SEMINAR
On
MASTECTOMY
Subject: Obstetrics and gynaecology nursing
SUBMITTED TO
[Link] tak
Vice principal SUBMITTED BY
School of nursing Bhopal, Pooja singh
BMHRC MSc nursing 1styr
Bhopal nursing college,
BMHRC
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Mastectomy
Surgery for breast cancer may involve mastectomy.
Mastectomy is the removal of the whole breast.
There are five different types of mastectomy: "simple" or "total" mastectomy, modified radical
mastectomy, radical mastectomy, partial mastectomy, and subcutaneous (nipple-sparing)
mastectomy
Types of mastectomy
PROCEDURE DESCRIPTION INDICATION
Lumpectomy (excisional Removal of tumor and For diagnosis of an abnormal
biopsy) surrounding tissue mammographic finding or
palpable breast lump if needle
biopsy not performed. Further
surgery may be needed.
Quadrantectomy (partial Removal of a breast quadrant Normal- to large-sized breasts.
mastectomy) that includes the tumor area Usually done at the same time
and possibly overlying skin as axillary surgery.
Sentinel lymph node biopsy Removal of only a few Performed to predict status of
gatekeeper lymph nodes lymph nodes—if negative for
tumor, axillary dissection is
not performed. May be done
in conjunction with
quadrantectomy or
mastectomy.
Axillary dissection Surgical removal of the Performed when lymph node
axillary lymph nodes is positive for tumor, mainly
for prognosis, staging, and
local/regional disease control.
Total or Simple mastectomy* Surgical removal of the entire Performed when lymph node
breast is positive for tumor, mainly
for prognosis, staging, and
local/regional disease control.
Modified radical Surgical removal of the entire Large or multifocal tumors;
mastectomy* breast and the axillary lymph women with very small
nodes (simple mastectomy breasts in whom local excision
plus axillary dissection) of tumor will be cosmetically
unacceptable; ineligibility for
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radiation therapy; patient
preference; prophylaxis.
Radical mastectomy* Removal of entire breast, Positive lymph nodes;
pectoral muscles, axillary advanced disease.
nodes Rarely done today—may be
performed for advanced
disease.
Nipple-sparing mastectomy
During nipple-sparing mastectomy, all of the breast tissue is removed, but the nipple is left alone.
Potential Complications
1. Infection
2. Hematoma, seroma
3. Lymphedema
4. Paresthesia, pain of axilla and arm
5. Impaired mobility of arm
Preoperative Management
Routine preoperative care. In addition:
1. The nature of the procedure is explained, along with expected postoperative care that includes
drain care, location of the incision, and mobility of the arm.
2. Information is clarified about diagnosis and possibility of further therapy.
a. Look for changes.
b. Feel for changes.
c. Check your left breast with your right hand in the same way.
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d. If you detect any changes, lumps, or knots, notify your health care provider
immediately.
3. Measures are taken to recognize the extreme anxiety and fear that the patient, family, and
significant others experience.
a. Discuss patient’s concerns and usual coping mechanisms.
b. Explore support systems with patient.
c. Discuss concerns regarding body image changes.
4. The patient’s overall medical condition is evaluated to guide preoperative care, help determine
how well the patient will tolerate surgery, and help prepare for complications that may occur
postoperatively.
Postoperative Management and Nursing Care
Routine postoperative care. In addition:
1. Dressing is removed and the wound is assessed for erythema, hematoma (fluid under incision),
edema, tenderness, odor, and drainage. Report suspected hematoma promptly.
a. Initial dressing may consist of gauze held in place by elastic, tape, or clear occlusive
dressing wrap.
b. Usually removed within 24 hours.
c. Incision may remain open to air or elastic wrap may be replaced if patient prefers.
2. Suction drain from wound is maintained.
a. May have 100 to 200 ml serous to serosanguineous drainage in the first 24 hours.
b. Report if grossly bloody or excessive in amount.
