1. The breast receives its principal blood supply from perforating
branches of the internal mammary artery, lateral branches of the
posterior intercostal arteries, and branches from the axillary artery,
including the highest thoracic, lateral thoracic, and pectoral branches
of the thoracoacromial artery.
2. The axillary lymph nodes usually receive >75% of the lymph
drainage from the breast, and the rest flows through the lymph vessels
that accompany the perforating branches of the internal mammary
artery and enters the parasternal (internal mammary) group of lymph
3. Breast development and function are initiated by a variety of
hormonal stimuli, with the major trophic effects being modulated
by estrogen, progesterone, and prolactin.
4. Benign breast disorders and diseases are related to the normal
processes of reproductive life and to involution, and there is a
spectrum of breast conditions that ranges from normal to disorder
to disease (aberrations of normal development and involution classification).
5. To calculate breast cancer risk using the Gail model, a woman’s
risk factors are translated into an overall risk score by multiplying
her relative risks from several categories. This risk score is then
compared with an adjusted population risk of breast cancer to determine
the woman’s individual risk. This model is not appropriate
for use in women with a known BRCA1 or BRCA2 mutation
or women with lobular or ductal carcinoma in situ.
6. Routine use of screening mammography in women ≥50 years of age
reduces mortality from breast cancer by 33%.
7. Core-needle biopsy is the preferred method for diagnosis of palpable
or nonpalpable breast abnormalities.
8. When a diagnosis of breast cancer is made, the surgeon should
determine the clinical stage, histologic characteristics, and appropriate
biomarker levels before initiating local therapy.
9. Sentinel node dissection is the preferred method for staging
of the regional lymph nodes in women with clinically node-negative
invasive breast cancer.
10. Local-regional and systemic therapy decisions for an individual
patient with breast cancer are best made using a multidisciplinary
Breast cancer, with its uncertain cause, has captured the attention
of surgeons throughout the ages. Despite centuries of theoretical
meandering and scientific inquiry, breast cancer remains one of
the most dreaded of human diseases.1–12 The
story of efforts to cope with breast cancer is complex, and there
is no successful conclusion as in diseases for which cause and cure
are known. However, progress has been made in lessening the horrors
that formerly devastated the body and psyche. Currently, 50% of
American women will consult a surgeon regarding breast disease,
25% will undergo breast biopsy, and 12% will develop
some variant of breast cancer.
The Smith Surgical Papyrus (3000–2500 b.c.)
is the earliest known document to refer to breast cancer. The cancer
was in a man, but the description encompassed most ...