The choice of treatment for breast cancer depends on tumor type, size, and location, as well as clinical characteristics
(staging). Therapy may include surgical intervention with/without radiation, chemotherapy, and hormone therapy. The
use of gene therapy and stem cell rescue (autologous bone marrow transplantation) is under investigation. Breast
reconstruction is often done at the time of cancer surgery because it does not compromise adjuvant treatment/interfere
with cure of the cancer, and it improves the patient’s adjustment and acceptance. Some oncologists, however, prefer to
postpone reconstruction until post-procedure therapy is completed, to reduce the risk of postoperative complications.
Types of surgery are generally grouped into three categories: radical mastectomy, total mastectomy, and more
limited procedures (e.g., segmental, lumpectomy).
Total (simple) mastectomy
removes all breast tissue, but all or most
axillary lymph nodes and chest muscles are left intact.
Modified radical mastectomy
(now the most common surgical
option) removes the entire breast, some or most lymph nodes, and sometimes the pectoralis minor chest muscles. Major
chest muscles are left intact.
Radical (Halsted’s) mastectomy
is a procedure that is rarely performed because it requires
removal of the entire breast, skin, major and minor pectoral muscles, axillary lymph nodes, and sometimes internal
mammary or supraclavicular lymph nodes. Limited procedures (i.e., lumpectomy) may be done on an outpatient basis
because only the tumor and some surrounding tissue are removed. Lumpectomy is reserved for well-defined
nonmetastatic tumors of less than 5 cm in size that do not involve the nipple. The procedure may be diagnostic
(determines cell type) and/or curative when combined with radiation therapy.
Inpatient acute surgical unit.
Cancer (for additional nursing interventions regarding cancer treatment)
Psychosocial aspects of care
Patient Assessment Database
Work, activity involving frequent/repetitive arm movements
Sleep style (e.g., sleeping on stomach)
Unilateral engorgement in affected arm (invaded lymph system)
Constant stressors in work/home life
Stress/fear involving diagnosis, prognosis, future expectations
Loss of appetite, recent weight loss
Pain in advanced/metastatic disease (localized pain rarely occurs in early malignancy)
Some experience discomfort or “funny feeling” in breast tissue
Heavy, painful breasts premenstrually usually indicate fibrocystic disease
Nodular axillary masses
Edema, erythema of involved skin
Presence of a breast lump (usually painless); changes in breast symmetry or size