Pre and post op care for mastectomy

1. Pre and Post-operative care
of patient for mastectomy
Prepared by:
Gianne T. Gregorio RN

2. DEFINITION
• MASTECTOMY - is surgery to remove all
breast tissue from a breast as a way to
treat or prevent breast cancer.
• Mastectomy is used to remove all
breast tissue for breast cancer or
patients with very high risk of
developing it.
• Mastectomy to remove one breast
(unilateral mastectomy)
• both breasts (bilateral mastectomy).

3. Types of breast surgery includes:
• Total (simple) mastectomy – removal of
breast tissue and nipple
• Modified radical mastectomy – removal
of the breast, most of the lymph nodes
under the arm, and often the lining over
the chest muscles
• Lumpectomy – surgery to remove
the tumor and a small amount of normal
tissue around it

4. Risk of Mastectomy
• Bleeding
• Infection
• Pain
• Swelling (lymphedema)
• 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)

5. Providing preoperative nursing care for
patients who are to undergo
Mastectomy is an integral part of the
therapeutic regimen. The nursing goal
is to provide support, alleviating anxiety,
managing pain, and providing
information.

6. Nursing Interventions Rationale
Check out and explore what information patient has about
diagnosis, expected surgical intervention, and future
therapies. Note presence of denial or extreme anxiety.
Provides knowledge base for the nurse to enable
reinforcement of needed information, and helps identify
patient with high anxiety, low capacity for information
processing, and need for special attention. Note: Denial may
be useful as a coping method for a time, but extreme anxiety
needs to be dealt with immediately.
Ascertain purpose and preparation for diagnostic tests.
More understanding of procedures and what is happening
increases feelings of control and lessens anxiety.
Implement an ambiance of concern, openness, and
availability, as well as privacy for patient and SO. Suggest
that SO be present as much as possible.
Time and privacy are needed to provide support, discuss
feelings of anticipated loss and other concerns. Therapeutic
communication skills, open questions, listening, and so forth
facilitate this process.
Encourage questions and provide time for expression of
fears. Tell patient that stress related to breast cancer can
persist for many months and to seek help and support.
Provides opportunity to identify and clarify misconceptions
and offer emotional support.
Consider role of rehabilitation after surgery.
Rehabilitation is an essential component of therapy intended
to meet physical, social, emotional, and vocational needs so
that patient can achieve the best possible level of physical
and emotional functioning.

7. Nursing Interventions Rationale
Consider reports of pain and stiffness, noting location,
duration, and intensity (0–10 scale). Note reports of numbness
and swelling. Be aware of verbal and nonverbal cues.
Aids in identifying degree of discomfort and effectiveness of
analgesia. The amount of tissue, muscle, and lymphatic
system removed can affect the amount of pain experienced.
Destruction of nerves in axillary region causes numbness in
upper arm and scapular region, which may be more
intolerable than surgical pain. Note: Pain in chest wall can
occur from muscle tension, be affected by extremes in heat
and cold, and continue for several months.
Discuss normality of phantom breast sensations.
Provides reassurance that sensations are not imaginary and
that relief can be obtained.
Facilitate patient to find position of comfort.
Elevation of arm, size of dressings, and presence of drains
affect patient’s ability to relax, rest and sleep effectively.
Provide basic comfort measures (reposition on back or
unaffected side, back rub) and diversional activities.
Encourage early ambulation and use of relaxation techniques,
guided imagery, Therapeutic Touch.
Promotes relaxation, helps refocus attention, and may
enhance coping abilities.
Splint or support chest during coughing and deep-breathing
exercises.
Facilitates participation in activity without undue discomfort.
Carry out appropriate pain medication on a regular schedule
before pain is severe and before activities are scheduled.
Maintains comfort level and permits patient to exercise arm
and to ambulate without pain hindering efforts.
Administer narcotics or analgesics as indicated.
Provides relief of discomfort and pain and facilitates rest,
participation in postoperative therapy.

8. Mastectomy Complications
Most patients recover from mastectomy 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.

9. Nursing Interventions Rationale
Stress proper hand washing technique
Handwashing is the single most effective way to prevent
infection
Provide regular catheter care To reduce risk of infection
Instruct on proper wound care
For first line defense against nosocomial infections or
cross contamination
Encourage to eat vitamin C rich foods To promote wound healing
Emphasized necessity of taking antibiotics as directed To boost the immune system
Closely observe and instruct to report signs and
symptoms of infection such as fever, sore throat,
swelling, pain and drainage
To prevent and detect as early as possible the presence
of any progressing infection
Inspect the wound for swelling, unusual drainage, odor
redness, or separation of the suture lines
Wound infection are accompanied by signs of
inflammation and a delay in healing
Empty and re-establish negative pressure in close wound
drains at least once per shift
Negative pressure pulls fluid from the incisional area,
which facilitates healing
Post-operative Care

10. Nursing Interventions Rationale
Elevate affected arm as indicated.
Promotes venous return, lessening possibility of
lymphedema.
Facilitate passive ROM (flexion and extension of elbow,
pronation and supination of wrist, clenching and
extending fingers) as soon as possible.
Early postoperative exercises are usually started in the
first 24 hr to prevent joint stiffness that can further limit
movement and mobility.
Have patient move fingers, noting sensations and color
of hand on affected side.
Lack of movement may reflect problems with the
intercostal brachial nerve, and discoloration can indicate
impaired circulation.
Encourage patient to use affected arm for personal
hygiene (feeding, combing hair, washing face).
Increases circulation, helps minimize edema, and
maintains strength and function of the arm and hand.
These activities use the arm without abduction, which
can stress the suture line in the early postoperative
period.
Help with self-care activities as necessary. Conserves patient’s energy, prevents undue fatigue.
Assist with ambulation and encourage correct posture.
Patient will feel unbalanced and may need assistance
until accustomed to change. Keeping back straight
prevents shoulder from moving forward, avoiding
permanent limitation in movement and posture.

11. Recommendations:
•Proper assessment should be done before
and after operation to prevent post-op
complications such as bleeding.
•Practice aseptic technique all the time - to
prevent infection.
•Inform treating physician for any untoward
complication noted – early detection can
lessen the extent of damage that might
happened to the patient.

12. https://www.mayoclinic.org/tests-
procedures/mastectomy/basics/definition/prc-20012749
http://www.healthcommunities.com/breast-
surgery/postoperative-care-complications-
mastectomy.shtml
https://nurseslabs.com/mastectomy-nursing-care-plans
REFERENCE:

13. Thank You For Listening!