MastectomyReported by:

Alex M. Cardana

Breast Cancer Overview

Breast cancer occurs when abnormal cells grow out of control in one or both breasts. They can invade nearby tissues and form a mass, called a malignant tumor.

Understnading Breast Cancer

cancer cells

Causes Risk Factors Aging: more common in older woman;

60yrs. old and up Family History of Breast Cancer Female Hormones: Using menopausal hormone therapy, that

includes estrogen-progestin and estrogen-testosterone.

Reproductive and menstrual history: The older a woman is when she has her

first child. Women who never had children started period before age 12 started menopause after age 55.

Causes

Race: more often in white women than Latina, Asian, or African American women.

Lifestyle: overweight/obese, lack of physical activity, and too much drinking alcohol

Symptoms A thickening in the breast or armpit. A change in the size or shape of the

breast. Changes in the skin of the breast, such

as a dimple or skin that looks like an orange peel.

A change in the nipple, such as scaling of the skin or a nipple that turns in.

A green or bloody fluid that comes from the nipple.

A change in the color or feel of the skin around the nipple (areola).

Diagnosis

Self Breast exam or Clinical Breast Exam

Mammogram are x-ray pictures of the breast.

An ultrasound device sends out sound waves that people cannot hear.

Diagnosis

Magnetic resonance imaging (MRI) uses a powerful magnet linked to a computer.

Biopsy

Staging

Staging

Stage I Stage II Stage III Stage IV

Treatment

Breast-conserving surgery, or Lumpectomy

Radiation Therapy Chemotheraphy Hormone Theraphy Biological Theraphy

Mastectomy

Mastectomy (Breast Removal Surgery)

A mastectomy is the surgical removal of the entire breast, usually to treat serious breast disease, such as breast cancer.

Four General Types

1. Subcutaneous mastectomy -- the entire breast is removed but the nipple and areola (the pigmented circle around the nipple) remain in place

2. Total (or simple) mastectomy -- removal of the whole breast, but not the lymph nodes under the arm (axillary nodes).

Four General Types

3. Modified radical mastectomy -- removal of the whole breast and most of the lymph nodes under the arm (axillary dissection)

4. Radical mastectomy -- removal of the chest wall muscles (pectorals) in addition to the breast and axillary lymph nodes. For many years, this operation was considered the standard for women with breast cancer, but it is rarely used today.

Subcutaneous Mastectomy

Woman with skin-sparing mastectomy.A pink line indicates "keyhole"–like incisionB pink highlighted area indicates tissue removed at mastectomy

Post-Op Subcutaneous Mastectomy

Total(Simple) Mastectomy

Woman with total (simple) mastectomy.A pink highlighted area indicates tissue removed at mastectomy

B axillary lymph nodes: levels IC axillary lymph nodes: levels IID axillary lymph nodes: levels III

Post-Op Total(Simple) Mastectomy

Modified Radical Mastectomy

Woman with modified radical mastectomy.A pink highlighted area indicates tissue removed at mastectomyB axillary lymph nodes: levels IC axillary lymph nodes: levels IID axillary lymph nodes: levels III

Post-Op Modified Radical Mastectomy

Radical MastectomyWoman with radical mastectomy.A pink highlighted area indicates tissue removed at mastectomyB axillary lymph nodes: levels IC axillary lymph nodes: levels IID axillary lymph nodes: levels IIIE supraclavicular lymph nodesF internal mammary lymph nodes

Post-Op Radical Mastectomy

Mastectomy Preparation

A few days before the surgery: Patient Assessment Laboratory Test: urinalysis, Blood

test, ECG Anesthesiologist examines the

patient and review the test results Patient ordered NPO on the night

prior to the surgery if surgery scheduled early morning.

Mastectomy Preparation

Showering with an antibacterial soap the night before the surgery.

Instructs and explains the procedure to the patient

Ask the patient to sign a consent form

During the Procedure

An intravenous (IV) line administers medicines that may be required during surgery.

Heart function is monitored by an ECG machine.

A blood-pressure cuff is placed on the woman's arm to monitor her blood pressure during surgery.

The operation site is washed and sterilized.

During the Procedure

Sterile drapes are placed over the woman to guard against infection. Only the operation site is kept uncovered.

General anesthesia is administered. The woman may be given a dose of antibiotics to prevent infection.

The surgeon makes an incision depending on the planned procedure.

Specimen collecting and saving

During the Procedure

The skin is closed with stitches or staples.

Drainage tubes are usually inserted into the operation site to drain out blood and fluid that may continue to ooze out of the tissues after the skin is closed.

Application of pressure dressing.

During the Procedure

The duration of the operation depends on the type of mastectomy being performed. Most mastectomies take one to two hours, not including the time required for any lymph node procedures (sentinel lymph node biopsy or axillary node dissection) or reconstruction procedures.

After the Procedure

Patient sent to recovery room Monitor V/S (BP, PR, RR) A patient may be give pain

medication via IV push or Oral A patient generally stays in the

hospital 1 to 7 days.

Risks After Surgery

Bleeding Infection Potential breathing & heart

problems Possible reactions to medicine Pain and soreness Scar

Risks After Surgery

Compromised blood supply to the skin of the chest wall.

Shoulder stiffness and numbness Fluid collection in the

armpit;seroma Infection due to Breast

reconstruction

Nursing Interventions

Before hospital discharge: Instruct patient to measure the fluid that drains.

Instruct wound care and medications

Provide psychological support

END…………