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Mastectomy - MASTECTOMY The choice of treatment for breast...

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MASTECTOMY 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. CARE SETTING Inpatient acute surgical unit. RELATED CONCERNS Cancer (for additional nursing interventions regarding cancer treatment) Psychosocial aspects of care Surgical intervention Patient Assessment Database ACTIVITY/REST May report: Work, activity involving frequent/repetitive arm movements Sleep style (e.g., sleeping on stomach) CIRCULATION May exhibit: Unilateral engorgement in affected arm (invaded lymph system) EGO INTEGRITY May report: Constant stressors in work/home life Stress/fear involving diagnosis, prognosis, future expectations FOOD/FLUID May report: Loss of appetite, recent weight loss PAIN/DISCOMFORT May report: 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 SAFETY May exhibit: Nodular axillary masses Edema, erythema of involved skin SEXUALITY May report: Presence of a breast lump (usually painless); changes in breast symmetry or size
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Changes in breast skin (pitting, dimpling), color or temperature (redness); unusual nipple discharge; itching, burning, or retracted nipple or changes in vein pattern
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