2. • A “teardrop” shape
• Extension:
• 2nd to 6th rib
• Sternum to ant axillary
line
• Vascular supply:
• medial and central
portion: perforating
branches from the
internal mammary artery
• Laterally lateral thoracic
3. • Lymphatic drainage
• Axillary lymph node
• Internal mammary lymph
node
Sentinel lymph node
• The sentinel node is
defined as the first
lymph node draining the
tumour-bearing area of
the breast.
4. Mammography
• Soft tissue
radiographs are taken
by placing the breast
in direct contact with
ultrasensitive film and
exposing it to low-
voltage, high-
amperage x-rays.
• The sensitivity
increases with age as
the breast becomes
less dense
5. Ultrasound
• Particularly useful in
young women with
dense breasts
• Distinguishing cysts
from solid lesions
• Localise impalpable
areas of breast
pathology
• Guide percutaneous
biopsy
• Operator dependent
6. Magnetic resonance
imaging
• to distinguish scar from
recurrence
• to assess multifocality
and multicentricity in
lobular cancer
• best imaging modality for
the breasts of women with
implants;
• as a screening tool in
high-risk women (because
of family history).
• biopsies can be
performed
7. Needle biopsy/cytology
• Fine needle aspiration
cytology (FNAC) is the
least invasive technique
of obtaining a cellular
diagnosis and is rapid
and very accurate
• Histology can be
obtained under local
anaesthesia using a
springloaded core
needle biopsy device
8. 1) History and clinical diagnosis
2) Imaging: Ultrasonogram, Mammography, MRI
3) Tissue diagnosis (histopathology): FNAC,
Truecut biopsy, incisional biopsy & excisional
biopsy
Accuracy about 99.9%
9. • Benign breast conditions
are practically a universal
phenomena among
women.
• It accounts for 80% of
clinical presentation
related to the breast.
• They considered as “
Aberration from Normal
Development and
Involution” ANDI
Fibrosis
Cysts formation
Epithelial proliferation
Lobular-alveolar atrophy
• Common benign diseases
• Fibroadenoma
• Fibrocystic diseases
• Intraductal papilloma
• Fat necrosis
• Mastitis
10. • Fibroadenoma is a benign tumor composed of stromal
and epithelial elements due to hyperplasia in a single
terminal duct unit
• It is commonly seen in young women
• The cause is unknown (ANDI)
• Fibroadenoma is a well circumscribed lesion in the breast
& develop before menopause
• The tumor may grow rapidly during pregnancy or
hormonal replacement therapy, in which case they can
simulate malignancy
11. • The fibroadenoma is well
capsulated and freely mobile
in breast (breast mouse)
• Either breast may be
affected; multiple &
successive tumors may
develop in same or contra-
lateral breast
• Diagnosis:
Triple assessment
• Treatment:
Reassurance of the patient
Excisional biopsy
12. • This is the most common
lesion of the female breast
• Incidence varying related to
age; in menstruating years
20% ,while in
premenopausal years 30-
50%
• The most common
acceptable description are:
Cystic lobular hyperplasia
Fibrocystic disease of breast
fibroadenosis
• Cystic hyperplasia is a
variant of normal cyclic
changes in the breast that
occurs with menstruation
13. Treatment of fibrocystic disease
Medical
• Diet therapy:
Caffeine restriction, diuretics, Iodine containing agents
• Vit E & B6
• Dihydroergotamine
• Antiprolactin drugs: Bromocriptine
• Hormones: OCP, Danazol
Surgical
Surgical treatment for removal of the lump in most severe
cases
14. • This benign lesion of
lactiferous duct wall occur
centrally beneath the
areola in 75% of cases.
• They are solitary
proliferation of ductal
epithelium
• The most common
presentation by bloody
nipple discharge,
sometimes associated
with pain.
• Treatment by wedge
resection.
15. • This is traumatic in nature &
is common with women with
large fatty breast.
• It result from injury to breast
by: Trauma, surgery, biopsy
…
• Clinically: Patient develop
severe bruising after trauma,
when bruise settle, the
women notice swelling
which is clinically cannot be
distinguished from breast
carcinoma.
• Diagnosis: By
histopathology.
• Treatment:
Assurance,
surgical excision and
16. • Dilated mammary ducts
with inspissated
secretions and marked
periductal inflammation
• Clinical feature
Noncyclical mastodynia
Nipple retraction
Thick, white creamy nipple
discharge
Difficulty with breast-feeding
• Treatment
Reassurance
Surgical incision and
drainage
17. • 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
18. • It is swelling of male breast; unilateral or bilateral
• The cause is often self evident from a full history and
examination.
• The testes should always be examined.
• If there is suspicion of a testicular tumor, U/S and
hormonal assays are requested.
• Treatment of gynecomastia:
For physiological causes reassurance is all what is needed.
Stop drugs causing gynecomastia.
Subcutaneous mastectomy in troublesome cases.
Liposuction- assisted mastectomy
19. • It is formed due to
obstruction of milk duct.
• The milk retained proximal
to the obstruction.
• The milk eventually
becomes cheese like.
• Classically appears as a
painless lump weeks to
months after stop of breast
feeding.
• The commonest
complication is infection.
• The treatment is by surgical
excision.
