Benign Breast Disease

Posted by e-Medical PPT
Majority of surgical consultation for Breast complaints ultimately prove to have a benign origin.
Surgeon’s role in management of Benign Breast Disease includes:
 Assessment of Breast Cancer Risk
 Breast Cancer Screening
 Providing Specific Diagnosis

Develops from Ectoderm Milk Streak
Lobules and Ducts
The breast glandular tissue consists of 15 to 20 lobules (clusters of milk forming glands, or acini) that enter into branching and interconnected ducts. The ducts widen beneath the nipple as lactiferous sinuses and then empty via nipple openings.

Blood Supply
Branches of Internal Mammary Artery, Intercostal arteries, Axillary Artery
Venous drainage via Internal Mammary, Intercostal, Axillary Veins

Lymphatic Drainage
97% to Axillary Nodes
Internal Mammary and Supraclavicular nodes
Three Lymph Node Levels:
Level I – Lateral to Pectoralis Minor
Level II – Deep to Pectoralis Minor
Level III – Medial to Pectoralis Minor
Rotter’s – Between Pectoralis Minor & Major

Long Thoracic Nerve
Serratus Anterior m.
Winged Scapula
Thoracodorsal Nerve
Latissimus Dorsi
Intercostobrachial Nerve

Breast Pain (Mastodynia)
More common during reproductive years (premenopausal)
Association with cancer is uncommon
Cyclic pain associated with Fibrocystic changes
Noncyclic pain associated with infection or cancer if associated with mass or bloody nipple discharge.
Tx: NSAIDs, Eve primrose oil, OCP, avoid caffeine

Simple cyst may be observed or aspirated
Bloody aspirate – send for cytology
Fibrocystic Changes
Not considered “disease”
No increase risk of cancer
Common finding >50%
Most common mass in <30 y/o
Smooth, firm, rounded, mobile
Definitive dx by core or excisional bx.
Change size with menses, pregnancy
Excise if growing or >30 y/o
Long-term risk = 2.17 for cancer (IDC)

Cystosarcoma Phyllodes
10% malignant
Resembles Fibroadenoma
Tx is WLE
Associated with THC, spironolactone
Liver Failure

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