INTRODUCTION

We prefer to study the case of Mastectomy because it is not common among the
cases that we assisted. It interests us because among the three groups who rotated in
the OR, only our group, the God- Centered, handled a different case like Modified
Radical Mastectomy. It also caught our attention because majority of the God-Centered
Group are females, it will enhance our awareness about the underlying disease.

Mastectomy

Mastectomy is an operation in which the entire breast, usually including the

nipple and the areola, is removed. Mastectomy is usually performed as a treatment of
breast cancer. In general, women with breast cancer can decide whether to be treated
with a lumpectomy or a mastectomy. A lumpectomy is the removal of the cancerous
breast tissue as well as a surrounding rim of healthy breast tissue. A lumpectomy is a
breast-conserving surgery that is usually followed by radiation therapy (high-dose x-rays
or other high-energy rays to kill cancer cells).
A woman may decide to have a mastectomy versus a lumpectomy based on the
following:

• If the tumor is big and, after the lumpectomy, very little breast tissue would
remain
• If she does not want to undergo radiation therapy after the surgery
• If she believes she will have less anxiety about a recurrence of breast cancer
with a mastectomy.
GENERAL TYPES OF MASTECTOMY

A SUBCUTANEOUS MASTECTOMY removes the entire breast, but leaves the nipple
and areola (the pigmented circle around the nipple) in place.

TOTAL (OR SIMPLE) MASTECTOMY is the removal of the whole breast, but not the
lymph nodes under the arm (axillary nodes).

In a MODIFIED RADICAL MASTECTOMY, the whole breast and most of the lymph
nodes under the arm (axillary nodes) are removed. Removal of these lymph nodes is
called an axillary dissection.
RADICAL MASTECTOMY involves 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. It is
mostly of historical interest.

Other Types of Mastectomy

QUANDRANTECTOMY: removal of a quarter of the breast, including the skin and

breast fascia (connective tissues). The surgeon may also perform a separate procedure
to remove some or all of the axillary (armpit) lymph nodes, either an axillary node
dissection or a sentinel node biopsy.

PARTIAL or SEGMENTAL Mastectomy: removal of a portion of the breast tissue and

a margin of normal breast tissue. This procedure usually involves removing less tissue
than a quandrantectomy but more than a lumpectomy or wide excision.
LUMPECTOMY or WIDE EXCISION: removal of the breast cancer tumor and a
surrounding margin of normal breast tissue.

EXCISIONAL BIOPSY: also the removal of the breast tumor and a surrounding margin
of normal breast tissue. Sometimes further surgery is not needed if an excisional biopsy
successfully removes the entire breast cancer tumor. This is most likely to occur if the
breast tumor is very small. An excisional biopsy may be performed with "needle" or
"wire" localization.

Mastectomy Preparation

• A few days before the surgery, a health-care provider evaluates the woman's
overall health to ensure that she is fit for the surgery.
• Several tests, such as routine blood workup, urinalysis, and electrocardiogram
(ECG), may be performed a few days before the surgery.
• Before the surgery, the anesthesiologist examines the woman and reviews the
test results.
• If the woman is taking any medication or is allergic to any medication, the
surgeon and the anesthesiologist should be informed. The surgeon and the
anesthetist should also be informed if the woman is taking any herbal
supplements. Some herbal supplements, such as ginkgo, can increase a
person's risk of bleeding and, therefore, should be discontinued before surgery.
• If the surgery is scheduled for early morning, the woman is required to not eat or
drink anything after midnight on the night prior to the surgery.
• Showering with an antibacterial soap the night before the surgery may be
required.
• A woman should follow any other instructions given by the health-care provider.
• The woman will be asked to sign a consent form stating that she understands the
risks involved in the surgery. She should feel free to ask the surgeon and the
anesthesiologist any questions prior to signing the consent form.
The Instruments

• Major instruments tray

• Vascular Hemoclips or USSC traumatic clip applier (regular size)
• Lahey Clamps
• 2 Blake Drains
• Skin Stapler or Marking Pen
• Kidney basin
• Knife
• Electrosurgical pencil
• Suction tubing

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.

• 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.

 • The surgeon removes the underlying breast tissue. This breast tissue is removed
and sent to a pathology laboratory for analysis. A pathologist examines the tissue
under a microscope to determine if it is benign (noncancerous) or malignant
(cancerous).

• 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.

• A pressure dressing may be placed over the operation site to minimize the
oozing after the surgery.

• 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

• After surgery, the woman is taken to a recovery room where her vital signs (blood
pressure, pulse, and breathing) are monitored. Once stable, she is moved out of
the recovery room.
• Depending on the severity of her pain, the woman may be given pain
medications orally or by intravenous injection. The medication does not eliminate
pain, but it does reduce the pain.
• A woman undergoing a mastectomy generally stays in the hospital for one to
seven days, depending on the type of mastectomy and the type of
reconstruction, if any. A few women are able to go home the night of their
mastectomy.
Aftercare

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. Aftercare can
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. Patients may stay in the hospital for one to two days. For about five to
seven days after surgery, there will be one or two drains left inside to remove any extra
fluid from the area after surgery. Usually, the surgeon will prescribe medication to
prevent pain. Movement restriction should be specifically discussed with the surgeon.

Risks

There are several risks associated with modified radical mastectomy. The
procedure is performed under general anesthesia, which itself carries risk. Women may
have short-term pain and tenderness. The most frequent risk of breast cancer surgery
(with extensive lymph node removal) is edema, or swelling of the arm, which is usually
mild, but the presence of fluid can increase the risk of infection. Leaving some lymph
nodes intact instead of removing all of them may help lessen the likelihood of swelling.
Nerves in the area may be damaged. There may be numbness in the arm or difficulty
moving shoulder muscles. There is also the risk of developing a lump scar (keloid) after
surgery. Another risk is that surgery did not remove all the cancer cells and that further
treatment may be necessary (with chemotherapy and/or radiotherapy). By far, the worst
risk is recurrence of cancer. However, immediate signs of risk following surgery include
fever, redness in the incision area, unusual drainage from the incision, and increasing
pain. If any of these signs develop, it is imperative to call the surgeon immediately.
FOLLOW-UP VISIT

• The first follow-up visit occurs about one week after the surgery to make sure the
incision is healing well and that no postoperative complications are present.

o During this visit, the surgeon explains the results of the biopsy and, if
necessary, discusses any further treatment (chemotherapy [using
medications to kill cancer cells], radiation therapy, or both).
o
o Stitches that dissolve by themselves are often used to close the incision. If
the surgeon used nondissolving stitches or clips, they are removed during
the first follow-up visit.
• Drainage tubes are usually removed (typically within two weeks) when the
amount of fluid draining from the operation site decreases to an acceptable
volume.

When to Seek Medical Care

A woman should contact a health-care provider if any of the following occur after a
mastectomy:

• fever,

• signs of an infection (such as excessive redness at the incision site),

• increased drainage of fluid, or

• the stitches come out.