mastectomy wardclass

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MASTECTOMYMASTECTOMY



TYPES

OF

MASTECTOMY



aims at removingaims at removing

thethe breastbreast, the, theunderlying musclesunderlying muscles

and all of theand all of the axillaaxilla;;

this operation isthis operation israrely done.rarely done.

Radical mastectomyRadical mastectomy



The removal of

the completebreast only

(subcutaneous

tissue, skin,

nipple).

Total or simple mastectomyTotal or simple mastectomy



aimed at taking onlythe cancerous lumpcancerous lump,

with some biopsies of some biopsies of

the lymph nodes of the lymph nodes of thethe axillaaxilla.

Radiation therapy is

usually given afterthis type of

operation.

LumpectomyLumpectomy



The removal of the

cancerous partcancerous part of the

breast tissue and somebreast tissue and some

normal tissue aroundnormal tissue around

itit.

More tissue is

removed in partial

mastectomy than in

lumpectomy.

Partial mastectomyPartial mastectomy



SubcutaneousSubcutaneous mastectomymastectomy

Aka ("nipple("nipple--sparing")sparing")

mastectomy, all of theall of thebreast tissuebreast tissue is removed, but

the nipple is left alonenipple is left alone.



Aims at removing the

breastbreast, some of thesome of the

underlying covering of underlying covering of the musclesthe muscles, and

possibly part of thepart of the

musclemuscle. Some of theSome of thelymph nodes of thelymph nodes of the axillaaxilla

are also taken out during

this type of operation.

Modified radical mastectomy



Anatomy andAnatomy and

Physiology of :Physiology of :

BREA

STBREA

ST



breasts are a secondary sexa secondary sex

characteristiccharacteristic; that is reproduction canoccur without them

The physiologic function of femalebreast is milk secretionmilk secretion to feed infants.

. An averageaverage nonlactatingnonlactating breast weighsbreast weighsbetween 150 and 250 g,between 150 and 250 g, and a lactating

breast weighs 400 to 500g.



The upper lateral quadrant of the breast,

which is mostly glandular, is the most

common site of breast cancer occurrence.

. A breast consists of 12-20 lobes, subdivided

into lobules, made up of acini. Breast lobes

are arranged like the spokes of a wheel

around the nipple. Each lobe is drained by a

duct, 12 to 20 of which open independently

on the surface of the nipple.



The nipple, normally located at the

fourth intercostals space, is surroundedby a circular pigmented area, called the

areola.

The sebaceous glands

(Montgomery·s glands) enlarge tolubricate the nipple during

pregnancy and lactation.



FUNCTIONS OF THE BREAST

The following physiologicchanges affect the breast:

Growth and developmentGrowth and development

The menstrual cycleThe menstrual cycle

Pregnancy and lactationPregnancy and lactation



LYMPHATIC DRAINAGE

There are three types of lymphatic drainageThere are three types of lymphatic drainageof the breast.of the breast.

kkCutaneousCutaneous or superficial lymphaticor superficial lymphatic

drainage from the skin.drainage from the skin.

kkAreolarAreolar lymphatic drainage from thelymphatic drainage from the

areola and nippleareola and nipple

kkGlandular lymphatic drainage fromGlandular lymphatic drainage fromdeep glandular tissuedeep glandular tissue



PATHOPHYSIOLOGYPATHOPHYSIOLOGYOFOF

BREAST

CANCER



TYPES:

invasive

noninvasive (often

referred to as in situ)



ductalductal carcinoma in situ (carcinoma in situ (DCISDCIS) ) -

cancer cells are found in the lining of the duct

lobular carcinoma in situlobular carcinoma in situ ((LCISLCIS) ) -

cancer cells are found in the lobules.

two types of noninvasive breasttwo types of noninvasive breast

cancers:cancers:



two types of invasive breasttwo types of invasive breast

cancer:cancer:

infiltrating ductal carcinoma -penetrates the

wall of the duct and travels to areas outside .

The most common type of breast cancer,

accounting for between 70%-80% of the cases

of breast cancer.

infiltrating lobular carcinoma -spreads through

the wall of the lobule and also travels to areas

outside of it.



