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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 nodes.

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 treatment approach.

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 of ...

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