外科学教学课件：Breast Disease.ppt

PART 1 Breast Disease
Anatomy
Modified sweat gland between the superficial and deep layers of the chest wall
Lying on 2nd－6th rib
Cooper’s Ligament
Fibrous band of tissue
Anatomy
Contains mainly fat tissue, connective tissue and glands
15-25 ducts
Breast tissue extends into axilla (“tail”)
Smallest, day 4-7
Tail
Anatomy
Ducts
Terminal ductules
Milking forming glands
Lobule
Ducts cancer in situ (DCIS)
Lobules cancer in situ (LCIS)
Anatomy
Breast is divided into quadrants
Upper-Outer quadrant has the greatest mass
UOQ is the site of about half of all breast cancers
Anatomy: lymphatics draining
Axillary pathway

Internal mammary pathway

Communication pathway

Rectus sheath→liver
Anatomy: Axillary lymph nodes
Axillary lymph nodes defined by pectoralis minor muscle
Level 1 – lateral
Level 2 – posterior
Level 3 – medial
Long Thoracic Nerve
Serratus anterior
Thoracodorsal Nerve
Latissimus Dorsi
Intercostalbrachial Nerve
Lateral cutaneous
Sensory to medial arm & axilla
Anatomy
Hormonal Effects
Estrogen
Development of the breast and lactiferous ducts
Progesterone
Secretory acinar tissue – lobules
Prolactin
Synergizes the effect of estrogen and progesterone
Breast Diseases
Classifiation as etiology
Congenital Malformation
Trauma
Inflammation
Tumor （benign or malignant）
Classifiation as anotomy
Glandular breast parenchyma (gland and stroma )
Nipple-Areolar Complex
Surrounding breast skin
Management of Breast Diseases
History
Clinical Breast Exam
Breast imaging
Tissue sampling
Therapy