Last updated on February 20th, 2023 at 09:10 am
A mastectomy is a surgical procedure that removes the entire breast to cure and prevent the progression of malignancy.
A mastectomy may be one therapy option for patients with early-stage breast cancer. Another alternative is breast-conserving surgery, known as lumpectomy, which removes only the tumor from the breast.
Moreover, choosing between a mastectomy and a lumpectomy can be challenging. Both methods are equally effective in avoiding breast cancer relapse. However, a lumpectomy is not an option for everyone diagnosed with breast cancer, and some patients will benefit more from a mastectomy.
A mastectomy may be performed considering the following factors:
- When a woman is unable to undergo breast-conserving surgery (lumpectomy), which saves the majority of the breast
- If a woman, for personal reasons, prefers Mastectomy over breast-conserving operations.
- For women at high risk of experiencing a relapse of breast cancer, performing a double mastectomy may be beneficial — a surgical procedure wherein two breasts are removed.
Types of Mastectomy
Mastectomy procedures are classified into various types:
- Total Mastectomy. Total Mastectomy is the surgical procedure that removes the entire breast, along with the nipple, the pigmented ring around the nipple (known as the areola), and most of the underlying skin.
- Modified radical Mastectomy. This surgical procedure removes the entire breast, the areola, the nipple, the skin around the breast, and the membrane over the chest muscles. Excision of several lymph nodes beneath the arm is also done in this procedure since breast cancer frequently spreads to lymph nodes. Thus, it can also spread to other parts of the body. In some circumstances, several parts of the chest wall muscles are also removed.
- Radical Mastectomy. The entire breast is removed during this procedure, including the nipple, areola, overlying skin, lymph nodes under the arm, and chest muscles beneath the breast. This was the typical procedure for many years. However, it is not commonly used nowadays. It may be indicated when breast cancer has gone to the chest muscles.
- Skin-sparing Mastectomy. The areola, nipple, and breast tissue are all removed in this type. However, the majority of the skin around the breast is preserved. This procedure is only necessary if breast reconstruction is performed immediately following a mastectomy. It may not be appropriate for large or close-to-the-skin tumors.
- Nipple-sparing mastectomy. This surgery is comparable to a skin-sparing mastectomy. It is also known as a total skin-sparing mastectomy. The whole breast tissue is removed, along with the ducts that surround the nipple and the areola. The skin of the nipple and areola, however, is maintained. These parts can be spared if no breast cancer cells are discovered near the nipple and areola. Otherwise, this procedure is not recommended. Reconstruction begins immediately following the mastectomy.
Risks of Mastectomy
Every medical procedure involves some level of risk. Mastectomy may result in the following complications:
- Temporary breast swelling
- Breast discomfort
- Scar tissue that can form at the location of the wound can cause hardness. (Keloid scar)
- Infection or bleeding from the wound
- Arm swelling (lymphedema) if lymph nodes were removed
- Pain in the surgically removed breast (phantom breast pain).
Medicines, exercise, and massage may all help in relieving these complications of mastectomy.
Complications of Mastectomy
All surgeries have the risk of bleeding and infection at the surgical site. The side effects may vary depending on the type of mastectomy. Possible risks and complications of mastectomy include:
- Tenderness or pain at the surgical site
- Inflammation around the surgical site
- Blood clots in the wound (hematoma)
- Clear fluid accumulation in the wound (seroma)
- Restricted movement of the shoulder or arm
- Loss of sensation in the upper arm or chest
- Neuropathic (nerve) pain that persists in the chest wall, armpit, and arm (often described as searing or shooting pain). It is also known as post-mastectomy pain syndrome (PMPS).
- Other adverse effects, such as lymphedema, may occur if the axillary lymph nodes are removed.
Nursing Process
Providing perioperative nursing care for patients undergoing a mastectomy is essential to the treatment regimen. The purpose of nursing is to provide support, reduce anxiety, manage discomfort, and deliver information. Thus, how the patient’s body reacts to the surgical procedure affects nursing administration and patient care.
Treatment may not be necessary for minor mastectomy complications. Severe cases, on the other hand, will necessitate rapid medical intervention. Nurses monitor symptoms and irregularities, identify the underlying cause, and initiate appropriate therapeutic strategies.
