Essentials of Breast Surgery - M. Sabel (Mosby, 2009) WW.pdf

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1600 John F. Kennedy Blvd.
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SURGICAL FOUNDATIONS: ESSENTIALS OF BREAST SURGERY
ISBN: 978-0-323-03758-7
Copyright
#
2009 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopying, recording, or any informa-
tion storage and retrieval system, without permission in writing from the publisher. Permissions
may be sought directly from Elsevier’s Rights Department: phone: ( þ 1) 215 239 3804 (US) or ( þ 44)
1865 843830 (UK); fax: ( þ 44) 1865 853333; e-mail: healthpermissions@elsevier.com . You may also
complete your request on-line via the Elsevier website at http://www.elsevier.com/permissions .
Notice
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our knowledge, changes in practice, treatment and drug therapy may
become necessary or appropriate. Readers are advised to check the most current information
provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of the practitioner, relying on
their own experience and knowledge of the patient, to make diagnoses, to determine dosages
and the best treatment for each individual patient, and to take all appropriate safety
precautions. To the fullest extent of the law, neither the Publisher nor the Editor assumes any
liability for any injury and/or damage to persons or property arising out of or related to any use
of the material contained in this book.
The Publisher
Library of Congress Cataloging-in-Publication Data
Sabel, Michael S.
Essentials of breast surgery / Michael S. Sabel. – 1st ed.
p. ; cm. – (Surgical foundations)
Includes bibliographical references and index.
ISBN 978-0-323-03758-7 (alk. paper)
1. Breast–Cancer–Surgery. 2. Breast–Surgery. I. Title. II. Series: Surgical foundations.
[DNLM: 1. Breast–surgery. 2. Breast Diseases–surgery. 3. Breast Neoplasms–therapy.
WP 910 S115e 2009]
RD667.5.S23 2009
616.99 0 449059–dc22
2009004600
Acquisitions Editor: Judith Fletcher
Developmental Editor: Martha Limbach
Project Manager: Mary Stermel
Design Direction: Steve Stave
Marketing Manager: Brenna Christensen
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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Dedication
To my wonderful wife, Janeel, who was
extremely understanding when family time
needed to be compromised, and to my beauti-
ful children, Alex and Madison, although they
weren’t quite as understanding. Also, to my
parents, Steven and Rhoda, who through
their love and patience got me to the point
where I can hopefully make them proud.
v
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Preface
The management of both benign and malig-
nant breast disease represents a major portion
of a surgeon’s responsibility, yet often com-
prises only a minor portion of their training.
The diagnostic workup and treatment of
breast disease is constantly changing and
increasingly complex, making it extremely
challenging for the surgical trainee or practi-
cing general surgeon to keep up with changes
in the field. Surgeons will see an extremely
high volume of patients with complaints
related to the breast, and it is imperative
that they allay fears, palliate symptoms, and
not miss diagnosing malignant disease.
Surgeons must also identify patients at high
risk of developing breast cancer so that
appropriate screening and prophylactic mea-
sures may be considered. The management of
malignant breast disease is increasingly multi-
faceted. The days of the surgeon seeing the
patient, completing surgical therapy, and then
referring the patient to other specialists have
passed; today the surgeon needs to work
in concert with radiologists, pathologists,
medical and radiation oncologists, plastic
surgeons, and other medical professionals to
formulate an appropriate diagnostic and ther-
apeutic plan. Multidisciplinary management
of the breast cancer patient is critical and often
guided by the surgeon even though surgery
may not be the first modality employed.
Any surgeon dealing with breast disease is in
need of a strong grasp of not only the anatomy
and physiology of the breast, but the potential
and limitations of breast imaging, benign and
malignant breast histology, genetics, cancer
biology, and an understanding of all treatment
modalities such as radiation and systemic
therapies. However, most textbooks on breast
disease are meant for clinicians and researchers
from multiple disciplines, containing extre-
mely thorough reviews of the research, the
evolution of treatment, and the randomized
trials that led us to this point. This can be
too confusing and overwhelming for the
surgeon in training or the practicing general
surgeon who must also focus on diseases
outside of the breast. Surgical Foundations:
Essentials of Breast Surgery captures the true
essentials of the management of breast disease
in an easily readable and absorbable format.
The principles of multimodality therapy
(chemotherapy, radiation therapy, hormonal
therapy) are explained from a surgical perspec-
tive, as are the basics of breast anatomy and
physiology, the diagnostic workup and
management of benign breast disease, and risk
stratification and reduction. Our goal is a
textbook that surgery residents, surgical oncol-
ogy fellows, and breast surgery fellows can
utilize in training (and beyond) and that
practicing general surgeons can use to enhance
their management of breast disease. Easy to
read, with a list of key topics to help focus the
reader and a liberal use of tables, boxes, and
figures to reinforce the information in each
chapter, this textbook will hopefully be a
useful resource to any surgeon responsible for
the management of diseases of the breast,
particularly breast cancer.
vii
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1
Anatomy and Physiology
of the Breast
Key Points
Know the development of the breast from intrauterine
development through puberty.
Describe the anatomy of the breast and the relationship of the breast to the
chest wall and axilla.
Understand the segmental distribution of the ductal-lobular units and the
pathway of milk from the lobules to the nipple
Name the muscles of the chest wall and axilla, their blood supply and
innervation, and the impact of a nerve injury.
Understand the arterial supply and venous and lymphatic drainage of the
breast and how this impacts breast pathology and surgery.
Describe the anatomy of the axilla, the boundaries of the “axillary pyramid,”
and the groupings of the lymph nodes in the axilla.
Understand the hormones that can affect breast physiology and how
lactation occurs.
Know the changes that the breast undergoes during the menstrual cycle,
during pregnancy, and after menopause.
1
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