← All decks
General Surgery
Breast
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
14 sections · 170 slides
Overview
- Scope of this topic
History of breast anatomy and surgery
- Reading the historical table
- Anatomic and Surgical History of the Breast
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
- Anatomic and Surgical History of the Breast (continued)
Embryogenesis of the breast
- Germ layer origin of the breast
- The milk lines
- Milk lines and the sites of supernumerary breast tissue
- Formation of the duct system
- Stages in formation of the duct system
- Nipple eversion and congenital inversion
- Development of the stroma and Montgomery's glands
- Hormonal control of mammary duct development
- Development of the breast
- Amastia, athelia and amazia
- Classification of supernumerary mammary structures
- Accessory versus ectopic breast tissue
- Indications for excision of supernumerary tissue
- Anomalies of breast size
- Gynecomastia
Topographic anatomy and fascial planes
- Extent of the breast on the chest wall
- Sagittal anatomy of the nonlactating breast
- Axillary tail of Spence
- Skin of the nipple and areola
- Superficial fascia of the breast
- Deep pectoral fascia
- Parasagittal section through the pectoral region
- Clavipectoral fascia
- Costocoracoid ligament and costocoracoid membrane
- Axillary fascia and the axillary sheath
- Layers from skin to chest wall
- The retromammary space
The axilla
- Boundaries of the axilla
- Medial and lateral walls of the axilla
- The walls of the axilla
- Contents of the axilla
- Topography of the axilla, anterior view
- Muscles and nerves relevant to mastectomy
- Muscles and Nerves Involved in Mastectomy: attachments
- Muscles and Nerves Involved in Mastectomy: attachments (continued)
- Muscles and Nerves Involved in Mastectomy: nerve supply and surgical relevance
- Muscles and Nerves Involved in Mastectomy: nerve supply and surgical relevance (continued)
Morphology of the gland
- Lobes of the breast
- Breast topography from a dissection photograph
- Radial arrangement of the ducts
- Lactiferous sinuses and intraductal papilloma
- Connective tissue around the ducts
- Localising the source of nipple discharge
- Suspensory ligaments of Cooper
- Skin dimpling from Cooper's ligament involvement
- Skin dimpling and peau d'orange contrasted
- Resting breast compared with the breast in pregnancy
Blood supply
- Sources of the arterial supply
- The internal thoracic artery
- Arterial pattern and choice of incision
- Branches of the axillary artery to the breast
- Intercostal contribution and its variability
- Variation in the arterial supply of the breast
- Arterial and venous supply from a dissection
- Venous drainage of the breast
- Venous routes of metastasis
- Pathways of venous drainage from the breast
- Portocaval anastomoses and hepatic metastasis
Lymphatic drainage
- Principles of lymph node terminology
- Haagensen's major node groups
- Lymph nodes of the breast and axilla
- External mammary and scapular nodes
- Central and interpectoral nodes
- Axillary vein and subclavicular nodes
- Subareolar plexus of Sappey
- Internal thoracic (mammary) nodes
- Imaging of the internal mammary nodes
- Regional lymph node classification
- Surgical levels of the axillary nodes
- Distribution of nodal metastasis by level
- Quadrant drainage and the central nodes
- Direction of lymph flow from breast and skin
- Lymphatic drainage of the breast
- Prognostic significance of nodal status
Innervation
- Cutaneous innervation of the breast
- Peripheral nerves encountered during mastectomy
- Thoracodorsal nerve
- Long thoracic nerve
- Medial and lateral pectoral nerves
- Intercostobrachial nerve
- Plan of the brachial plexus
Histology and physiology
- Glandular organisation and puberty
- Physiological gynecomastia
- Hormones of breast development
- Structure of the nipple
- Section through the nipple
- Histology of the resting breast
- Organisation of the resting breast
- The lactating breast
- Secretory cell products in lactation
- Developing breast in the fifth month of pregnancy
- The milk ejection reflex
- Regression of breast tissue and menopause
Surgical applications
- Types of mastectomy
- Subcutaneous mastectomy
- Contralateral prophylactic mastectomy
- Diagnostic biopsy techniques
- The sentinel node concept
- Technique of lymphatic mapping
- Subareolar versus peritumoral injection
- Lymphatic mapping missing the sentinel node after large excision
- Multiple perimeter injections improving mapping accuracy
- Accuracy and limitations of sentinel node biopsy
- The case for and against replacing axillary dissection
- Credentialing and training in sentinel lymphadenectomy
- Anatomical basis of local therapy
- Distribution of tumour location by histology
- Distribution of Tumor Location According to Histology, All Patients
- Tumour location and mortality by quadrant
The triangular bed of mastectomy
- Boundaries of the triangular bed of radical mastectomy
- The triangular bed of an axillary dissection
- Steps of the axillary dissection
- The triangular bed of a modified radical mastectomy
Anatomic complications of mastectomy
- Skin complications
- Vascular injury and blood loss
- Lymphedema after axillary dissection
- Pneumothorax during ligation of perforators
- Consequences of nerve injury
- Flap complications and reconstruction
- Adequacy of nodal retrieval and examination
- Current position on axillary dissection
Summary
- Key anatomical facts
- Key surgical points
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
- Join our WhatsApp groups