Nursing Diagnosis for Mastectomy
Ineffective Therapeutic Regimen Management
Nursing Diagnosis: Ineffective Therapeutic Regimen Management
Related to:
- Mastectomy
Secondary to:
- Breast Cancer
As evidenced by:
- Unwillingness to participate in the management of the underlying condition
- Expressed dissatisfaction with the recommended regimen
- The patient’s verbalization that they did not adhere to the prescribed treatment plan
Expected Outcomes:
- The patient will acknowledge the importance of changing behaviors to achieve an effective therapeutic regimen.
- The patient will begin to participate in developing solutions to certain factors that are impeding the progress of the prescribed treatment regimen.
Assessment:
- Examine the patient for relevant factors that may ruin the success of the prescribed treatment plan.
The patient’s perception of the severity and possible danger of illness influences their adherence to the program.
- Assess the patient’s behavior and willingness to comply with the recommended therapeutic regimen.
Monitor the patient to see if they are compliant with the treatment plan. Their participation in the treatment process is beneficial in achieving effective therapeutic management.
- Examine the patient’s ability to comprehend or recall their desired health-related activities.
Cognitive impairments necessitate the implementation of an alternative solution.
Mastectomy Nursing Interventions:
- When interacting with patients, utilize therapeutic communication skills.
Patients with breast cancer who have had a mastectomy may need someone to whom they can talk comfortably. As a result, nurses’ therapeutic communication skills may be advantageous to them.
- Provide positive encouragement to the patient for their efforts to adhere to the treatment regimen.
This approach aims to motivate patients to continue the appropriate behaviors required for adequate therapeutic management.
- Encourage patient and significant other’s involvement in treatment process planning and evaluation.
This intervention increases the patient’s commitment to planning and maximizing treatment management outcomes following mastectomy.
- Assist the patient in developing effective strategies for monitoring the mastectomy therapeutic regimen.
This method encourages early detection of changes, permitting a proactive approach.
- Determine which home and community-based nursing services would benefit patients that have undergone a mastectomy.
These services benefit patients who have had a mastectomy regarding assessment, follow-up care, and education.
Acute Pain
Perioperative nursing care is an essential component of the treatment plan for patients who will undergo a mastectomy. The objectives of nursing are to offer knowledge, treat pain, reduce anxiety, and offer support.
Nursing Diagnosis: Acute Pain
Related to:
- Surgery: muscle dissection, nerve disruption, and tissue trauma
As evidenced by:
- Reports of muscle tone changes, shoulder/arm pain, chest numbness, and stiffness
- Self-focus, diversion, and defensive actions
Expected outcomes:
- The patient will report less pain or discomfort.
- The patient will seem at ease and be able to rest or sleep as needed.
Assessment:
1. Take into account complaints of pain and stiffness, noting the source, duration, and severity (0–10 scale). Take note of any complaints of swelling or numbness. Pay attention to both verbal and nonverbal cues.
This helps determine the level of discomfort and the efficacy of analgesia. The amount of muscle, tissue and lymphatic system removal may have an impact on how much pain is felt. Upper arm and scapular numbness that results from nerve damage in the axillary region may be more uncomfortable than surgical pain.
Mastectomy Nursing Interventions:
1. Discuss whether or not phantom breast sensations are frequent.
Gives reassurance that the feelings one is experiencing are real and that resolution is possible.
2. Help the patient find a comfortable position.
The patient’s capacity to unwind, rest, and sleep soundly is impacted by the arm’s elevation, the size of the dressings, and the presence of drains.
3. Reposition the patient on their back or the unaffected side, give them a back rub and offer simple comfort measures and distractions.
This encourages the patient’s relaxation, aids in attention refocusing, and might improve coping skills.
Impaired Skin Integrity
Skin integrity is considered to be compromised by the actual incision of the skin during surgery.
Nursing Diagnosis: Impaired Skin Integrity
Related to:
- Surgery: the presence of a surgical wound where the incision was made on the breast
As evidenced by:
- Pain
- Numbness in surrounding areas
- Disruption of the skin surface
- Redness
- Itchiness
- Poor capillary refill
Expected outcomes:
- The patient will take part in both treatment and preventative initiatives.
