Mastectomy

Reported 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 incision
B 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 I
C axillary lymph nodes: levels II
D 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 mastectomy
B axillary lymph nodes: levels I
C axillary lymph nodes: levels II
D axillary lymph nodes: levels III
Post-Op Modified Radical
Mastectomy
Radical
Mastectomy
Woman with radical mastectomy.
A pink highlighted area indicates tissue
removed at mastectomy
B axillary lymph nodes: levels I
C axillary lymph nodes: levels II
D axillary lymph nodes: levels III
E supraclavicular lymph nodes
F 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…………