Breast - Anatomy, Congenital and Benign Diseases MCQs

Alveolar epithelium is cuboidal in the resting phase, and columnar during lactation. The fibrous stroma forms septa (suspensory ligaments of Cooper) which anchor the skin and gland to the pectoral fascia. It forms the major part of the gland but is absent beneath the areola and nipple. Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Upper Limb Page number - 749

About 75% of the lymph draining the breast goes to the axillary lymph nodes, via the pectoral lymph nodes. All of this lymph from the pectoral lymph nodes must drain to the central lymph nodes as well. This is why it is so important to examine all these groups of axillary lymph nodes when performing a breast exam. Most of the rest of the lymph drainage from the breast goes to the parasternal nodes, although a small amount goes to the opposite breast and a small amount drains to the abdominal wall. Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Upper Limb Page number - 737

Autologous tissue reconstruction in breast surgery is done using the following muscle flaps- Latissimus dorsi flap - based on the thoracodorsal pedicle Muscle-preserving perforator abdominal flaps - Ex: Deep inferior epigastric perforator flap Transverse rectus abdominis flap - based on superior or inferior epigastric artery or both. Reference : Love & Bailey short practice of surgery, chapter: 53, Edition: 27th, Pg: 879

Lymphatic metastasis- Occurs primarily to the axillary and the internal mammary lymph nodes. Tumours in the posterior one-third of the breast are more likely to drain to the internal mammary nodes . Involvement of supraclavicular nodes and of any contralateral lymph nodes represents advanced disease. Reference : Bailey & Love's short practice of surgery, chapter: 58, Edition: 28 th , Pg: 932

Staphylococcal abscess - Present with point tenderness, erythema, and hyperthermia . Treatment - Initial approach is with analgesics, antibiotics and repeated aspiration of the abscess. Incision and drainage is done if Abscess is not resolving with repeated aspiration and antibiotic therapy Thinning or necrosis of the overlying skin Staphylococcus aureus (localised, involves deeper breast tissue) and Streptococcus species (diffuse superficial involvement) are the organisms most frequently recovered from nipple discharge from an infected breast. Reference : Schwartz Principles of surgery, chapter: 17, Edition: 11 th , Pg: 550

The most common cause of spontaneous nipple discharge from a single duct is a solitary intraductal papilloma (60%-80%) in one of the large subareolar ducts under the nipple. Subareolar duct ectasia producing inflammation and dilatation of large collecting ducts under the nipple is common (20%) and usually involves discharge from multiple ducts. Reference : Sabiston textbook of Surgery, chapter: 35, Edition: 21 st , Pg: 814

Duct ectasia/periductal mastitis- This is a dilatation of the breast ducts, which is often associated with periductal inflammation. The disease is more common in smokers . Nipple discharge (of any colour), a subareolar mass, abscess, mammary duct fistula and/or nipple retraction are the most common symptoms. Pathogenesis - Initially, there is a dilatation in one or more of the larger lactiferous ducts, which fill with a stagnant black or green secretion . This may discharge. These fluids then set up an irritant reaction in surrounding tissue, leading to periductal mastitis or even abscess and fistula formation. In some cases, a chronic indurated mass forms beneath the areola, which mimics a carcinoma. Fibrosis eventually develops, which may cause slit-like nipple retraction. Reference : Bailey & Love's short practice of surgery, chapter: 58, Edition: 28 th , Pg: 929

Giant Fibroadenoma Occasionally occur during puberty . They are over 5 cm in diameter and are often rapidly growing. Other features are similar to fibroadenoma. Enucleated through a submammary incision . They are more common in the Afro-Caribbean Reference : Bailey & Love's short practice of surgery, chapter: 58, Edition: 28 th , Pg: 922