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Second Semester S.Y. 2022-2023

Nursing Care Management 42120 RLE

PARTIAL
MASTECTOMY
Sentinel Lymph Node Dissection with Frozen Section
____
In Partial Fulfillment of the Requirements in the Course
NCM 42120L

Prepared by:
Consolacion, Jill Rae L.
BSN 4-A (Group 2)

Presented to:
UPHSD Nursing Faculty

March 2023

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (02) 8871-0639
www.perpetualdalta.edu.ph
Las Piñas Campus
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INTRODUCTION

A partial mastectomy is a surgical procedure that removes cancer or other abnormal tissue from the breast and
some normal tissue around it, but not the breast itself. Some lymph nodes under the arm may be removed for
biopsy. Part of the chest wall lining may also be removed if the cancer is near it. Also called breast-conserving
surgery, breast-sparing surgery, lumpectomy, quadrantectomy, and segmental mastectomy.

Risks

As with any surgery, partial mastectomies come with potential risks. These can include:

• bleeding
• infection
• pain, swelling, or tenderness near the incision site
• formation of hard scar tissue at the surgical site
• shoulder pain and stiffness
• numbness, under the arm due to lymph node removal
• buildup of blood in the surgical site

Complications

Most patients recover 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

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (02) 8871-0639
www.perpetualdalta.edu.ph
Las Piñas Campus
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Preparation for the Surgery

• Stop taking aspirin or other blood-thinning medication - A week or longer before your surgery, talk
to your provider about which medications to avoid because they can increase your risk of excessive
bleeding.
• Don't eat or drink 8 to 12 hours before surgery.
• Prepare for a hospital stay.

What to expect?

Before surgery

A mastectomy without reconstruction usually takes one to three hours. The patient will probably meet your
anesthesiologist before the surgery to talk about her medical history, any allergies she may have, and the plan for
administering anesthesia during the surgery. The surgeon or their assistant may draw markings on the breast that
show where the incision will be made. Usually this is done with a felt-tip marker. The patient will be sitting up
while this happens so that the natural crease of your breast can be marked.

During surgery

A mastectomy without immediate breast reconstruction can take 1-3 hours. If immediate breast reconstruction is
performed during the mastectomy, the surgery will take longer (about 3 to 4 hours for reconstruction with tissue
expanders or breast implants and 6 to 8 hours for reconstruction with tissue flaps). During the mastectomy, the
surgeon separates the breast tissue from the skin and muscle. All the breast tissue that the surgeon can see —
which lies between the collarbone and ribs, from the side of the body to the breastbone in the center — is removed.
Regardless of the type of mastectomy you have, the breast tissue and lymph nodes that are removed will be sent
to a laboratory for analysis. As the surgery is completed, the incision is closed with stitches (sutures), which either
dissolve or are removed later. The patient might also have one or two small plastic tubes placed where the breast
was removed. The tubes will drain any fluids that accumulate after surgery. The tubes are sewn into place, and
the ends are attached to a small drainage bag.

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (02) 8871-0639
www.perpetualdalta.edu.ph
Las Piñas Campus
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PERPETUAL HELP
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After surgery

The patient may expect to:

• Be remain in the hospital for 1 or 2 days typically

• Be taken to a recovery room where your blood pressure, pulse and breathing are monitored
• Have a dressing (bandage) over the surgery site
• Feel some pain, numbness, and a pinching sensation in your underarm area
• Receive instructions on how to care for yourself at home, including taking care of their incision and drains,
recognizing signs of infection, and understanding activity restrictions
• Talk with their health care team about when to resume wearing a bra or wearing a breast prosthesis
• Be given prescriptions for pain medication and possibly an antibiotic.

NURSING MANAGEMENT (PRE-OPERATIVE AND POST-OPERATIVE)

To provide support, alleviating anxiety, managing pain, and providing information.

PRE-OPERATIVE NURSING RESPONSIBILITIES

Time and privacy are needed to provide support.

Implement an ambiance of concern, openness, and Discuss feelings of anticipated loss and other
availability, as well as privacy for patient. concerns. Therapeutic communication skills, open
questions, listening, and so forth facilitate this
process.
Encourage questions and provide time for Provides opportunity to identify and clarify
expression of fears. misconceptions and offer emotional support.
The amount of tissue, muscle, and lymphatic system
Consider reports of pain and stiffness, noting removed can affect the amount of pain experienced.
location, duration, and intensity (0-10 scale). Note Destruction of nerves in axillary region causes
reports of numbness and swelling.

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (02) 8871-0639
www.perpetualdalta.edu.ph
Las Piñas Campus
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numbness in upper arm and scapular region, which

may be more intolerable than surgical pain.
Elevation of arm, size of dressings, and presence of
Facilitate patient to find position of comfort. drains affect patient’s ability to relax, rest, and sleep
effectively.
Provide basic comfort measures (repositioning on Promotes relaxation, helps refocus attention, and
back or unaffected side, back rub) and diversional may enhance coping abilities.
activities. Encourage early ambulation and use of
relaxation techniques.

POST - OPERATIVE NURSING RESPONSIBILITIES

Stress proper handwashing technique. Handwashing is the single most effective way to
prevent infection.
Encourage to eat vitamin C rich foods To promote wound healing
Instruct the patient to avoid strenuous activity, heavy Doing overly vigorous or strenuous exercises too
lifting, and vigorous exercise. soon following a surgical procedure can be
detrimental to the body's healing process.
Emphasized necessity of taking antibiotics as To boost the immune system
directed.
Closely observe and instruct to report signs and To prevent and detect as early as possible the
symptoms of infection such as fever, sore throat, presence of any progressing infection.
swelling, pain, and drainage.
Inspect the wound for swelling, unusual drainage, Wound infections are accompanied by signs of
odor, redness, or separation of the suture lines. inflammation and a delay in healing.
Facilitate passive ROM (flexion and extension of Early postoperative exercises are usually started in
elbow, pronation, and supination of wrist, clenching the first 24 hr. to prevent joint stiffness that can
and extending fingers) as soon as possible. further limit movement and mobility.

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (02) 8871-0639
www.perpetualdalta.edu.ph
Las Piñas Campus
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Help with self-care activities as necessary. Conserve patient’s energy, prevents undue fatigue.
Patient will feel unbalanced and may need assistance
Assist with ambulation and encourage correct until accustomed to change. Keeping back straight
posture. prevents shoulder from moving forward, avoiding
permanent limitation in movement and posture.

References:

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/partial-mastectomy. (2011, February 2).

Www.cancer.gov. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/partial-mastectomy

Partial mastectomy: What is it, what to expect, and recovery. (2019, June 27).

Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/325570

Gianne Gregorio. (2018, June 15). Pre and post of care for mastectomy.

https://www.slideshare.net/GianneGregorio/pre-and-post-of-care-for-mastectomy

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (02) 8871-0639
www.perpetualdalta.edu.ph
Las Piñas Campus