1. BREAST LUMP

2. Schwartz's Principles of Surgery, Ninth Edition
BREAST LUMP
Abdul.Kader WEISS M.D
CHIRURGIE GENERALE ET VISCERALE /CHIRURGIE COELIOSCOPIQUE
D.E.S , A.F.S ,A.F.S.A , DU / FRANCE
Reference
Surgery at a Glance 2ed
Anatomy at a Glance
Schwartz's Principles of Surgery, Ninth Edition

3. DEFINITION

4. ANY PALPABLE MASS IN THE BREAST
DEFINITION
ANY PALPABLE MASS IN THE BREAST

5. ENLARGEMENT OF THE WHOLE BREAST CAN OCCUR EITHER UNI- OR BILATERALLY

6. BUT

7. THIS IS NOT STRICTLY A BREAST LUMP

8. ANATOMY

9. SPECIALIZED SKIN GLANDS

10. SPECIALIZED SKIN GLANDS COMPRISING

11. SPECIALIZED SKIN GLANDS COMPRISING
FAT

12. SPECIALIZED SKIN GLANDS COMPRISING
FAT
GLANDULAR

13. SPECIALIZED SKIN GLANDS COMPRISING
FAT
GLANDULAR
AND
CONNECTIVE TISSUE

16. BLOOD SUPPLY

18. VENOUS DRAINAGE

19. CORRESPONDS TO THE ARTERIAL SUPPLY
VENOUS DRAINAGE
CORRESPONDS TO THE ARTERIAL SUPPLY

20. LYMPHATIC DRAINAGE

21. THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS

22. THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS
A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS

23. THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS
A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS
B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns

24. THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS
A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS
B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns
C - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns

25. THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS
A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS
B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns
C - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns
D - THE CENTRAL GROUP, 3-4 L.Ns , EMBEDDED IN THE FAT OF THE AXILLA

26. THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS
A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS
B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns
C - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns
D - THE CENTRAL GROUP, 3-4 L.Ns , EMBEDDED IN THE FAT OF THE AXILLA
E - THE SUBCLAVICULAR GROUP (APICAL ), 6-12 L.Ns

27. THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS
A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS
B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns
C - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns
D - THE CENTRAL GROUP, 3-4 L.Ns , EMBEDDED IN THE FAT OF THE AXILLA
E - THE SUBCLAVICULAR GROUP (APICAL ), 6-12 L.Ns
F - THE INTERPECTORAL GROUP (ROTTER'S NODES), 1-4 L.Ns

29. LYMPHATIC PATHWAYS OF THE BREAST

30. LYMPHATIC PATHWAYS OF THE BREAST

31. LYMPHATIC PATHWAYS OF THE BREAST
LEFT BREAST

32. LYMPHATIC PATHWAYS OF THE BREAST
LEFT BREAST
ARROWS INDICATE THE DIRECTION OF LYMPH FLOW

33. THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE

34. THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE

35. THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE
Lymph nodes located lateral to or below the lower border of the pectoralis minor muscle are referred to as
LEVEL I LYMPH NODES
which include the axillary vein, external mammary, and scapular groups.

36. which include the central and interpectoral groups.
THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE
Lymph nodes located superficial or deep to the pectoralis minor muscle are referred to as
LEVEL II LYMPH NODES
which include the central and interpectoral groups.

37. which consist of the subclavicular group
THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE
Lymph nodes located medial to or above the upper border of the pectoralis minor muscle are referred to as
LEVEL III LYMPH NODES
which consist of the subclavicular group

38. THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE

39. TOPOGRAPHY

40. TOPOGRAPHY

41. BREAST LUMP

42. BREAST LUMP
KEY POINTS

43. BREAST LUMP
KEY POINTS
The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease.

44. BREAST LUMP
KEY POINTS
The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease.
The commonest breast lumps occurring over the age of 50 years are carcinomas and cysts.

