Surgical Treatment for BREAST CANCER

The main goal of surgical treatment is to eradicate the local presence of the
cancer to prevent metastasis on other organs such as the Lungs and bones.

There are two main types of surgical treatment for breast cancer namely:

1. Breast Conserving Surgery

2. Mastectomy

Breast conserving surgery

Breast conserving surgery consists of lumpectomy, wide

excision, partial or segmental mastectomy or quadrantectomy
(resectionof the involved breast quadrant) and removal of axillary nodes
(axillary lymph node dissection).

The goal of breast conservation is to remove the tumor completely with

clear margins while achieving an acceptable cosemetic result.

Lumpectomy Removal of varying amounts of

breast tissue , including the
Wide excision malignant tissue and some
surrounding tissue to ensure
Partial mastectomy
clear margins; axillary lymph
Segmental mastectomy nodes are also removed with
this procedures, if the cancer
Quadrantectomy
was of the invasive type

Removal of some or all fat-

Axillary lymph node dissection enmeshed axillary lymph
nodes for determination of
extent of disease spread.

Mastectomy

Surgery to remove the breast (mastectomy) is important for women

with operable breast cancer who are not candidates for breast
conserving surgeries. There are different variations on the procedure:

• Simple mastectomy (or "total mastectomy"): In this

procedure, the entire breast tissue is removed, but axillary
contents are undisturbed. Sometimes the "sentinel lymph
node"--that is, the first axillary lymph node that the
metastasizing cancer cells would be expected to drain into—is
 removed. This surgery is sometimes done bilaterally (on both
breasts) on patients who wish to undergo mastectomy as a
cancer-preventative measure. Patients who undergo simple
mastectomy can usually leave the hospital after a brief stay.
Frequently, a drainage tube is inserted during surgery in their
chest and attached to a small suction device to remove
subcutaneous fluid. These are usually removed several days
after surgery as drainage decrease to less than 20-30 ml per
day.

• Modified radical mastectomy: The entire breast tissue is

removed along with the axillary contents (fatty tissue and lymph
nodes). In contrast to a radical mastectomy, the pectoral
muscles are spared.

• Radical mastectomy (or "Halsted mastectomy"): First

performed in 1882, this procedure involves removing the entire
breast, the axillary lymph nodes, and the pectoralis major and
minor muscles behind the breast. This procedure is more
disfiguring than a modified radical mastectomy and provides no
survival benefit for most tumors. This operation is now reserved
for tumors involving the pectoralis major muscle or recurrent
breast cancer involving the chest wall.

COMPLICATIONS:

- Hematoma at incision site

- Infection

- Accumulation of serosanguinous fluid

- Nerve trauma

- Numbeness, tingling and burning sensations

- Impaired arm and shoulder mobility

- Lymphedema

Psychological effects:

- Altered body image of self concept as a result in alteration or loss of

breast
 - Fear of reccurence

Pos-operative care:

- Relieve pain and discomfort

o Elevation of the extremity in moderate relieves pain because it

decrease tension

o Analgesics

- Maintain skin integrity and preventing infection

o Dressings and drains should be inspected.

- Promote positive body image

o Provide privacy for the patient when inspecting incision site

o Allow the patient to express feelings to the nurse

o Explain that feelings are normal

- Promote positive adjustment and Coping

o Encourage patient to discuss issues and concerns

o Provide emotional support

- Participation in Care

o Encourage ambulation

o Encourage to do exercises for arms, chest shoulder, hands to

restore full range of motion

Exercise after Breast surgery:

1. Wall handclimbing- stand facing the wall with feet apart and toes as
close to the wall as possible.

2. Rope turning – tie rope to door knob. Stand facing the door and make wide
swings as possible. Begin slowly at first. Speed up later.

3. Rod of broomstick lifting- grasp a rod with both hands, held about 2 feet
apart. Keeping the arms straight, raise rod over head.
4. Pulley tugging- toss a light rope over a shower curtain rod. Pull the left arm
up by tugging the down with the right arm.

DISCHARGE PLAN

MEDICATIONS

Analgesics

EXCERCISE

Encourage patient for ambulation and teach patient how to

perform exercises for breast surgery patients

TREATMENT

Antibiotic for incase of infectionsa

HYGIENE

Encourage patient to do self care such as management of

drainage.

OUT-PATIENT

Follow up visits every 3 months for 2 years, followed by 6

months for 5 years. Encourage and teach patient to perform BSE between
appointments.

DIET

DAT diet
JERICHO JAMES TOPACIO

BSN 4-3