries of breast
Haematoma >>>> lump >>>> bruises .
Traumatic fat necrosis >>>> acute >>>> or chronic
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24. 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 .
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26. 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 .
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28. 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.
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29. 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 .
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30. Duct ectasia / periductal mastitis
Ductectasia is dilatation of the breast duct associated with periductal inflammation .
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33. Thank You
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