Pre and Post-operative care

of patient for mastectomy

Prepared by:
Gianne T. Gregorio RN
 DEFINITION
• MASTECTOMY - is surgery to remove all
breast tissue from a breast as a way to
treat or prevent breast cancer.
• Mastectomy is used to remove all
breast tissue for breast cancer or
patients with very high risk of
developing it.
• Mastectomy to remove one breast
(unilateral mastectomy)
• both breasts (bilateral mastectomy).
Types of breast surgery includes:
• Total (simple) mastectomy – removal of
breast tissue and nipple
• Modified radical mastectomy – removal
of the breast, most of the lymph nodes
under the arm, and often the lining over
the chest muscles
• Lumpectomy – surgery to remove
the tumor and a small amount of normal
tissue around it
 Risk of Mastectomy
• Bleeding
• Infection
• Pain
• Swelling (lymphedema)
• Formation of hard scar tissue at the surgical
site
• Shoulder pain and stiffness
• Numbness, particularly under your arm, from
lymph node removal
• Buildup of blood in the surgical site
(hematoma)
 Providing preoperative nursing care for
patients who are to undergo
Mastectomy is an integral part of the
therapeutic regimen. The nursing goal
is to provide support, alleviating anxiety,
managing pain, and providing
information.
 Nursing Interventions Rationale
Provides knowledge base for the nurse to enable
reinforcement of needed information, and helps identify
Check out and explore what information patient has about
patient with high anxiety, low capacity for information
diagnosis, expected surgical intervention, and future
processing, and need for special attention. Note: Denial may
therapies. Note presence of denial or extreme anxiety.
be useful as a coping method for a time, but extreme anxiety
needs to be dealt with immediately.

More understanding of procedures and what is happening

Ascertain purpose and preparation for diagnostic tests.
increases feelings of control and lessens anxiety.

Time and privacy are needed to provide support, discuss

Implement an ambiance of concern, openness, and
feelings of anticipated loss and other concerns. Therapeutic
availability, as well as privacy for patient and SO. Suggest
communication skills, open questions, listening, and so forth
that SO be present as much as possible.
facilitate this process.

Encourage questions and provide time for expression of

Provides opportunity to identify and clarify misconceptions
fears. Tell patient that stress related to breast cancer can
and offer emotional support.
persist for many months and to seek help and support.

Rehabilitation is an essential component of therapy intended

to meet physical, social, emotional, and vocational needs so
Consider role of rehabilitation after surgery.
that patient can achieve the best possible level of physical
and emotional functioning.
 Nursing Interventions Rationale

Aids in identifying degree of discomfort and effectiveness of

analgesia. The amount of tissue, muscle, and lymphatic
system removed can affect the amount of pain experienced.
Consider reports of pain and stiffness, noting location,
Destruction of nerves in axillary region causes numbness in
duration, and intensity (0–10 scale). Note reports of numbness
upper arm and scapular region, which may be more
and swelling. Be aware of verbal and nonverbal cues.
intolerable than surgical pain. Note: Pain in chest wall can
occur from muscle tension, be affected by extremes in heat
and cold, and continue for several months.

Provides reassurance that sensations are not imaginary and

Discuss normality of phantom breast sensations.
that relief can be obtained.

Elevation of arm, size of dressings, and presence of drains

Facilitate patient to find position of comfort.
affect patient’s ability to relax, rest and sleep effectively.

Provide basic comfort measures (reposition on back or

unaffected side, back rub) and diversional activities. Promotes relaxation, helps refocus attention, and may
Encourage early ambulation and use of relaxation techniques, enhance coping abilities.
guided imagery, Therapeutic Touch.

Splint or support chest during coughing and deep-breathing

Facilitates participation in activity without undue discomfort.
exercises.

Carry out appropriate pain medication on a regular schedule Maintains comfort level and permits patient to exercise arm
before pain is severe and before activities are scheduled. and to ambulate without pain hindering efforts.

Provides relief of discomfort and pain and facilitates rest,

Administer narcotics or analgesics as indicated.
participation in postoperative therapy.
 Mastectomy Complications
Most patients recover from mastectomy without any problems, but complications
such as infection, lymphedema, and seroma can occur.

•Infection usually manifests as redness and swelling of the incision with pus or
foul-smelling drainage. Fever may also indicate infection.

•Lymphedema may occur when the lymph nodes are removed. The arm on the
affected side sometimes becomes swollen when the lymph system is damaged by
lymph node removal or radiation. Sometimes it resolves on its own, but the
condition can become chronic.

•Seroma occurs when blood or fluid accumulates in an area of the body that has
just undergone surgery. Sometimes the body absorbs it, but if it becomes painful
or infected, it must be removed.
 Post-operative Care
Nursing Interventions Rationale

Handwashing is the single most effective way to prevent

Stress proper hand washing technique
infection

Provide regular catheter care To reduce risk of infection

For first line defense against nosocomial infections or

Instruct on proper wound care
cross contamination

Encourage to eat vitamin C rich foods To promote wound healing

Emphasized necessity of taking antibiotics as directed To boost the immune system

Closely observe and instruct to report signs and

To prevent and detect as early as possible the presence
symptoms of infection such as fever, sore throat,
of any progressing infection
swelling, pain and drainage

Inspect the wound for swelling, unusual drainage, odor Wound infection are accompanied by signs of
redness, or separation of the suture lines inflammation and a delay in healing

Empty and re-establish negative pressure in close wound Negative pressure pulls fluid from the incisional area,
drains at least once per shift which facilitates healing
 Nursing Interventions Rationale
Promotes venous return, lessening possibility of
Elevate affected arm as indicated.
lymphedema.

Facilitate passive ROM (flexion and extension of elbow, Early postoperative exercises are usually started in the
pronation and supination of wrist, clenching and first 24 hr to prevent joint stiffness that can further limit
extending fingers) as soon as possible. movement and mobility.

Lack of movement may reflect problems with the

Have patient move fingers, noting sensations and color
intercostal brachial nerve, and discoloration can indicate
of hand on affected side.
impaired circulation.

Increases circulation, helps minimize edema, and

maintains strength and function of the arm and hand.
Encourage patient to use affected arm for personal
These activities use the arm without abduction, which
hygiene (feeding, combing hair, washing face).
can stress the suture line in the early postoperative
period.

Help with self-care activities as necessary. Conserves patient’s energy, prevents undue fatigue.

Patient will feel unbalanced and may need assistance

until accustomed to change. Keeping back straight
Assist with ambulation and encourage correct posture.
prevents shoulder from moving forward, avoiding
permanent limitation in movement and posture.
Recommendations:
•Proper assessment should be done before
and after operation to prevent post-op
complications such as bleeding.
•Practice aseptic technique all the time - to
prevent infection.
•Inform treating physician for any untoward
complication noted – early detection can
lessen the extent of damage that might
happened to the patient.
 REFERENCE:
https://www.mayoclinic.org/tests-
procedures/mastectomy/basics/definition/prc-20012749

http://www.healthcommunities.com/breast-
surgery/postoperative-care-complications-
mastectomy.shtml

https://nurseslabs.com/mastectomy-nursing-care-plans
Thank You For Listening!