Breast surgery

Abstract

Chapter 32 provides an overview of breast surgery including common presenting symptoms, an approach to clinical assessment, and the investigation and management of breast lumps. An approach to the clinical assessment of breast lumps is described, including helpful mnemonics to assist in the recall of the key questions to ask in a focused history (including appropriate identification of risk factors). A systematic approach to breast examination is presented, followed by the key imaging modalities used to identify a breast lump, including mammography, ultrasound, fine needle aspiration cytology, and sometimes magnetic resonance imaging. The pathophysiology and genetic contributions of the BRCA1 and BRCA2 genes are described. The role of screening for breast cancer is described in detail, including commonly used descriptions of grading and staging of disease. The management of options including chemotherapy, radiotherapy, and adjuvant treatment (such as tamoxifen, anastrozole, and trastuzumab) are provided. Common benign breast lumps include fibroadenomas, breast cysts, duct ectasia, breast abscesses, and fat necrosis and the presentation and management of each are described. Breast surgery may form part of the management of breast cancer and include mastectomy, wide local excision, sentinel lymph node biopsy, axillary dissection, and breast reconstruction at a later date. Essential clinical skills including focused history taking, a systematic approach to breast examination is provided.