[Breast surgery] Introduction

Breast surgeons specialise in diseases of the breasts, including the skin, nipples, areolae, and mammary glands.

There is significant overlap with plastic surgery and oncology.

Etymology 

From Proto-Germanic

• breustam = breast

 

Subspecialties 

• Breast surgical oncology
• Oncoplastic breast surgery 

History taking

Physical examination

Procedures:

• Breast reduction (and lift) 
• Breast augmentation (enlargement) 
• Breast biopsy
• Central duct excision
• Breast-conserving surgery 
• Preventive mastectomy 
• Lobectomy
• Mastectomy 
• Mastopexy (breast lift)
• Breast reconstruction 
• Implant reconstruction
• DIEP flap

 

Problems:

• Obesity
• Back pain secondary to large breasts
• Breast trauma
• Burns

 

Breast diseases

 

Diseases:

• Breast cancer
• Mastitis
• Breast abscess
• Intraductal papilloma 
• Duct ectasia 
• Gynaecomastia
• Congenital defects
• Accessory breast
• Tuberous breasts

Mastitis

Disease class: Breast diseases

Disease class: Puerperal disorders

Invasive ductal carcinoma

This is the most common form of breast cancer (about 55% of cases).

See also

• Ductal carcinoma in-situ (DCIS)

Ductal carcinoma in situ

This is a premaligant change which can progress to invasive breast cancer.

 

See also

• Invasive ductal carcinoma

Paget's disease of the breast

This is a consequence of invasive breast cancer.

 

Symptoms and signs

• Itchy, erythematous rash (similar to eczema) over the areola and nipple

Breast cancer

In the UK, this is the #1 most common cancer.

 

Non-invasive types

• Ductal carcinoma in-situ (DCIS)

 

Invasive types

• Invasive ductal carcinoma (IDC)

 

Associated diseases

• Paget's disease of the breast

The mammary glands

Physiology

The mammary glands are exocrine glands which produce milk (galactopoiesis) in response to prolactin signals from the hypothalamus and pituitary gland.

Milk is released from the glands, through the ducts and out through the nipples (lactation) in response to oxytocin signals from the hypothalamus and pituitary gland. Stimulation of the nipples (as in breastfeeding), triggers the release of more oxytocin, which facilitates the ejection of more milk. This is known as the 'milk ejection reflex' or the 'let-down reflex'.

 

Pathophysiology

In women with poor breastfeeding technique, there may be insufficient liberation of milk from the ductal system of the breasts. This allows milk to remain in the ducts and glands, which allows time for bacteria to proliferate. This results in mastitis and potentially more severe infections such as breast abscess.

 

Hormones

• Stimulated by: Prolactin (PRL)
• Action: Stimulates milk production in the mammary glands

• Stimulated by: Oxytocin 
• Action: Stimulates milk ejection from the mammary glands