20. • It is called also plasma cell mastitis
• It is widening of breast ducts due to inspissation of
normal breast secretion
• Mostly in women in their 40s and 50s
• It present as solitary or multiple tender swelling in the sub
or peri-areolar region
• Nipple retraction, skin adherence, edema & axillary
adenopathy may accompany a hard, diffuse mass within
the breast
21. • Palpation reveals a number of cord like swelling which
radiate from the areola
• The ducts are dilated & contains an inspissated yellow
cheesy material on cutting down
• The condition may be mistaken for a breast cancer
• Treatment: Excision and biopsy
22. • Bloody: intraductal
papilloma & breast ca
• Purulent: subareolar
infection
• Milky white:
galactorrhea
• Green/yellow or
brown: fibrocystic
disease
23.
24. Introduction
• Breast cancer is the second cause of cancer deaths in
women
• Breast cancer can also occur in men, but it is far less
common
• Distribution:
• Upper and outer quadrant: 60%
• Upper and inner quadrant: 12%
• Lower and outer quadrant: 10%
• Lower and inner quadrant: 6%
• Central: 12%
25. • Geographical : common in western countries.
• Age – risk increases with age.
• Race: whites are more affected
• Genetic factor – BRCA1 , BRCA2, P53 supressor gene.
• Gender – male less than 5%
• Dietary factor – diet low in phytoestrogen, excess alcohol
• Early Menarche & late menopause
• Endocrine factors: nulliparous, hormonal therapy
• Radiation of chest area
26. • Pathologically, breast cancer divided into 2 types
depending on their origin
Ductal carcinoma
Lobular carcinoma
Classification:
1. TNM classification
2. Manchester classification
27.
28. Stage I Confined to breast
Mobile lump < 2 cm
No palpable axillary LN
Stage II Confined to breast
Mobile lump 2-5 cm
Mobile palpable axillary LN
Stage III Stage IIIA Fixed lump
Size >5 cm
Palpable fixed axillary
LN
Stage IIIB Fixed lump
Any size
Skin involvement
Palpable fixed axillary
LN
Stage IV Distant metastasis
32. • 10 – 20% of all cases
• Subdivided into in situ
and invasive forms
depending on whether
basement membrane of
lobule has been
invaded by tumor cells
or
not
33. • Rare variety
• Present as painful and
swollen breast
• Highly aggressive
• Axillary lymph nodes
involved quite early
• Frequently occurs during
lactation so often called
lactational carcinoma
• Mimics breast abscess
& biopsy confirms the
diagnosis
• Progress is grave
34. When the disease is
discovered early, have more
treatment options and better
chance for cure
Lump of the breast or
thickening in the breast, often
the lump is painless
Bloody discharge from the
nipple
Retraction or indentation of
the nipple
Change in the size of
contours of the breast
Flattening or indentation of
the skin over the breast
35. In advanced cases, pitting
edema in the skin like the
skin of an orange
• May be enlarged axillary
lymph nodes due to
malignant spread
• In advanced cases,
ulceration of skin or even
bleeding from ulcer
surface
• Signs of systemic
metastasis
36. • Superficial manifestation of
underlying breast cancer
• Usually unilateral
• Present as eczema like
condition of nipple & areola
• Nipple erodes slowly &
eventually disappears
• Clinically felt as palpable
mass in subareolar area
• It is consider stage I breast
cancer
• Treated by simple
mastectomy
• Axillary clearance when
needed
• Oncology treatment
38. • “Cure” the primary disease
• “Control” of local disease in the breast and axilla
• “Conservation” of local form and function
• “Prevention” or delay of the occurrence of distant
metastases
39. • Achieve local control
• Appropriate surgery
Wide local excision (clear margins) and radiotherapy, or
Mastectomy ± radiotherapy (offer reconstruction –immediate or
delayed) Combined with axillary procedure
Await final pathology and receptor measurements
Use risk assessment tool; stage if appropriate
• Treat risk of systemic disease
Offer chemotherapy if prognostic factors poor; include Herceptin if
Her-2 positive
Radiotherapy
Hormone therapy if oestrogen receptor or progesterone receptor
positive
40. • Conservative breast surgery
1. Wide local excision:
Removing the tumour plus a 1 cm margin of normal breast tissue.
2. Quadrantectomy:
Removing the entire segment of the breast that contains the
tumour
41. • Simple mastectomy
Simple mastectomy involves removal of only the breast with no
dissection of the axilla, except for the region of the axillary tail of the
breast
• Patey mastectomy
The breast and associated structures are dissected en bloc and the
excised mass is composed of:
the whole breast
a large portion of skin, the centre of which overlies the tumour
but which always includes the nipple
all of the fat, fascia and lymph nodes of the axilla
• Radical mastectomy
Excision of the breast, axillary lymph nodes and pectoralis major
and minor muscles
43. 1. About the disease
2. Proposed treatment
3. Alternative treatment
4. Expected side effect
5. Management of side effect
6. Post operative follow-up
7. Post-operative systemic therapy
8. Prognosis
9. Consequence of no treatment
10.Consent from husband/authorised guardian
44. Stage I Wide local excision with 2 cm of normal tissue
Stage II Breast conservative surgery with radiothrapy
Simple mastectomy with axillary sampling /dissection
Stage III Palliative (neoadjuvent chemo- restage-surgery)
Stage IV Palliative(chemo, radiotherapy)
