1. On pectoral fascia and musculature ofthe chest wall Over upper anterior rib cage 2nd or 3rd to6th Fat surrounding Internal mammary artery & lateralthoracic artery Axillary vein, internal mammary veins &intercostal veins

2. A Ducts B Lobules C Lactiferous sinus D Nipple E Fat F Pectoralis major G Ribs and intercostalmuscles A Duct cells B Basement membrane C Duct lumen 3. Coopers ligament 4. Axillary lymph nodesdefined by pectoralisminor muscle Level 1 lateral Level 2 posterior Level 3 medial 5. Estrogen- Development of the breast andlactiferous ducts Progesterone- Together with estrogen causes lobular andalveolar growth Prolactin- Synergizes the effect of estrogen andprogesterone 6. Inspection Overall inspection- symmetry, size, shape, skin color,venous pattern, lump, local dimpling Nipple- excoriation, inversion, discharge,edema and redness Skin- redness, edema, Peau dorange 7. 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 8. 90% of the breast lump are found bypatients themselves. Encourage female have regular selfbreast examination. 9. In Front a Mirror 10. In The Shower 11. Lying Down 12. Mammography Ultrasound Magnetic Resonance (MR) Computed tomography (CT) Positron Emission Tomography (PET) 13. Mammographic screening is key to the early detection of breast cancer 14. Fine needle aspiration- Cytology Core biopsy- Image guided- Stereotactic Excisional biopsy- Needle localization 15. Abnormalities of Normal Developmentand Involution Most benign disorders are related tonormal process of reproductive life There is a spectrum that ranges fromnormal to aberration and occasionally todisease 16. These include conditions of well defineetiology Example: fat necrosis, breast abscess 17. Cyst formation Fibrosis Hyperplasia of epithelium in the lining ofthe ducts and acini may occur Papillomatosis 18. Breast lump Mastalgia cyclical and non cyclical Nipple discharge Infection 19. Normal breast nodularity orcyclicalnodularity- Upper quad and axillary tail- Assessment is clinical, supplemented byUSG cytology or core needle histology- Excisional biopsy if doubt persists 20. Fibroadenoma- 15-25 yrs- Firm, smooth or lobulated and extremely mobile- increase in size during pregnancyand involutes after parturition- 5cm is giant fibroadenoma- Estrogen may play an importantrole in its pathogenesis- If age25, size increases, giantfibroadenoma and positive family h/o ofcarcinoma 21. Breast cysts- 40-50 years- smooth and tense and easilypalpable against the chest wall- USG and needle aspiration confirms- Excisional biopsy is done if residualmass is present or blood stained fluid ispresent 22. Galactocele- Painless swelling appears in breastduring or after cessation of lactation- Cyst filled with milky material andhas same character as other cysts- Mainly found towards areola- Repeated aspiration 23. Galactocele 24. Cyclical- Related to menstrual cycle- Duration of>1 week per cycle is significantand called pronounced symptoms- Etiology1. Hyperprolactenemia2. Increase level of estrogen after ovulation3. Abnormality of prostaglandin secondary to deficient essential fatty acid intake in diet 25. Non Cyclical Mastalgia- True non cyclical mastalgia- Chest wall pain 26. Non Medical Measures- Reassurance- Breast support- Dietary measures Medical Measures- NSAIDS- Evening primrose oil- Danazol- Tamoxifen Surgical measures- subcutaneous mastectomy the last resort 27. Discharge from single duct- Blood stained1. Intraductal carcinoma2. Intraductal papilloma3. Duct ectasia- Serous1. Fibrocystic disease2. Duct ectasia3. Carcinoma 28. Discharge from more than one duct- Blood Stained1. Carcinoma2. Duct ectasia- Grumous1. Duct ectasia- Purulent1. Infection- Serous1. Duct ectasia2. Fibrocystic disease3. Carcinoma 29. Cause Hormonal imbalance Excessive estrogen production 30. Clinical present Pain or lump, nipple discharge (15%) Tense cyst no fluctuant Cyst may appear rapidly and then maintaintheir size or shrink after next menstraualflow Most painful in pre-menstraual period 31. Diagnosis- Pain or lump- FNA Management- Hormonal therapy- Mastectomy 32. Dilation of ducts associated withperiductal inflammation Presented as nipple discharge, subareolarmass, abscess, mammary fistula and/ornipple retraction To rule out malignancy if lump or nippleretraction- if suspicion remain excisional biopsy- excision of all major ducts 33. Bacterial mastitis- cellulitic stage- abscess form Tuberculosis Actinomycosis Syphilis 34. 40-50 years old. 6%-8% malignant tendency. Forming from the epitheliallinings of the main ducts. Nodule at the areola margin. Pressure reproduces the bloodydischarge. 35. Types of Intraductal Papilloma Solitary intraductal papillomas one lump,usually near a nipple, causes nippledischarge Multiple papillomas groups of lumps,farther away from a nipple, usually doesntcause discharge, and cant be feltTreatment Surgical excision (involved duct or radicalresection if it is proved malignant by frozensection) 36. Cause- Lactic stasis- Bacterial invasion Clinical present- Swelling pain- Painful mass with reddish skin General features:Chill, fever, ipsilateral LN enlargement,bacteriaemia Abscess formation 37. Thermo therapy- 25% Magnesium sulfate Antibiotic therapy- Local and general administration Drainage Prevention 38. 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 39. THE END