1、,,,,乳 房 疾 病,忻 瑩 乳腺甲狀腺外科 杭州醫(yī)學院附屬浙江省人民醫(yī)院,,,,,,乳房、腋窩查體,乳房與藝術,Breast cancer and Art,，,Bathsheba Bathing by Rembrandt Harmensz van Rijn (1606-1669

2、)《沐浴的芭特葉巴》，倫勃朗,,La Notte by Michelangelo di Lodovico Buonarroti Simoni (1475-1564)《夜》，米開朗基羅,Breast Cancer and Art,La Fornarina by Raffaello Sanzio of Urbino (1483–1520) 《弗馬里娜》，拉斐爾,The Madonna Delivers Milan From

3、the Plague by II Cerano (1573–1632) 《麥當娜在瘟疫中誕下米蘭》，切拉諾,Anatomy,LN, lobe, lobule, duct, gland, nipple,lumpskin ulcerationaxillary lymph node enlargement,dimpling signorange-peel signnipple discharge & retraction

4、 shape change,,Clinical manifestation,,,hyperplasia of mammary glands,,periodic pain.,,tuberculosis,,rare, often not primary.,,benign lumps,,fibroadenoma, phylloides, cyst, lipoma,

5、 etc.,,mastitis,,trauma, lactation, anatomy defect,Differential Diagnosis,,,bones of a woman, showing the deformations of metastatic breast cancer.,French surgeon Barthélémy Cabrol. to remove the underlying ch

6、est muscles+breast.,,William Halsted , U.Sradical mastectomy:breast+ pectoralis major/minor muscles +ALD,A tumor through time,~2200 BC,DEEP CUT 1590,KNIFE SKILLS ~1894,,,Robert Egan , an X-ray examination to detect brea

7、st tumours. 1970s, mammography.,surgery combined with chemotherapy works better,,tamoxifen approved in the United States as a treatment for advanced metastatic breast cancer.,A tumor through time,DOUBLE STANDARD 1975,DR

8、UG STOP 1977,X-RAY VISION 1956,,A tumor through time,,,The US Nurses’ Health Study reveals that HRT increases the risk of breast cancer,People live as long after lumpectomy combined with radiation as they do after radic

9、al mastectomy.,,BRCA1,BRCA 2.“triple-receptor-negative” breast cancer Herceptin,GENE TIMES,BUSTED FLUSH 1995,LESS IS MORE 2002,docummentary：PE， DDx， plan,surgical technique: suture, dressing change,to take ca

10、re of your patient: physical, psychological,Let Your Patient Be Your Artwork,01,,,,02,,,,03,,,,Breast-conserving radical resection with omentum reconstruction,Do You Agree It Is Art?,,Cosmetic outcome after surgery,Prosp