כירורגיה של השד

physiology of breast feeding

baby locates nipple, tactile receptors in nipple are activated, hypothalamus send impulses to the anterior and posterior pituitary gland

prolactin

secreted from the anterior pituitary gland it is responsible for milk creation

oxytocin

secreted from the posterior pituitary gland, it is responsible for pushing the milk into the larger ducts

mastitis

common during breast feeding. It is caused by congestion or obstruction in the pathway leading to milk stasis and then bacterial infection

signs of mastitis

local fever, pain, and redness; hard area on the breast

ultrasound

method of diagnosis of mastitis

PO or IV antibiotics, pumping until breast is empty, surgical drainage of abscess

method of treatment of mastitis

risk factors for breast cancer

women, BRCA 1 and 2, family history, past breast disease, breast mostly compromised of connective tissue instead of fat, radiation to the area, hormonal treatments

signs of breast cancer

lump, change in breast shape, irritation that doesn’t go away, redness and hot breast without connection to an infection, secretions from the nipple unrelated to breast feeding

physical examination, mammography, MRI once a year for those at risk

methods of early diagnosis of breast cancer

US, MRI, CT

methods of diagnosis of breast cancer when there is already suspicion of a growth

cysts

benign breast tumor common in childbearing age, its size will change based on the menstrual cycle, must be checked often

fibroedenoma

benign breast tumor common in young women, it is a growth of connective tissue, diagnosed by US

Ductal carcinoma in situ

local breast cancer. in early stages it will only be in the milk ducts, but without treatment it can spread and metastasize

ductal carcinoma

invasive breast cancer in the milk ducts that spread to the breast tissue

lobular carcinoma

invasive breast cancer that originates in the milk glands

puget’s disease

a rare invasive breast cancer. signs are scaly and red rash (like and orange peel), irritation, bleeds, ulcers, secretions from the nipple

inflammatory breast cancer

invasive breast cancer where the cancerous cells sit in the milk ducts and block them. This causes an inflammatory response

sentinel lymph node biopsy

biopsy of the lymph node nearest the tumor. before the procedure a blue radioactive material is injected in order to mark the lymph node. Side effects include blue urine and a grayish face

lumpectomy

choice treatment of breast cancer. a small incision that keeps the breast shape and there is no removal of lymph nodes.

simple mastectomy

removal of the breast tissue and clean shoulders.

radical mastectomy

complete removal of the breast along with lymph nodes and part of the pectoralis muscle. PT for the hand will be needed afterwards

complications of a mastectomy

pain, bleeding, infection, lymphedema, seroma, decreased stability

nursing treatment after a mastectomy

הדרכה לא להרטיב את הפצע ללפחות 48 שעות אחרי הניתוח, אם יש צלקת בבית השחי מניעת שימוש בדיודארנט עד להחלמת האזור