MASTECTOMY CASE

1. What is Mastectomy?
- A Mastectomy is a surgery that removes one or both breasts to treat or prevent
breast cancer. For patients with early-stage breast cancer, a mastectomy may be
one treatment option. Breast-conserving surgery (lumpectomy) in which only the
tumor is removed from the breast may be another option.
Types of Mastectomies
● Simple (or total) mastectomy - in this procedure, the surgeon removes the
entire breast, including the nipple, areola and some skin. Some underarm lymph
nodes may be removed depending on the situation.
● Skin-sparing mastectomy - the majority of the skin over the breast is left intact
during this procedure. The breast tissue nipple, and areola are the only parts
removed. The amount of breast tissue removed is the same with the simple
mastectomy, and implants or tissue from other parts of the body can be used to
reconstruct the breast during the surgery.
● Nipple-sparing mastectomy - a procedure that leaves the nipple and areola
intact, along with the breast skin. All the breast tissue underneath the nipple,
areola, and breast skin is removed. The tissue beneath the nipple and areola are
checked for cancer. If cancer is detected, the nipple and areola are then
removed.
● Radical Mastectomy - a surgery in which the breast, chest muscles, and all of
the lymph nodes under the arm are removed. This was the breast cancer
operation used most often during the past, but it is used rarely now. Doctors
consider radical mastectomy only when the tumor has spread to the chest
muscles.
● Modified radical Mastectomy - it is a procedure in which the entire breast is
removed including the skin, areola, nipple, and most axillary lymph nodes, but the
pectoralis major muscle is spared. A modified radical mastectomy was the
primary method of treatment for breast cancer.
● Double Mastectomy - also known as a bilateral mastectomy. It is a surgery in
which both breasts are removed at the same time to remove or reduce the risk of
breast cancer in women who are at high risk for the disease.

2. What causes a patient to undergo Mastectomy?

● If a patient has Breast cancer or is at very high risk of developing it
- Mastectomy may be recommended for patients with big, malignant, or
centrally placed tumors. Mastectomy is advised if there are insufficient
margins surrounding the primary tumor and the breast is too small for a
more comprehensive excision. 5-10% of breast cancer cases are thought
to be hereditary, they are the direct outcome of gene alterations
(mutations) passed down from a parent. BRCA1 and BRCA2: An inherited
mutation in the BRCA1 or BRCA2 gene is the most common cause of
hereditary breast cancer. That is why some women who think that they
 are at risk tend to undergo mastectomy to prevent the cancer in
progressing, this includes well known actress Angelina Jolie
● Body dysphoria
- Body dysmorphic disorder is a mental health condition in which you can't
stop obsessing about one or more perceived flaws in your appearance,
even if they're minor or hidden from others. However, you may be
humiliated, ashamed, and anxious to the point where you avoid many
social situations. Some women perceive having breasts as a defect on
their body which makes them want to undergo the operation
● Body transitioning
- Transgender men's chest wall contouring, usually via mastectomy, is
often their first and only surgical procedure. Moreover, studies have
demonstrated that masculinizing chest restoration improves psychosocial
functioning and quality of life. Undergoing mastectomy makes the patient
feel more satisfied and contented with their body because they feel like a
huge weight has finally been removed from their chest (literally), and the
feeling of being one step closer to your dream body is a bliss

3. What are the possible laboratory work-ups that will order by the surgeon to the
patient before undergo Mastectomy?
● Mammogram
- A mammogram is an X-ray picture of the breast. It is used to look for early
signs of breast cancer. Regular mammograms are the best tests to find
breast cancer early.
● Ultrasound
- Ultrasound imaging of the breast uses sound waves to produce pictures
of the internal structures of the breast. It is used to help diagnose breast
lumps or other abnormalities found during a physical exam, or on a
mammogram or breast MRI. Ultrasound is safe, noninvasive, and does
not use radiation.
● MRI
- Magnetic resonance imaging of the breast uses a powerful magnetic field,
radio waves, and a computer to produce detailed pictures of the
structures within the breast. It is primarily used as a supplemental toll to
breast screening with mammography or ultrasound. Breast MRI does not
use ionizing radiation, and it is the best method for determining whether
silicone breast implants have ruptured.
● Bone Scan, PET Scan, or CT Scan
- Depending on the patient's pathology, if at risk for distant disease, a bone
scan, PET scan, and/or CT scans may be recommended to check for
metastases.