- The patient will be able to show steady improvement in the healing of wounds.
Assessment:
1. Examine the incision site, taking note of the lesion’s size, color, location, temperature, texture, and consistency.
This offers comparable baseline information.
2. Examine the skin or injured region for any odors or discharges.
Help to evaluate the emergence of infection, bleeding, or the early stages of wound healing.
Mastectomy Nursing Interventions:
1. Maintain a clean and dry environment, carefully tend to wounds, support incisions, and guard against infection.
To help aid the body’s inherent recovery process.
2. Increase the patient’s intake of calories and protein.
This helps the patient’s wound heal quickly.
3. Encourage getting enough sleep and rest.
Prevents the patient from exhaustion and offers rest
4. Promote early mobilization and ambulation.
This helps increase circulation and lessens the hazards of immobility.
5. Apply the aseptic method when treating, cleaning, and dressing lesions.
Helps minimize the chance of contamination and infection.
Risk for Dysfunctional Grieving
Dysfunctional grief may be marked by a broad range of behaviors that may include pervasive denial, or a refusal to partake in self-care measures or the activities of daily living.
Nursing Diagnosis: Risk for Dysfunctional Grieving
Related to:
- Surgery: Cancer Diagnosis
As evidenced by:
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Expected outcomes:
- The patient will express verbally that they are starting to deal with their sadness at losing their breast.
- The patient will take part in treatment to discover new coping mechanisms for anxiety and inferiority issues.
Assessment:
1. Examine the patient’s capacity for managing everyday tasks and the time since a loss has happened.
The client may require more assistance if they persist and interfere with routine tasks.
2. Keep in mind the grieving stage the patient is in.
Grief stages may follow a predictable progression or be felt at various levels.
Mastectomy Nursing Interventions:
1. Encourage the client and the family to list any effective coping mechanisms they may have previously employed.
These can be applied in the present situation to make grieving easier.
2. Stay with the patient and protect their privacy while they are feeling sensitive.
The nurse’s presence offers assistance. The patient’s dignity is demonstrated by maintaining privacy.
3. Encourage others to share with others who can relate, such as a fellow breast cancer survivor.
Sharing a major loss with someone who has overcome a similar situation creates a link that promotes healing.
Fear
The causes of fear are, in some ways, universal; most people share a fear of dying, of being alone, and of suffering from a physical deformity or damage.
Nursing Diagnosis: Fear
Related to:
- Invasive procedure
- Hospitalization
- Loss of body parts
As evidenced by:
- Tachypnea
- Tachycardia
- Denial
- Fright
- Fatigue
- Dry mouth
- Narrowed focus
- Insomnia
- Crying
Expected outcomes:
- The patient will use practical coping strategies and tools to demonstrate understanding.
- The patient will exhibit a spectrum of emotions that are appropriate and diminish dread.
Assessment:
1. Determine the patient’s level of fear and the coping mechanisms they employ.
This aids in evaluating the patient’s coping mechanisms’ efficacy.
2. Keep track of the patient’s fears’ vocal and nonverbal manifestations.
As the level of dread rises, physiological signs and complaints will become more severe.
Mastectomy Nursing Interventions:
1. Compare the patient’s responses—verbal and nonverbal.
Observe any coincidences or incorrect impressions of the scenario.
2. Determine the extent to which the patient’s anxiety may be preventing him or her from performing ADLs.
Anti-anxiety drugs may be necessary for the treatment of persistent, paralyzing concerns.
3. Create a cooperative partnership through continued care.
If the patient’s house is hazardous, their anxieties may not be relieved and eventually become incapacitating.
4. When necessary, implement safety precautions inside the house.
It’s important to understand what causes fear and how to address it while coming up with alternative reactions.
5. Encourage the patient to investigate particular instances that happened before the onset of terror as their fear fades.
Rest enhances coping skills.
6. Practice guided imagery, meditation, or relaxation exercises
This lessens the body’s reaction to fear.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
Disclaimer:
Please follow your facilities guidelines, policies, and procedures.
The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.
This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.
