2.  On pectoral fascia and musculature of
the chest wall
 Over upper anterior rib cage 2nd or 3rd to
6th
 Fat surrounding
 Internal mammary artery & lateral
thoracic artery
 Axillary vein, internal mammary veins &
intercostal veins

3.  A – Ducts
 B – Lobules
 C – Lactiferous sinus
 D – Nipple
 E – Fat
 F – Pectoralis major
 G – Ribs and intercostal
muscles
 A – Duct cells
 B – Basement membrane
 C – Duct lumen

4. Cooper’s ligament

5.  Axillary lymph nodes
defined by pectoralis
minor muscle
› Level 1 – lateral
› Level 2 – posterior
› Level 3 – medial

7.  Estrogen
- Development of the breast and
lactiferous ducts
 Progesterone
- Together with estrogen causes lobular and
alveolar growth
 Prolactin
- Synergizes the effect of estrogen and
progesterone

8. Inspection
 Overall inspection
- symmetry, size, shape, skin color,
venous pattern, lump, local dimpling
 Nipple
- excoriation, inversion, discharge,
edema and redness
 Skin
- redness, edema, Peau d’orange

10. Palpation
 Gentle palpation
- quadrant by quadrant
 Mass
- number, size, consistency and mobility
 Lymph node
- anterior, posterior, lateral, central and apical
 Character of the discharge
- Milky, serous, or green-brown discharge
- Bloody discharge

12.  90% of the breast lump are found by
patients themselves.
 Encourage female have regular self
breast examination.

13. In Front a Mirror

14. In The Shower

15. Lying Down

16.  Mammography
 Ultrasound
 Magnetic Resonance (MR)
 Computed tomography (CT)
 Positron Emission Tomography (PET)

17. Mammographic screening is key to the early detection of breast cancer

18.  Fine needle aspiration
- Cytology
 Core biopsy
- Image guided
- Stereotactic
 Excisional biopsy
- Needle localization

20.  Abnormalities of Normal Development
and Involution
 Most benign disorders are related to
normal process of reproductive life
 There is a spectrum that ranges from
normal to aberration and occasionally to
disease

21.  These include conditions of well define
etiology
 Example: fat necrosis, breast abscess

22.  Cyst formation
 Fibrosis
 Hyperplasia of epithelium in the lining of
the ducts and acini may occur
 Papillomatosis

23.  Breast lump
 Mastalgia – cyclical and non cyclical
 Nipple discharge
 Infection

24.  Normal breast nodularity or cyclical
nodularity
- Upper quad and axillary tail
- Assessment is clinical, supplemented by
USG cytology or core needle histology
- Excisional biopsy if doubt persists

25.  Fibroadenoma
- 15-25 yrs
- Firm, smooth or lobulated and extremely mobile
- increase in size during pregnancy
and involutes after parturition
- 5cm is giant fibroadenoma
- Estrogen may play an important
role in its pathogenesis
- If age<25 conservative.
- Excision is done, if age>25, size increases, giant
fibroadenoma and positive family h/o of carcinoma

26.  Breast cysts
- 40-50 years
- smooth and tense and easily
palpable against the chest wall
- USG and needle aspiration confirms
- Excisional biopsy is done if residual
mass is present or blood stained fluid is
present

27.  Galactocele
- Painless swelling appears in breast
during or after cessation of lactation
- Cyst filled with milky material and
has same character as other cysts
- Mainly found towards areola
- Repeated aspiration

28. Galactocele

29.  Cyclical
- Related to menstrual cycle
- Duration of >1 week per cycle is significant
and called “pronounced” symptoms
- Etiology
1. Hyperprolactenemia
2. Increase level of estrogen after ovulation
3. Abnormality of prostaglandin secondary
to deficient essential fatty acid intake in diet

30.  Non Cyclical Mastalgia
- True non cyclical mastalgia
- Chest wall pain

31.  Non Medical Measures
- Reassurance
- Breast support
- Dietary measures
 Medical Measures
- NSAIDS
- Evening primrose oil
- Danazol
- Tamoxifen
 Surgical measures
- subcutaneous mastectomy – the last resort

32.  Discharge from single duct
- Blood stained
1. Intraductal carcinoma
2. Intraductal papilloma
3. Duct ectasia
- Serous
1. Fibrocystic disease
2. Duct ectasia
3. Carcinoma

33.  Discharge from more than one duct
- Blood Stained
1. Carcinoma
2. Duct ectasia
- Grumous
1. Duct ectasia
- Purulent
1. Infection
- Serous
1. Duct ectasia
2. Fibrocystic disease
3. Carcinoma

34. Cause
 Hormonal imbalance
 Excessive estrogen production

35. Clinical present
 Pain or lump, nipple discharge (15%)
 Tense cyst no fluctuant
 Cyst may appear rapidly and then maintain
their size or shrink after next menstraual
flow
 Most painful in pre-menstraual period

36.  Diagnosis
- Pain or lump
- FNA
 Management
- Hormonal therapy
- Mastectomy

37.  Dilation of ducts associated with
periductal inflammation
 Presented as nipple discharge, subareolar
mass, abscess, mammary fistula and/or
nipple retraction
 To rule out malignancy if lump or nipple
retraction
- if suspicion remain excisional biopsy
- excision of all major ducts

38.  Bacterial mastitis
- cellulitic stage
- abscess form
 Tuberculosis
 Actinomycosis
 Syphilis

39.  40-50 years old.
 6%-8% malignant tendency.
 Forming from the epithelial
linings of the main ducts.
 Nodule at the areola margin.
 Pressure reproduces the bloody
discharge.

40. Types of Intraductal Papilloma
 Solitary intraductal papillomas – one lump,
usually near a nipple, causes nipple
discharge
 Multiple papillomas – groups of lumps,
farther away from a nipple, usually doesn't
cause discharge, and can't be felt
Treatment
 Surgical excision (involved duct or radical
resection if it is proved malignant by frozen
section)

41.  Cause
- Lactic stasis
- Bacterial invasion
 Clinical present
- Swelling pain
- Painful mass with reddish skin
 General features:
Chill, fever, ipsilateral LN enlargement,
bacteriaemia
 Abscess formation

42.  Thermo therapy
- 25% Magnesium sulfate
 Antibiotic therapy
- Local and general administration
 Drainage
 Prevention

43.  After breast surgery or breast injury
 Bruised, injured, or dead fatty tissue
 Clinical features
- Hard lump
- Tender or painful
- drainage from nipple
- nipple will pull inward
 Triple assessment
 Management
- NSAIDS
- Vacuum-assisted core needle or lumpectomy

44. THE END