45. BREAST LUMP
KEY POINTS
The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease.
The commonest breast lumps occurring over the age of 50 years are carcinomas and cysts.
Pain is more characteristic of infection/inflammation than tumours.

46. BREAST LUMP
KEY POINTS
The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease.
The commonest breast lumps occurring over the age of 50 years are carcinomas and cysts.
Pain is more characteristic of infection/inflammation than tumours.
Skin/chest wall tethering is more characteristic of tumours than benign disease.

47. BREAST LUMP
KEY POINTS
The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease.
The commonest breast lumps occurring over the age of 50 years are carcinomas and cysts.
Pain is more characteristic of infection/inflammation than tumours.
Skin/chest wall tethering is more characteristic of tumours than benign disease.
Multiple lesions are usually benign (cysts or fibrocystic disease).

66. DIFFERENTIAL DIAGNOSIS

67. DIFFERENTIAL DIAGNOSIS

68. DIFFERENTIAL DIAGNOSIS
WHOLE

69. DIFFERENTIAL DIAGNOSIS
WHOLE
LOCALIZED

70. DIFFERENTIAL DIAGNOSIS
WHOLE
LOCALIZED
BEHIND

71. SWELLING OF THE WHOLE BREAST
BILATERAL
UNILATERAL

72. SWELLING OF THE WHOLE BREAST
BILATERAL
UNILATERAL
PREGNANCY

73. SWELLING OF THE WHOLE BREAST
BILATERAL
UNILATERAL
PREGNANCY
LACTATION

74. SWELLING OF THE WHOLE BREAST
BILATERAL
UNILATERAL
PREGNANCY
LACTATION
IDIOPATHIC HYPERTROPHY

75. SWELLING OF THE WHOLE BREAST
BILATERAL
UNILATERAL
PREGNANCY
LACTATION
IDIOPATHIC HYPERTROPHY
DRUG INDUCED

76. SWELLING OF THE WHOLE BREAST
BILATERAL
UNILATERAL
PREGNANCY
LACTATION
IDIOPATHIC HYPERTROPHY
DRUG INDUCED
(E.G. STILBOESTROL, CIMETIDINE)

77. SWELLING OF THE WHOLE BREAST
BILATERAL
UNILATERAL
PREGNANCY
ENLARGEMENT IN THE N.B
LACTATION
IDIOPATHIC HYPERTROPHY
DRUG INDUCED
(E.G. STILBOESTROL, CIMETIDINE)

78. SWELLING OF THE WHOLE BREAST
BILATERAL
UNILATERAL
PREGNANCY
ENLARGEMENT IN THE N.B
LACTATION
PUBERTY
IDIOPATHIC HYPERTROPHY
DRUG INDUCED
(E.G. STILBOESTROL, CIMETIDINE)

79. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS

80. LOCALIZED SWELLINGS IN THE BREAST

81. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset

82. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.

83. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS

84. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.

85. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.

86. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS

87. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:

88. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:
• FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.

89. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:
• FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.
• FAT NECROSIS: irregular, ill defined, hard, ?skin tethering.

90. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:
• FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.
• FAT NECROSIS: irregular, ill defined, hard, ?skin tethering.
• LIPOMA: well defined, soft, non-tender, fairly mobile.

91. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:
• FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.
• FAT NECROSIS: irregular, ill defined, hard, ?skin tethering.
• LIPOMA: well defined, soft, non-tender, fairly mobile.
• CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant).

92. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:
• FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.
• FAT NECROSIS: irregular, ill defined, hard, ?skin tethering.
• LIPOMA: well defined, soft, non-tender, fairly mobile.
• CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant).
MALIGNANT INCLUDE:

93. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:
• FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.
• FAT NECROSIS: irregular, ill defined, hard, ?skin tethering.
• LIPOMA: well defined, soft, non-tender, fairly mobile.
• CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant).
MALIGNANT INCLUDE:
• CARCINOMA

94. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:
• FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.
• FAT NECROSIS: irregular, ill defined, hard, ?skin tethering.
• LIPOMA: well defined, soft, non-tender, fairly mobile.
• CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant).
MALIGNANT INCLUDE:
• CARCINOMA
EARLY : ill defined, hard, irregular, skin tethering

95. LOCALIZED SWELLINGS IN THE BREAST
MASTITIS/BREAST ABSCESS
DURING LACTATION:RED, hot, tender lump, systemic upset
TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
• GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.
• FIBROCYSTIC DISEASE: irregular, ill defined, often tender.
SOLID LUMPS
BENIGN INCLUDE:
• FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.
• FAT NECROSIS: irregular, ill defined, hard, ?skin tethering.
• LIPOMA: well defined, soft, non-tender, fairly mobile.
• CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant).
MALIGNANT INCLUDE:
• CARCINOMA
EARLY : ill defined, hard, irregular, skin tethering
LATE : spreading fixity, ulceration, fungation, ‘peau d’orange’.

96. SWELLINGS BEHIND THE BREAST

97. SWELLINGS BEHIND THE BREAST
RIB DEFORMITIES

98. SWELLINGS BEHIND THE BREAST
RIB DEFORMITIES
CHONDROMA

99. SWELLINGS BEHIND THE BREAST
RIB DEFORMITIES
CHONDROMA
COSTOCHONDRITIS (TIETZE’S DISEASE)

100. KEY INVESTIGATIONS

101. KEY INVESTIGATIONS
FNAC

102. Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
KEY INVESTIGATIONS
FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis

103. Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
KEY INVESTIGATIONS
FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis

104. KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUND
Fibroadenoma, cysts, tumours (best for young women/ dense breasts)

105. KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUND
Fibroadenoma, cysts, tumours (best for young women/ dense breasts)
MAMMOGRAPHY

106. KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUND
Fibroadenoma, cysts, tumours (best for young women/ dense breasts)
MAMMOGRAPHY
Tumours, cysts, fibrocystic disease, fat necrosis.

107. BIOPSY (‘TRUCUT’/OPEN SURGICAL)
KEY INVESTIGATIONS
FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUND
Fibroadenoma, cysts, tumours (best for young women/ dense breasts)
MAMMOGRAPHY
Tumours, cysts, fibrocystic disease, fat necrosis.
BIOPSY (‘TRUCUT’/OPEN SURGICAL)

108. BIOPSY (‘TRUCUT’/OPEN SURGICAL)
KEY INVESTIGATIONS
FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUND
Fibroadenoma, cysts, tumours (best for young women/ dense breasts)
MAMMOGRAPHY
Tumours, cysts, fibrocystic disease, fat necrosis.
BIOPSY (‘TRUCUT’/OPEN SURGICAL)
Usually provides definitive histology (may be radiologically guided if lump is small or impalpable-detected by mammography as part of breast screening programme

109. EXAMINATION OF THE BREAST

110. EXAMINATION OF THE BREAST

111. EXAMINATION OF THE BREAST
A. Inspection of the breast with arms at sides.

112. EXAMINATION OF THE BREAST
A. Inspection of the breast with arms at sides.
B. Inspection of the breast with arms raised.

113. EXAMINATION OF THE BREAST
A. Inspection of the breast with arms at sides.
B. Inspection of the breast with arms raised.
C. Palpation of the breast with the patient supine.

114. EXAMINATION OF THE BREAST
A. Inspection of the breast with arms at sides.
B. Inspection of the breast with arms raised.
C. Palpation of the breast with the patient supine.
D. Palpation of the axilla.

115. DUCTOGRAM

116. DUCTOGRAM

117. BREAST CYST
ECHOGRAPHY

118. BREAST CYST
ECHOGRAPHY

119. MAMMOGRAPHY

120. MAMMOGRAPHY

121. THANK YOU

122. THANK YOU
Abdul.Kader WEISS M.D 2010

123. THANK YOU
Abdul.Kader WEISS M.D 2010