Lisa Mifsud.

Assessment and Management of Surgical Breast Disease

Anatomy

Anatomy

Internal Thoracic artery

Lateral thoracic artery and lateral mammary branches

Anatomy

Breast disease

• Mastalgia

• Lumps

• Nipple discharge

• Cancer

Risk factors

• Family history• Previous neoplastic

breast changes• Certain breast

conditions• Oestrogen exposure

Assessment

• History and Examination

• Radiography• Cytology/histology

StagingTx Primary tumour cannot be assessed

Tis Carcinoma in situ

T1 Tumour size <2cm

T2 Tumour size 2-5cm

T3 Tumour size > 5cm

T4 Any tumour size with fixation to chest wall or skin

Nx Regional lymph nodes cannot be assessed

N0 Axillary nodes not involved

N1 Ipsilateral axillary node metastases (mobile)

N2 Ipsilateral axillary node metastases (fixed)

N3 Ipsilateral supraclavicular or internal mammary node mets.

Mx Presence of distant mets cannot be assessed

M0 No distant mets

M1 Distant mets

Treatment Guidelines

Surgical options

• Breast:– Conservative– Mastectomy

• Axilla– Sentinal node biopsy– Level 1 dissection– Level 2 dissection– Level 3 dissection

Prognosis

• Invasive versus insitu

• Size and grade

• Histological type

• Number of lymph nodes involved

• Lymphovascular invasion

• Oestrogen/progesterone receptor status

• HER-2 overexpression

Complications• General risks of surgery

– Bleeding– Infection

• Specific risks of breast/axillary surgery– Lymphodema: – Numbness – Seroma– Frozen shoulder– Axillary web syndrome– Skin flap necrosis

• Anaesthetic risks of GA• Risk of immobility