Preoperative Tests to make sure that the patient is in stable condition to receive
anesthesia.
 ● Chest X-Rays
- Chest X-rays. X-rays can help diagnose causes of shortness of breath,
chest pain, cough, and certain fevers. They can also help diagnose
abnormal heart, breathing, and lung sounds.
● EKG
- This test records the heart's electrical activity. It detects abnormal cardiac
rhythms (arrhythmias or dysrhythmias), detects heart muscle injury, and
aids in the diagnosis of chest discomfort, palpitations, and heart murmurs.
● Blood Tests
- Glucose. This test determines how much sugar is in the blood.
- Potassium. The quantity of potassium, sodium, and other electrolytes in
your blood is measured with this test. These substances aid in the
regulation of cardiac rhythms and other bodily activities.
a full blood count
- (CBC). This test looks for anemia (low red blood cell count) and infection.
Coagulation tests
- (PT/PTT) are used to determine how well blood clots. The purpose of
these tests is to determine how effectively the blood clots.
4. What will be the nursing considerations to the patient before undergo Mastectomy
procedure?
○ Education and Preparation for Surgery - As a nurse, you play a significant role
in effectively educating your patient and addressing any concerns. Start by giving
her an overview of what she can expect before, during and after the surgery.
Explain that she will most likely spend the first night after the operation in the
hospital and that she might have a surgical drain inserted. If a drain is inserted,
she will probably have to go home with it. In that case, information about drain
care will be given before discharge.
○ Do not eat or drink anything after midnight on the night before your surgery
- any medications that you take routinely should be taken at the usual time with a
sip or two of water. People with diabetes, heart disease and other illnesses
should contact their primary care doctor for directions. Inform us if you are taking
Coumadin or other blood thinning medication.
○ Do not take aspirin or aspirin-containing products for 10 days before your
surgery - Tylenol is okay. Also, stop taking vitamin E supplements two weeks
before your surgery or as soon as possible, although vitamin E in a multivitamin
is OK.
○ Wear comfortable clothing - A two-piece, loose fitting outfit with a zipper or
buttons is comfortable and really easy to put on. Some women prefer a loose
dress with a zipper or buttons in front. Please bring it with you.
○ Discuss normality of phantom breast sensations - Provides reassurance that
sensations are not imaginary and relief can be obtained.
○ Managing anxiety and fear- As a nurse, your goal should be to treat the patient
holistically, including psychological, emotional, and social issues. So pay
 attention to your patient's emotions, because a mastectomy can generate anxiety
about body image, reliance, recuperation, and the healing process.
5. What are the post-operative management to consider and health education to
post-Mastectomy patients?
● Pain Management
- The goal of pain management is to assess the level of discomfort of the
patient and to give medication as needed. The patient will have better
results controlling pain if he takes pain medication before the pain is
severe.
- Pain medication such as Vicodin, Ibuprofen or Tylenol are recommended
to take for pain when pain is experienced on a regular schedule.
Everyone is different and if one plan to decrease the patient's pain is not
working, it will be changed. Healing and recovery improve with good pain
control.
- After a lymph node dissection, an ice pack might help relieve pain and
swelling, especially in the armpit. A little cushion placed in the armpit may
also help to alleviate soreness.
● Incision and Dressing Care
- Do not remove the dressing, steri-strips or stitches. In seven to ten days,
the dressing will be removed. Unless the sutures absorb on their own, we
will remove them in one to two weeks. Do not attempt to replace the
dressing or steri-strips if they fall off.
- If you have a plastic dressing and the drain(s) are out, you may shower
the next day.
- If you have gauze and paper tape applied, you can take it off two days
following surgery and shower. After showering, carefully dry your incision
with a towel. Avoid touching or removing the steri-strips or sutures.
● Activity
- Until the sutures are removed, avoid strenuous activities, heavy lifting,
and severe exercise. Inform your caregiver about your activities, and he
or she will assist you in developing a personal plan.
- Walking is a common activity that may easily be resumed.
● Diet
- After you've recovered from anesthesia and are able to consume fluids,
you can resume your usual diet.
- We recommend drinking eight to ten glasses of water and non-caffeinated
beverages every day, as well as eating lots of fruits and vegetables and
avoiding high-fat meals.
- Encourage patient to eat vitamin C rich foods to promote wound healing.
● Follow-Up Care
- At your post-operative appointment, the dressing will be changed or
removed.
- The pathology results from your surgery should be available within one
week after your surgery.
References:
● UCSF Health. (2019, March 14). Mastectomy: Instructions After Surgery. Ucsfhealth.org;
UCSF Health.
https://www.ucsfhealth.org/education/mastectomy-instructions-after-surgery
● ‌Tests Done Before Surgery. Johns Hopkins Medicine. (n.d.).
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tests-performed-b
efore-surgery.
● Acr, R. A. (2020, January 29). Ultrasound - Breast. Radiologyinfo.Org.
https://www.radiologyinfo.org/en/info/breastus
● What tests will I undergo before a mastectomy?: Breast cancer treatment. Sharecare.
(n.d.). Retrieved November 23, 2021, from
https://www.sharecare.com/health/breast-cancer-treatment/what-tests-undergo-before-m
astectomy.
● Mastectomy: Mastectomies for breast cancer. American Cancer Society. (n.d.).
Retrieved November 23, 2021, from
https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/mastec
tomy.html.
● Acr, R. A. (2021, July 30). Magnetic Resonance Imaging (MRI) - Breast.
Radiologyinfo.Org.
https://www.radiologyinfo.org/en/info/breastmr#:%7E:text=Magnetic%20resonance%20i
maging%20(MRI)%20of,screening%20with%20mammography%20or%20ultrasound.