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Hello, everyone. I hope you're all doing well. My name is Rosa and I'm doctor. Uh Welcome to today's session on breast surgery. We're very excited to have you all here with us today. Uh Today I am joined by Mo who got breast surgery just to introduce Mo. He is 1/4 year from the University of Sheffield to make the session as engaging as possible or be releasing calls throughout the session. So be sure to participate, these responses are completely anonymous. We encourage you to participate actively. If you have any questions during the session, please feel free to pop them in the chart and we'll be happy to address them towards the end of the session. Well, I'll also share a feedback form at the complete along with exclusive discount codes, surgery and cost the mcs this session and the recording and slides will be shared on a metal page as well as the website a couple of hours after the session. So follow up as you will hopefully know by now, we have launched a very learning photo which is hosted on our website through this learning portal. You'll access uh practice questions, session recording and division material. As a bonus, all members will get a discount code to get 10% off the Kinki medics and flash cards, surgical flash cards and the knowledge bundle membership is completely free. So be sure to head on to our website after the session to explore this. We also have an exciting opportunity for all of our attendees. Two people will win free access to the GKI metics surgical flashcards and the GKI medics ay stationss to enter simply complete the global form at the end the session and enter the unique code. We will provide the more sessions you attend the higher chance of winning. So be sure to stay until the end of today's session and attend as many of our other sessions until the end of the series. Finally, before we begin with doctor Thank of partners, the Royal College of Surgeons England, Kiki medics, the MDU more than skin, deep metal TV, and P MLC S without further ado, I'm now hand you over to low. Hi, everyone. My name's Mo, I'm 1/4 year medical student at the University of Sheffield. Um I've got a really good uh big question for surgery and today I'm gonna be teaching you about breast pathology. Um We're gonna be going over some of the benign and the malignant conditions. Um, breast cancer is really common. It's the most common cancer in women. And um it's really highly relevant. Um If you're sitting in GPA lot of patients will come in with breast issues and it's a really common referral as well. So we'll go through, oh, thank you to all our partners as well for helping us set up these sessions. Um And I'll take you through the learning objectives. So, what we're gonna go through today is understanding the anatomy of the breast and a breast, the breast examination. Um understanding the anatomy is really useful to help you understand some of the conditions we talk about later on and within the breast examination, I'll teach you how to distinguish between a benign and a malignant condition, um which is really useful. Um So we're going to go over some of the benign breast conditions such as fibro adenomas, cysts and metastases. Um And I'll also take you through the process of breast cancer screening and um the diagnosis and treatment of breast cancer. Perfect. So, we'll start with the anatomy. Um I'm sure most of you have seen images like this. Um It demonstrates on the right side here, the thoracic wall and the pectoralis major with the breast itself being in front of the um pectoralis major. You've got the lobules, which we'll talk about um the lactiferous ducts, which also I was just referred to as ducts and then the fatty tissue, which is the breast tissue itself going into some of these. Um So the structure of the breast is composed of glandular tissue, connective tissue which holds everything together and the adipose tissue, which is the fatty tissue. We talked about. Um the glandular tissue itself is um composed of the lobules and the ducts. So the lobules are on here, the purply bits, they um they produce the milk and then this milk then drains through the ducts and converges at the nipple. Um which the milk is then released from. Um the blood supply is mainly from the internal thoracic lateral thoracic and intercoastal arteries. Now, this is important, but I've put a little star next to the lymphatic drainage cos um this is really important um as this is how cancer can spread. So we'll talk about it later on, but um cancer can spread through the axilla and onto other parts of the body as well. So it's really important to know that it's um the lymphatic drainage is through the axillary nodes, but also the supraclavicular and the internal mammary nodes as well. So it's important to check these. Um the nerve supplies, the intercoastal nerves which provide sensory and autonomic innervation as well. Perfect. So we'll go on to the examination itself. Um Before you start, there's general principles, most of them are the same as normal um examinations for any other conditions. Um But I'll go over a few points just to highlight um the first thing is you want to explain the reason and the process for the examination cos um patients will be coming in and they'll be really stressed So if you take a minute to just explain what you're gonna do, it can really help them be at ease. Um You obviously want to obtain informed consent. Um Having a chaperone present is really important. Um Allow the patient to get undressed and dressed in privacy. You really wanna remain their, remain their dignity and make sure that they're covered up until the point of um examination. You don't want them to just be unnecessarily exposed. Um Obviously ask about any areas of pain, any abnormalities that they've noticed themselves. So this can be really important because um they might be self examining at home and they've realized something that is a new change which is more of a um suspicious um indication. Um And then also if, if you have a minute, you can teach them how to self examine as well. Cos this is really important. Um We've got the next steps here as well. We'll go through them together. So when it comes to inspection, there's four different uh three different positions, sorry that you want to examine the patient in before you even start feeling and palpating. The first one is relaxed with, relaxed with your arms by your sides. So this is just the neutral position, then you're gonna want them to put their hands on their hips and press into it. What this does is it contracts the breast and the pectoral muscles to check for any tethering, which is just um the skin or nipple being pulled inwards or fixed. Um and this could indicate a malignancy. So it's really important and it's the same with when the hands are placed behind the head. Um The key things you're gonna wanna comment on. So this is if you're the consultant or regi registrar that you're with, um ask you to look at a breast, you wanna comment on any asymmetry. This is could be size or shape. Now, these can be normal, but it's important to note this down because with their next appointment, you can compare between the two any scars or cosmetic augmentation. So this is um implants or other cancer surgeries. Um This is important to note down as well. We've spoken about the tethering or fixation of the skin and then any nipple changes as well. These can also be normal. Um but it's important to document it down and also any discharge cos some, some forms of discharge can be really red flagged. So we need to focus on these. Um Finally, we've got skin abnormalities. Erythema is just a reddish inflammation, her orange, we'll speak about that later on, but it's, it looks like a very dimply like a, like an orange peel and it signifies um a blocked lymphatic drainage. Um You've also got Paget's disease of the nipple. This looks like eczema on the nipple. Um And we'll talk about that again later on. Um Perfect. So when it comes to palpation, this is right after the inspection. Um, it's, it's important to use the flats of your fingers. Um, if you're using the fingertips, what you can do is the, the surface area is decreased and you might miss some lumps. It's also hard to get the depth right. So make sure you're using the flats of your fingers. Um, you need to position the patient in uh lying back 45 degrees with their hands behind their head. Oh, sorry, only one hand behind their head, which is the side that you're being examined on. Um, you've got four different methods for examination. Um I'll go through them all. So we've got the vertical lines. Um This is going up and down, usually starting from the outside of the breast all the way towards the sternum. Um This is the most thorough, it's the most evidence based and it reduces um, missed areas. Then we've got the quadrants. This is splitting the breast into four different quadrants. You've got the upper, outer, upper, inner, lower, outer and lower, inner as well. Um So these four quadrants are really important and.