3. Arm on affected side is observed for edema, erythema, and pain.
4. Patient teaching about drain care, exercises, surgical outcome, and BSE occurs.
5. Female relatives, especially sisters, daughters, and mother, who may need closer breast cancer
surveillance are discussed.
NURSING ALERT
Mastectomy patients may have an elastic wrap bandage that should fit snugly but not so tightly
that it hinders respiration. It should fit comfortably and support unaffected breast.
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EQUIVALENT EXERCISE DAILY ACTIVITIES
1 Stand erect. –Lean forward at waist. –Allow arms to hang. –Swing arms from side to side
together; then in opposite direction. –Next, swing arms from front to back together; then in
opposite direction.
2. Stand erect facing wall with palms flat against wall; arms extended. –Relax arms and
shoulders and allow upper part of body to lean forward against hands. –Push away to original
position; repeat.
3. Stand erect facing wall with palms flat against wall. –Climb the wall with the fingers; descend,
repeat.
4. Toss a rope over the shower curtain rod. –Hold the ends of the rope (knotted) in each hand and
alternately pull on each end. –Using a seesaw motion and with arms outstretched, slide the rope
up and down over the rod.
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5. Stand erect and clasp hands at small of back; raise hands; lower; repeat. –Clasp hands back of
neck; reach downward; upward; repeat.
6 . Flex and extend each finger in turn. Broom sweeping Vacuum cleaning Mopping floor
Pulling out and pushing in drawers Weaving Playing golf Pushing self out of bath tub
Kneading bread Breaststroke—swimming Sawing or cutting types of crafts Raising windows
Washing windows Hanging clothes on line Reaching to an upper shelf Fastening brassiere
Buttoning blouse or dress Pulling up a dress zipper Fastening beads Washing the back Drying
the back with a bath towel Raising and lowering a window blind Closing and opening window
drapes Sewing, knitting, crocheting Typing, painting, playing piano or other musical instrument
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Nursing management
Nursing Diagnoses
Impaired Physical Mobility related to impaired movement of arm on operative side
Deficient Knowledge related to care of incision, arm, and performance of BSE
Ineffective Tissue Perfusion of affected arm related to lymphedema
Disturbed Body Image related to loss of breast (for mastectomy patient)
Anxiety related to diagnosis of cancer
Sexual Dysfunction related to loss of breast and diagnosis of breast cancer
Compromised Family Coping related to diagnosis of cancer
Nursing Interventions In addition to routine postoperative interventions, provide the
following care-
Patient Education and Health Maintenance
1. Advise patient to call surgeon for signs of infection, increased pain, or edema of arm.
2. Make sure that patient knows schedule for follow-up with surgeon.
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3. Provide resources for patient for ongoing information and support: American Cancer Society,
800-ACS-2345 or [Link], has numerous pages of information about surgery, nutrition
and cancer, lymphedema, psychosocial issues, and other concerns.
To reduce the risk of lymphedema of your arm after the removal of lymph
nodes, follow these general guidelines to prevent infection and obstruction of
blood and lymph fluid.
Take care of your skin to prevent dryness, cracking, and irritation that may lead to infection.
Keep your arm clean and cover any open areas.
Take care of your fingernails to avoid ripped cuticles and nails.
Avoid using a razor for underarm hair removal.
Protect hands and fingers from injury while gardening, sewing, cooking, and other chores.
Avoid constricting clothing around arms.
Avoid having blood drawn or needles inserted into affected arm.
Avoid having blood pressure taken on affected arm.
Prevent insect bites and stings through use of repellent and protective clothing.
Prevention of Lymphedema
References
1. [Link]
2. [Link]
3. Suddarth’s & Brunner, Textbook of medical – surgical nursing, publisher- wolters Kluwer(India) Pvt.
Ltd. New Delhi, Edition- Eleventh, Volume II. Pp 1462-1467
4. Nettina Sandra M., Lippincot, Manual of Nursing Practice, Publisher Jaypee Brothers Medical
Publishers (p) Ltd., Edition- Eighth, Pp-861-872
