1. The document describes a radical mastectomy procedure which involves removing the entire breast, nipple, areola and nearby lymph nodes and chest wall muscles. 2. A radical mastectomy is indicated for breast tumors that have grown into the chest wall muscles, while a modified radical mastectomy spares the pectoralis major muscle. 3. The document outlines the anatomy of the breast, equipment used in a mastectomy including surgical tools and sentinel lymph node tracing techniques, post-operative care activities, and risks of the procedure such as bleeding, infection and lymphedema.

1. Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Heritage City of Vigan
College of Nursing
Website: www.unp.edu.ph
Radical Mastectomy
In Partial Fulfillment
Of the Course Requirements in
NCM 112 Related Learning Experience (RLE)
Submitted by:
Kyle Audrie A.
Arcalas
BSN III-A

2. INTRODUCTION
A mastectomy is a surgical procedure involving removal of all or part of the breast. The term
originates from the Greek word mastos, meaning woman's breast and the Latin term ectomia which signifies
excision of. Mastectomy classifies into partial, simple, modified-radical, and radical. This activity describes
the indications, contraindications, and complications of mastectomy and highlights the role of the
interprofessional team in the management of patients with breast cancer.
Radical mastectomy involves the complete removal of a person's breast, areola, nipple, nearby
lymph nodes, and muscles of the chest wall. Surgeons only perform this surgery when a tumor has grown
into the chest wall muscles. People will likely need assistance when recovering at home. A modified radical
mastectomy 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. Historically, a modified radical
mastectomy was the primary method of treatment for breast cancer. As the treatment of breast cancer
evolved, breast conservation has become more widely used. However, mastectomy still remains a viable
option for women with breast cancer.
A mastectomy is an umbrella term used for several techniques to remove one or both breasts. In
addition, the surgeon may also remove nearby lymph nodes to determine whether the cancer has spread.
During an axillary node dissection, the surgeon removes a number of lymph nodes from your armpit on the
side of the tumor. In a sentinel lymph node biopsy, your surgeon removes only the first few nodes into
which a tumor drain (sentinel nodes). Lymph nodes removed during a mastectomy are then tested for
cancer. If no cancer is present, no further lymph nodes need be removed. If cancer is present, the surgeon
will discuss options, such as radiation to your armpit. If this is what you decide to do, no further lymph
nodes will need to be removed. Removing all of the breast tissue and most of the lymph nodes is called a
modified radical mastectomy. Newer mastectomy techniques remove less tissue and fewer lymph nodes.

3. Patients are placed in the operating room table in the supine position, with the arm at a 90-degree
angle from the body

4. INDICATIONS
 Prior radiation therapy to the breast or chest wall.
 Radiation therapy contraindicated by pregnancy (except patients in the third trimester who can
receive radiation postpartum)
 Inflammatory breast cancer.
 Diffuse suspicious or malignant-appearing microcalcifications.
RISKS OF A MASTECTOMY INCLUDE:
 Bleeding.
 Infection.
 Pain.
 Swelling (lymphedema) in your arm if you have an axillary node dissection.
 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)
TYPE OF ANESTHESIA
Combined paravertebral block and general anesthetic is our preferred method of anesthesia for
mastectomy as it results in excellent perioperative analgesia, a reduction in the incidence of PONV, greater
patient satisfaction, and the potential for earlier hospital discharge.

5. ANATOMYAND PHYSIOLOGY
The breast is found on the anterior thoracic wall and overlies the pectoralis major muscle. The
superior border of the mature female breast approaches the level of the second or third rib and then extends
inferiorly to the inframammary crease or fold. The medial boundary of the breast is the sternal border.
Laterally, the breast extends to the mid-axillary line. Posteriorly, approximately two-thirds of the breast
overlies the pectoralis major muscle, and the remaining portion overlies the serratus anterior and upper
portion of the oblique abdominal muscles The portion of the upper breast that extends superior-laterally
toward the axilla is often referred to as the axillary tail of Spence. The breast divides into four quadrants
which allow for consistency in the documentation of findings on physical examination or breast imaging.
The four quadrants are upper inner, upper outer, lower inner and lower outer. The majority of breast tissue
resides in the upper outer quadrant, including the axillary tail of Spence. As a result, it is the most common
location for breast cancers. The breast is composed of mammary tissue and covered by subcutaneous fat
and skin and possesses superficial and deep fascial layers. The superficial layer of fascia is deep to the

6. dermis and covers the breast anteriorly and then extends over the medial and lateral breast. The deep layer
of superficial fascia covers the posterior surface of the breast and lies anterior to the pectoralis major fascia.
EQUIPMENTUSED
Mastectomy may be performed using sharp dissection with a scalpel or scissor technique. Another
alternative is to use an energy device such as electrocautery or one of the various ultrasonic devices for
dissection of the breast from the superficial tissues and to release the posterior attachments from the chest
wall. Standard general surgery equipment, including retractors and suction, are often utilized. At the
discretion of the surgeon, a temporary, closed suction drain (i.e., Jackson Pratt drain) may be placed in the
wound bed to decrease the rate of seroma formation. Absorbable suture is the most common choice for
closure of the mastectomy defect and incision.
Axillary sentinel lymph node biopsy is commonly an option for staging purposes at the time of
definitive breast surgery. Most surgeons employ a dual tracer technique, which typically involves the use
of technetium sulfur colloid which is injected into the breast preoperatively by the nuclear medicine
department of radiology. Intra-operatively many surgeons will inject a vital blue dye, such as methylene
blue or isosulfan blue, into the breast to aid in the identification of axillary sentinel lymph nodes. A gamma
probe is required to detect any nuclear tracer uptake in the axilla and to guide dissection and exploration in
this region for biopsy.
Breast Surgery Post-Operative Care
 Monitor vital signs such as pulse, breathing and blood pressure.
 Take your temperature.
 Monitor for signs of complications.
 Check your incisions and surgical drains.
 Check intravenous infusions.

7.  Monitor your urine output.
 Maintain your comfort with body positioning and pain medication.