LEFT BREAST

MASTECTOMY
Presented By: Ma. Lormy Bueno,
Jizell Aira Contreras and
Cristalyn Costoy
 Modified Radical Mastectomy (MRM)
INTRODUCTION
Modified Radical Mastectomy is a surgical
procedure primarily performed to treat breast
cancer. It involves the removal of the entire breast
tissue, including the breast skin, areola, nipple, and
most axillary (underarm) ct lymph nodes while
preserving the pectoral muscles.

Origin and Relevance:

MRM has evolved as an effective treatment for
breast cancer, especially in cases of invasive
breast cancer where cancer cells spread to nearby
tissues or lymph nodes. It’s less invasive than a
radical mastectomy (which removes the chest
muscles), allowing quicker recovery while still
addressing the malignancy. This procedure is
crucial in preventing the spread of cancer and in
offering the patient a better quality of life post-
recovery.
 Indications
Primary Indication: Invasive ductal
carcinoma in the left breast with positive
lymph node involvement.

Other Indications:

Large tumor size compared to breast

size
Failure to respond to chemotherapy
Patient preference to avoid breast-
conserving surgery and risk of
recurrence.
CASE SCENARIO Patient J. D. 52 years old, female, married, G1P1
was scheduled for Left Breast Mastectomy due
to her lumps in left breast.

Patient J. D. discovered a lump in her left breast

three months ago. She has experienced
occasional pain and a slight inversion of the
nipple. A mammogram and biopsy were
performed, which confirmed the presence of
invasive ductal carcinoma. After consulting with
her oncology team, she decided to proceed
with a modified radical mastectomy.

Medical History: Hypertension, and history of

smoking (quit 5 years ago), Alcohol drinker
Family History: Sister had breast cancer at age
55
PATHOPHYSIOLOGY
LABS AND DIAGNOSTIC
MAMMOGRAM

A mammogram is an X-ray image

of your breasts. It can be used
either for breast cancer screening
or for diagnostic purposes, such as
to investigate symptoms or
unusual findings on another
imaging test.
LABS AND DIAGNOSTIC
BREAST ULTRASOUND
A breast ultrasound is an imaging
test your provider uses to get
pictures of the inside of your breast.
You might need a breast
ultrasound if your provider wants
another look at an area that was
abnormal or unclear on a
mammogram. Your provider might
also recommend getting a breast
ultrasound in addition to a
mammogram for breast cancer
screenings.
LABS AND DIAGNOSTIC
BIOPSY
A breast biopsy is a procedure to
remove a sample of breast tissue
for testing. The tissue sample is sent
to a lab, where doctors who
specialize in analyzing blood and
body tissue (pathologists) examine
the tissue sample and provide a
diagnosis.
LABS AND DIAGNOSTIC
MRI /MAGNETIC RESONANCE IMAGING
Magnetic resonance imaging (MRI) of
the breast, also called breast MRI, is a
test used to find breast cancer. It also
can help rule out breast cancer when
there are other problems in the breast.
A breast MRI makes pictures of the
inside of the breast. It uses powerful
magnets, radio waves and a
computer to make images with a lot of
detail.
A breast MRI might be done after a
biopsy shows cancer. Breast MRI can
show the extent of the cancer or an
issue with the other breast.
POSITIONING OF THE PATIENT
SUPINE POSTION
The patient will be positioned on her
back (supine) with the arm on the
affected side extended outward to
expose the surgical area (the chest
and axilla). Padding will be applied
to prevent nerve or skin injuries
during the operation.
INSTRUMENTS
KELLY STRAIGHT

KELLY CURVED DEBAKEY

TISSUE FORCEPS W/O TEETH BLADE HOLDER #3

TISSUE FORCEPS W/TEETH
MAYO SCISSORS
INSTRUMENTS

METZENBAUM SCISSORS
BOBCOCK FORCEPS MOSQUITO STRAIGHT FORCEPS OCHSNER FORCEPS

PEANS FORCEPS

ALLIS TISSUE FORCEPS TOWEL CLAMP ADSON WITH TEETH

INSTRUMENTS

ARMY NAVY RETRACTOR RICHARDSON RETRACTOR

SENN MILLER RETRACTOR

MOSQUITO CURVED FORCEPS

TENACULUM FORCEPS
SITE MARKING

The breast to be removed (left

breast)
The incision lines around the breast
and underarm area for lymph node
dissection.
ANESTHESIA

Type: General Anesthesia

(inhalation)
The patient will undergo general
anesthesia to ensure she is
unconscious and pain-free
throughout the procedure. Due to
her history of hypertension,
anesthesia will be managed
carefully, with preoperative
screening and close intraoperative
monitoring of blood pressure.
SKIN PREPERATION
Preoperative Skin Cleansing:

• Use a broad-spectrum antiseptic,

such as chlorhexidine gluconate or
povidone-iodine.
• Apply antiseptic to a wide area,
including the entire chest wall, axilla,
shoulder, neck, and upper arm on the
side of surgery.
• Cleanse in a circular motion, moving
outward from the incision site.
• Allow the antiseptic to dry
completely before draping to
maximize its effectiveness.
SPECIMEN
The breast tissue, including the tumor
and surrounding tissue, as well as the
axillary lymph nodes, will be removed
and sent to pathology. The
histopathological examination will
assess:
Tumor margins: Ensuring no cancer
cells are left at the edges.
Lymph node status: To determine
the extent of cancer spread,
critical for staging and further
treatment planning.
HEALTH TEACHING

WOUND CARE DRAIN MANAGEMENT PAIN MANAGEMENT

If a drain is placed, Review prescribed pain

Instruction on how to
teach her how to empty medications and the
care for the surgical site,
and care for it until it’s importance of adhering
prevent infection, and
removed. to dosage and timing to
recognize signs of
avoid breakthrough
complications (e.g.,
pain.
redness, swelling, fever).
HEALTH TEACHING

LYMPHEDEMA PREVENTION LIFESTYLE MODIFICATIONS DIET AND HYDRATION

Encourage healthy Maintain a healthy,

Teach her to avoid
habits such as a balanced diet with
heavy lifting and
balanced diet, quitting plenty of fluids to
repetitive arm
smoking if necessary, support healing. Include
movements, and explain
and regular follow-up protein-rich foods, fruits,
signs of lymphedema
appointments. vegetables, and whole
(e.g., swelling,
grains.
tightness).
If you experience
nausea from anesthesia
or medication, try
eating small meals and
sipping liquids slowly.
HEALTH TEACHING

PHYSICAL ACTIVITY EMOTIONAL SUPPORT FOLLOW-UP CARE

Emotional recovery is just Regular follow-up
Gradually return to as important as physical appointments with your
normal activities, but recovery. It is normal to surgeon and oncologist
avoid strenuous exercise feel a range of emotions are critical for
or heavy lifting until your after breast cancer monitoring recovery and
doctor clears you to do surgery. discussing further
so. Consider speaking with a treatment options like
Regular walking can counselor or joining a chemotherapy or
help improve circulation support group for radiation therapy.
and promote healing. individuals with breast Make sure to attend
cancer. these appointments to
Lean on your family and ensure that any
friends for support, and complications are
don’t hesitate to ask for identified and
help when you need it. addressed early.
Thank you
very much!