Breast Examination: Anatomy, Differentials, and Surgery, Lecture notes of Anatomy

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Breast examination

Anatomy, Examination , Differentials & Surgery

Presentation: Jure Hederih Powerpoint: Amelia Shard & Jure Hederih

Anatomy Arteries

• Axillary ➢ Most of breast
• Internal thoracic (internal mammary) ➢ Some of medial breast Lymphatics
• Axilla (75%) ➢ Surgical levels – relation to pectoralis minor 1. Inferior 2. Posterior 3. Anterior/Medial Nerves
• Long thoracic
  • Axilla – beware in surgery!

Palpation

1.Lymph nodes (Axillary, supraclavicular)

2.Positon

• Hand behind head
• 45º

3.UNAFFECTED breast

• 2 hands
• Flat of hands
• Clock face / Concentric circles

4.AFFECTED breast

5.Offer to check for mets (lung, liver, spine)

https://geekymedics.com/breast-examination-osce-guide/

Completion Privacy + Thanks If LUMP found… (see lumps presentation) Describe lump 6 students Site, Size, Shape , Surface, Skin, Scar 3 teachers Tenderness, Temperature , Transillumination CAMPFIRE Consistency, Attachment, Mobility , Pulsation, Fluctuation, Irreducibility, Regional nodes, Edge Triple assessment

1. Full history + examination
2. Radiology <35y  USS

   35y  Mammogram

3. Core biopsy (FNA still sometimes done)

Common DDx Inflammatory

• Mastitis Key Hx: Breastfeeding; breast hot, erythematous and tender; may have an abscess
• Fat necrosis Key Hx: Usually 2° to trauma, but not always reported. Firm and irregular, so !!!
• Duct ectasia Key Hx: Inflammation and discharge, breast is lumpy Other benign lumps
• Fibroadenoma Key Hx: Young (20y-35y), firm & rubbery, mobile and round, can be large

Malignancy – key Hx points Predisposing factors 1.) Age (More common in older pt) 2.) FHx (Particularly breast cancer and gynae malignancy – even if not Mendelian) 3.) Good rule of thumb: “Whatever gives you higher lifetime exposure to sex hormones will put you at a greater risk”, i.e.

• Early menarche? (will increase duration of sex hormone exposure)
• Late menopause? (same as early menarche)
• Ever taken OCP? Or HRT? (artificial increase in sex hormones)
• Nr. of pregnancies and children? (hormones decrease during pregnancy)
• Breastfeeding? (sex hormones suppressed during breastfeeding)
• BMI? (high BMI is associated with more steroid hormone production, because of larger adipocytes)

Surgical intervention: Mastectomy

• No LN involvement, can completely excise
• Can clear LN in the same opp if necessary
  • Prophylactic (e.g. BRCA)
  • Multifocal or cannot completely resect w partial, but neg. LN
    • Common with LN involvement and more extensive/multifocal disease
      • Mostly done if pec major involvement and pos. LN

Thank you!

Questions?