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MRM is surgical procedure that the entire breast is removed, including the skin, areola and nipple, as well as most
of the lymph nodes under the arm. o This surgery is most commonly recommended if the tumor is large and cancer
has already spread to the lymph nodes. o Takes 2 to 4 hours and usually involves a one- to two-night hospital stay.
A single incision across half the chest usually allows the surgeon to remove the breast and the lymph nodes.
PURPOSES OF MRM
1.) Removal of breast cancer (abnormal cells in the breast that grow rapidly and replace normal healthy tissue) –
This procedure leaves a chest muscle called the pectoralis major intact. – This sparing of the pectoralis major
muscle will avoid a disfiguring hollow defect below the clavicle.
2.) Allow for the option of breast reconstruction, a procedure that is possible, if desired, due to intact muscles
around the shoulder of the affected side. 3.) Involves removal of large multiple tumor growths located underneath
the nipple and cancer cells on the breast margins
Day of Surgery:
• complete preoperative assessment sheet
• assess vital signs • provide necessary hygiene
• prepare hair and remove cosmetics •
remove prostheses
• finish preparation of patient's gastrointestinal tract
• have patient void (if no catheter inserted)
• apply leg procedures
• perform special procedures – e.g., insert foley, NG tube
• safeguard valuables
After mastectomy, some women may undergo breast reconstruction (which can be done during mastectomy).
Recent studies have indicated that women who desire cosmetic reconstructive surgery have a higher quality of life
and better sense of well-being than those who do not utilize this option.
After breast cancer surgery, women should undergo frequent testing to ensure early detection
of cancer recurrence.
It is recommended that annual mammograms, physical examination, or additional tests
(biopsy) be performed annually.
Also include psychotherapy since mastectomy is emotionally traumatic.
Affected women may be worried or have concerns about appearance, the relationship
with their sexual partner, and possible physical limitations
– Community-centered support groups usually made up of former breast cancer surgery
patients can be a source of emotional support after surgery.
Surgeon will prescribe medication to prevent pain. (PRN)
Fatigue is to be expected following the surgery.
Nursing Responsibility: Encourage patients to plan a lighter schedule, with the possibility
of daily naps
Nursing Interventions in a post-op mrm
a. Respiratory status Interventions:
» encourage patient to perform respiratory exercises
» encourage early ambulation » assist patients who are restricted to bed to turn every 1 to
2 hours
» suction as necessary
b. circulatory status Interventions:
– encourage patient to perform leg exercises
– apply leg procedures
– encourage early ambulation
– position patient in bed so that blood supply is not interrupted to extremities
– administer anticoagulants as ordered
– promote adequate fluid intake
g. Comfort Interventions:
– administer pain medications as ordered (especially for the first 24-48 hours)
RISKS • The procedure is performed under general anesthesia, which itself carries risk.
1.) edema, or swelling of the arm (usually mild)
2.) numbness in the arm or difficulty moving shoulder muscles. (due to damaged nerve)
3.) risk of developing a lump scar (keloid) after surgery
4.) If surgery did not remove all the cancer cells and that further treatment may be necessary
(with chemotherapy and/or radiotherapy)