Surgical Physiology

1. Thelarche
Hormone dependent maturation.
- 'prepubertal gynecomastia' defined as before 12 years unaccompanied by other pubertal changes.
Deposition of fat, formation of new ducts, and appearance of lobules.

2. Resting post-pubertal breast
Cyclic stimulation leads to epithelium and stromal hypertrophy.
Oedema in late luteal phase (premenstrual) can cause pain and engorement.
- increased nodularity.

3. Pregnancy
Diminution of fibrous stroma & hyperplasia of lobular units = "adenosis of pregnancy".

4. Menopause
Defined as cessation of menstrual flow for 1 year; median age 51, usually between 40-55.
May induce pain / irregularity in breasts due to hormonal irregularity.
Symptoms: sweating, vag dryness, UTIs, cognitive side effects.
- involution and less epithelium in breastl more fat, less ct, loss of lobules.
HRT preserves pre-menopausal breast tissue.
- less risk of colon cancer, Alzheimers, heart attack, stroke, PE, gallbladder disease.
- is also an important risk factor in breast cancer.