Join F1 Doctor Sarah for an on-demand educational session pertinent to budding medical professionals planning to specialize in breast surgery. The interactive discussion will delve into common breast-related presentations, pathological conditions, their management, and their corresponding investigations. The session will further facilitate a deeper understanding of these conditions with relevant SDA questions to prepare for UK Malay exams and finals, and provide guidance regarding potential training pathways in breast surgery. Additionally, the session comprehensively covers anatomy of the breasts, the vasculature, innervation, and importantly the lymphatic relevance in breast metastasis. Lastly, the session promises to break down the subject matter into subgroups for efficient comprehension and easy recall.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
Hi guys. Um I'm just gonna let a few more people join and then we can go ahead. Ok. So I'm gonna just um start ahead. My name is Sarah. I'm an F one doctor and I'm gonna be presenting to you guys and teaching you a little bit about breast conditions and breast surgery. So thanks everyone for coming and I've got one of my other colleagues Daniel who's moderating as well. So hopefully this will be useful for you guys. Um So just to go over our learning outcomes for today, I'm just gonna go with some common breast related presentations and conditions and we can go over um the management and investigations for these specially tailored for your UK Malay exams and finals and then we'll apply our learning with some SDA questions. And then I just wanted to highlight at the end um for anyone who's interested, sort of how having getting into a care in breast surgery works and possible training pathways. So let's go. Um So just some differentials for breast pain and tenderness. Um Common ones are so cyclical changes with periods um monthly, you know, uh ladies can complain of pain and tenderness um around the hormonal changes, pregnancy mastitis, they could be malignancy or metastasis, um, abscess and cysts as well. So we'll cover these kind of things. Um Right. So in terms of presentations related to breasts, they, there can be pain and tenderness, there can be a breast lump or nipple changes or skin changes. And then obviously, we have galacturia where there's milky discharge and gynecomastia, which I'm not really going to touch over today because that's more of an endocrinology sort of issue. Um But it's definitely a presentation and then obviously, there's the systemic symptoms that come with all these presentations. And then, um those are the list of conditions that we'll go over. Obviously, there's a lot more um conditions that we could cover. But for your, for the UK exam, I've just gone over the, what they've um mentioned in the contact map and what comes more commonly. So, um you guys are more prepared for that. Um So just a little bit about breast anatomy. I'm just gonna do a summary, I'm sure we all know a thing or two about it. So we have the mammary glands as you can see. And these are basically modified sweat glands. Um and they are made up of a series of ducts and secretory lobules. And each of those lobules within the glands have a lot of alveoli that are drained by a single lactiferous duct. Um And then the, the, the ducts converge uh at the nipple essentially as you can see in the photo. Um and then you've got connected to str stroma which sort of supports the mammary structures and the glands. And you've got the fibrous and fatty components to it as well. Um There's the ligament of cooper, which is a suspensory ligament that sort of um is around the breast issue and helps to support those structures. Um And then you've got the pectoral fascia where the base of the breast lies as well. So that's just a little bit about um the anatomy. There is a potential space, there's a space called the retro maori space where you've got the loose connective tissue between the breast and the pectoral fascia. And that's often used in a plastic surgery or reconstructive surgery, um especially with implants and things like that. So that's just a little piece of information and then just to quickly go over anatomy again with the vasculature and things like that. Um the arterial supply to the media aspect of the breast is through the internal thoracic artery, um which is a branch of the subclavian artery. And then um the lateral part of the breast receives blood from four different vessels, but I'm not gonna fool everyone with all of those things. And then the veins um correspond with the arteries and they all drain into the axillary and internal thoracic veins in terms of innervation. Uh There's the anterior and lateral subcutaneous branches of the intercostal nerves um and the nerves can uh they provide sensory and auto autonomic nerve fibers. Um And then finally, we've got the milk production and secretion, which is regulated by hormones. So, it's not um to do with the nerves, the nerve structures are just there for sensory and autonomic functions and the um hormones are what really drive the milk production of secretion. Um in terms of lymphatics, um obviously, the lymphatics have a very uh great importance when it comes to metastasis of brain cancer cells. Um There's three different groups of lymph nodes that receive the lymph um from breast tissue, the axil axillary node, which receives about 75% of the lymph from the breast tissue. And then we've got the parasternal node nodes which receive 20% and then the posterior intercostal nodes which receive about 5%. So, um that's of clinical importance with the notes and then going on then. So I've kind of tried to break it up into subgroups of conditions.
