dr.

Riahsyah
dr.Riahsyah Damanik,SpB(K)Onk
Damanik,SpB(K)Onk
Oncology Sub.Departement
Department of Surgery
FK. USU / RSUP H.A. Malik

ANATOMY

Assesment
- Clinical Exam

- Imaging
- Pathology

~ Tripple Assesment

Clinical Exam
History
Onset lump
Duration o/t Lump (Progressivity)
Fluctuation with menstrual cycle
Lump character/other lump
Pain with / without radiation
Medication, Lactation
Risk Factor

 Examination

Self breast ex. (SADARI)

Clinical Breast ex. (SARANIS)
Imaging (USG, Mammography,MRI)

SADARI
(SBE)

Posisi

Posisi
berbaring

Posisi berbaring dengan bantal diletakan di

punggung

Lokasi dominan tumor

Clinical Breast Exam

Skin
Nipple Areola complex
Breast Tissue
Tumor
Axillary node

BREAST CANCER
Breast palpation

BREAST CANCER

Regional node assessment

Benign Breast Disease

(ANDI and NON ANDI)

60 % : Normal Process
30 % : Aberration
10 % : Disease

Classification BBD

Causes of lumps in the Breast

Fibrocystic change
(Fibrocystic Diseases)

 Pathofisiology
10 %

with complain

50 % (autopsy) variation physiologic

pathologic condition
Fibrocystic ~ carcinoma
Fibrocystic change

 Etiology
Cyclic change
Estrogen hormon
No correlated oral contraceptive

 Clinical

Pain
Nipple discharge
Breast density
Nodularity
Mixed solid cystic lesion

 Pathology
FNAB
Core biopsy
Exc. Biopsy

Risk of malignancy
Hyperplasia (mild)
Hyperplasia moderate / florid (1.5 2 x)
Hyperplasia atypic (4 5 x )

 Treatment
Medical
EPO
Hormonal
(Danazol, Bromocriptine, Tamoxifen)

Psychological
Surgical (exc. mastectomy)

Solid - Cyst

Fibroadenoma
Benign
>> young women
Macroscopic

Solid
Well border
Capsulated
Movable
White grey
Size 1 5 cm ( > giant)
Adenoma tubuler (>> glanduler)
Adenoma intracanaliculer (>> stroma)
Multiple (10%)

 Imaging

USG
Mammography (<<)
MRI (<)

Pathology

FNAB
Core (confuse)

Treatment
Excision

Fibroadenoma

Phyllodes Tumor
~ Cysto sarcoma phyllodes (leaf like)
Range benign (loc.rec) Malignant
(metastases)
Size 1 40 cm
Well circumscribed (like true caps)
Microscopic :
Epithelial + Conn. T.Stroma

 Clinical

Painless mass
Smooth, rounded, multimoduler
Continuous growth (rapid <<)
Varicose vein
Ulceration (skin ischemia)
Dimpling (Peau dorange)
Ax.Node (20%)

Radiologic
Mammographic ~ Fibroadenoma
Polylobulated
Sonogram : cyst with solid

 Treatment

Wide excision ( 2 cm margin)

Sub.cutaneous mastectomy
Simple mastectomy
(+) CRX (Systemic Disease)
HT
No Response
XRT

Phyllodes Tumor

Intraductal Papiloma

>> Colecting duct sub areolar region

Women 35 55 years
< 0 5 cm (non palpable)
Discharge (Bloody or serous) 50-90%
Radiologic
Mammographic (Mass or calcification)
Ultrasonographic

Microscopic

Solitary or multiple
6 % Ca

Treatment

Excision
Microdoechectomy

Microdoechtomy

FAT NECROSIS
History

Trauma
Prior Surgery

Present

Palpable Mass
Painless
Skin Thickenig / Retraction

Mammographic

Density , calcification

GALACTOCELE
Etiology

Ductule Draining
Blocked
Trapping Milk

DD /

Duct ectasia
Subareolar abscess

Clinical

Lump / swelling
Painless (Pain (+) with infection)
After lactation
Smooth movable
Aspiration milk

 Imaging
USG
50 % cystic
37 % mixed
13 % solid

Treatment
Aspiration
Curretage
Excision (<< / solid)

MASTITIS
( INFLAMMATORY / ABCESS )
Etiologic : Staphylococcus aureus or
Streptococcus spp, Myc. TBC.
Most commonly occurs during early weeks
of breast-feeding
Physical exam : Focal tenderness with
erythema and warmth of overly ing skin,
fluctuant mass Occasionally palpable.

 Diagnosis
Ultrasound can be used to localize an abscess ; if
abscess present, aspirate fluid for Gram stain and
culture.

Treatment
Continue breast feeding and recommend use of
breast pump as an alternative

Cellulitis
Wound care and IV antibiotics

Abscess
Incision/Excision and drainage followed by IV
antibiotics

Breast Abcess

Gynecomastia
Definition : Development of female-like breast
tissue in males.
May be physiologic or pathologic.
At least 2 cm of excess subareolar breast tissue is
required to make the diagnosis.
Treatment : Treat underlying cause if specific cause
identified ; if normal physiology is responsible, only
surgical excision (subareolar mastectomy) may be
effective.

Gynecomastia
Unilateral

Mammary Duct Ectasia

(Plasma Cell Mastitis)
Definition : Inflammatory and dilation of
mammary ducts.
Most commonly occurs in the perimenopausal
years.
Presentation : Noncyclical breast pain with lumps
under nipple/areola with or without a nipple
discharge.
Exam : Palpable lumps under areola, possible
nipple discharge
Diagnosis : Based on exam ; excisional biopsy
required to rule out cnacer.
Treatment : Excision of affected ducts