MASTECTOMY

TYPES
OF

MASTECTOMY

Radical mastectomy
aims at removing the breast, the breast, underlying muscles and all of the axilla; axilla; this operation is rarely done.

Total or simple mastectomy The removal of the complete breast only (subcutaneous tissue, skin, nipple).

Lumpectomy
aimed at taking only lump, the cancerous lump with some biopsies of the lymph nodes of the axilla. axilla Radiation therapy is usually given after this type of operation.

Partial mastectomy
The removal of the cancerous part of the breast tissue and some normal tissue around it it. More tissue is removed in partial mastectomy than in lumpectomy.

Subcutaneous mastectomy

Aka ("nipple-sparing") ("nipplemastectomy, all of the breast tissue is removed, but alone. the nipple is left alone

Modified radical mastectomy

Aims at removing the breast, breast some of the underlying covering of the muscles and muscles, possibly part of the muscle. muscle Some of the lymph nodes of the axilla are also taken out during this type of operation.

Anatomy and Physiology of : BREAST

breasts are a secondary sex characteristic; characteristic that is reproduction can occur without them The physiologic function of female breast is milk secretion to feed infants. . An average nonlactating breast weighs 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 surrounded by a circular pigmented area, called the areola.

The sebaceous glands (Montgomerys glands) enlarge to lubricate the nipple during pregnancy and lactation.

FUNCTIONS OF THE BREAST

The following physiologic changes affect the breast: Growth and development The menstrual cycle Pregnancy and lactation

LYMPHATIC DRAINAGE There are three types of lymphatic drainage of the breast. kCutaneous or superficial lymphatic drainage from the skin. kAreolar lymphatic drainage from the areola and nipple kGlandular lymphatic drainage from deep glandular tissue

PATHOPHYSIOLOGY OF
BREAST CANCER

TYPES:
invasive noninvasive (often referred to as in situ)

two types of noninvasive breast cancers:

ductal carcinoma in situ (DCIS) (DCIS) cancer cells are found in the lining of the duct lobular carcinoma in situ (LCIS) LCIS) cancer cells are found in the lobules.

two types of invasive breast 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 an indicator of the tumors 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 in the ductal-lobular epithelial cells of the breast and spread via the lymphatic system to the 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 0 noninvasive carcinomas (LCIS or DCIS). Cancer cells have not invaded the surrounding breast tissue.

Stage I the tumor is no more than 2 cm in size and cancer cells have not spread beyond the breast.

Stage II either the tumor has spread to the lymph nodes under the arms but the tumor is less than 2 cm in size, or the tumor has not spread to the lymph nodes under the arms but is greater than 5 cm in size, or the tumor is between 2 and 5 cm and may or may not have spread to the nodes.

Stage III the tumor is greater than 5 cm in size and has spread to the lymph nodes under the arms.

Stage IV the cancer has spread to other prts of the body (metastatic cancer).

NURSING RESPONSIBILITIES Preoperative Antiembolitic hose may be put on the legs, 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 straining back muscles, to prevent pressure damage to tissue, and for comfort.

Monitor vital signs. Use a gentle circular motion beginning at the 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 on the affected side. For lesions in the upper outer quadrant, include the axilla. The scrub is performed with a gentle touch, as cancer cells could (theoretically) be dislodged from the specimen into the bloodstream if vigorous scrubbing were done.

Check chart for patient sensitivities and allergies, including to latex products, e.g., gloves, drains (such as Penrose), or elasticized dressings (such as pressure bandages).

Assess hemodynamic factors, e.g., keep the patients legs uncrossed and apply antiembolitic hose before positioning the patient, if requested.

Intraoperative 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 hold the patients hand during the administration of anesthesia, etc.

 The patients arm on the affected side is held up in a tube, or impervious stockinette as a drape sheet is placed under the axilla. The field around the breast is draped with folded towels. The arm is brought through the fenestration of a laparotomy sheet.

Postoperative

Provide emotional support regarding feelings of altered body image for the mastectomy patient in particular, considering the emotional nature of this surgery. Give the patient an opportunity to express his or her feelings.

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. Instruct patient that bruising and some swelling are common in women after surgery

Educate patient that a low-grade fever that is less than 100 degrees Fahrenheit is normal the day after surgery.

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

 Encourage patient to increase fluid intake 8-10 glasses of water and noncaffeinated 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.

Instruct patient to avoid strenuous activity, heavy lifting and vigorous exercise until the stitches are removed.

RECOMMENDED EXERCISE AFTER MASTECTOMY