The finding of breast cancer in

the axillary lymph nodes is anindicator of the tumor·s ability

for potential distant spread and

is not merely contagious growth

into the adjacent region of the

breast. Most primary breast

cancers are adenocarcinomas

located in the upper outer

quadrant of the breast.



ETIOLOGY:

Hormone (estrogen)

Genetics (BRCA-1 and BRCA-2 )



Breast cancer are malignant

tumors that typically begin inthe ductal-lobular epithelial

cells of the breast and spread

via the lymphatic system tothe axillary lymph nodes. The

tumor may then metastasize to

distant regions of the body,including lungs, liver, bone, and

brain.



Stages of

Breast Cancer



Stage IStage I the tumor is no more than 2 cm

in size and cancer cells have not spread

beyond the breast.

Stage 0Stage 0 noninvasive carcinomas (LCIS

or DCIS). Cancer cells have not invadedthe surrounding breast tissue.



Stage II either the tumor hasspread to the lymph nodes under the

arms but the tumor is less than 2 cm

in size, or the tumor has not spreadto the lymph nodes under the arms

but is greater than 5 cm in size, or

the tumor is between 2 and 5 cm andmay or may not have spread to the

nodes.



StageStage IIIIII the tumor is greater than 5 cm

in size and has spread to the lymph nodesunder the arms.

Stage IV the cancer has spread to

other prts of the body (metastaticcancer).



NURSING RESPONSIBILITIES

Preoperative

Antiembolitic hose may be put on thelegs, particularly if a long procedure is

anticipated.

A pillow may be placed under the head,

as well as an additional small pad placed

under the lumbar spine and/or a pillow

placed under the knees to avoid strainingback muscles, to prevent pressure

damage to tissue, and for comfort.



Use a gentle circular motion beginning atthe site of incision and extending

from neckline to lower ribs, including a

wide margin beyond the midline

and under the arm, down to the table onthe affected side. For lesions

in the upper outer quadrant, include the

axilla. The scrub is performed

with a ´gentle touch,µ as cancer cellscould (theoretically) be dislodged

from the specimen into the bloodstream if

vigorous scrubbing were done.

Monitor vital signs.



Assess hemodynamic factors, e.g., keep

the patient·s legs uncrossed and apply

antiembolitic hose before positioning the

patient, if requested.

Check chart for patient sensitivities and

allergies, including to

latex products, e.g., gloves, drains (suchas Penrose), or elasticized

dressings (such as pressure bandages).



Keep the patient adequately covered

to avoid overexposure of

areas not involved in the procedure.

The circulator should provide

measures of emotional support to

the patient, e.g., maintain eye

contact with the patient and holdthe patient·s hand during the

administration of anesthesia, etc.

Intraoperative



The patient·s arm on the

affected side is held up in a tube,or impervious

stockinette as a drape sheet is

placed under the axilla. The fieldaround the breast is draped

with folded towels. The arm is

brought

through the fenestration of alaparotomy sheet.



PostoperativePostoperative

Provide emotional support regardingfeelings of altered body

image for the mastectomy patient in

particular, considering the

emotional nature of this surgery. Givethe patient an opportunity to express

his or her feelings.



Instruct patient that bruising and some

swelling are common in women after

surgery

Instruct patient not to remove the

dressing, steri-strips or stitches. This

will be removed 7-10 days. If the

dressing or steri-strips fall off, do not

attempt to replace them.



Patient will have a Jackson-Pratt(JP) drain after your surgery.

Educate patient that a low-gradefever that is less than 100 degrees

Fahrenheit is normal the day after

surgery.



Instruct patient to avoid strenuous

activity, heavy lifting and vigorous

exercise until the stitches are removed.

Encourage patient to increase fluid

intake 8-10 glasses of water and non-

caffeinated beverages per day, plenty of fruits and vegetables as well as lower fat

foods

Patient may resume regular diet as

soon as she can take fluids after recovering from anesthesia.



R ECOMMENDED

R ECOMMENDED EXER CISE AFTER EXER CISE AFTER

MASTECTOMY MASTECTOMY

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