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Patient Education (8) Surgery
LOCAL TREATMENT : SURGICAL RESECTION
MODIFIED RADICAL MASTECTOMY
This procedure removes the entire breast including the nipple and some lymph nodes under the arm.
ADVANTAGES-No chest muscle is removed and the patient retains normal use of her arm. Breast reconstruction is an option and may be performed at the time of the modified radical mastectomy or at a later date.
DISADVANTAGES-The breast is removed. In some cases, there may be swelling of the arm because of the removal of the lymph nodes.
This type of surgery removes only the breast tissue including the nipple. It may be followed by radiation therapy.
ADVANTAGES-Chest muscles are not removed and arm strength is not diminished. All of the underarm lymph nodes remain, so the risk of swelling of the arm is greatly reduced. Breast reconstruction is an option.
DISADVANTAGES-The breast is removed. If cancer has spread to the underarm lymph nodes, it may remain undiscovered.
PARTIAL MASTECTOMY / LUMPECTOMY WITH AXILLARY DISSECTION
This procedure removes the tumor as well as a rim of tissue to obtain clear margins (healthy breast tissue). Once the diagnosis of breast cancer has been made, the patient undergoes a second surgical procedure at a later date for the removal of lymph nodes to check for the possible spread of cancer and to stage the disease. This is referred to as an axillary dissection. After surgery, once the patient has healed, they begin postop radiation therapy for approximately six weeks. This option is also referred to as Breast Conservation with Radiation Therapy.
ADVANTAGES-The breast is preserved. There is little possibility of loss of muscle strength.
DISADVANTAGES-If a woman has extremely small breasts and the tumor is large, this procedure may noticeably change the shape of the breast. If the tumor involves the nipple, this procedure may not be feasible and a mastectomy should be done.
The Sentinel Lymphadenectomy: This technique uses a radioactive dye and a blue colorant and replaces the formal axillary dissection. It is less invasive and identify some key anatomical lymph nodes where the cancer will spread to first. Thus, only a few lymph nodes are removed versus 10 to 20.
MASTECTOMY OR AXILLARY DISSECTION: AFTER SURGERY (Post operative Care)
Each woman reacts to surgery differently, but most women are able to go home the same day or are hospitalized for one night. The patient will be discharged from the hospital with a drain namely Blake Drains. They are soft, plastic tubes attached to a suction bulb coming out of the skin below the incision. This drain is placed during surgery and removes fluid (seroma) that accumulates under the incision site after surgery. The body creates this fluid to the removal of the breast tissue and the lymph glands. Every patients body produces a different amount of seroma. The discharge nurse will instruct the patient as to how to empty the drain properly and record the amount of drainage to report to the surgeon on their postop visit. Patients have found it helpful to wear a band of elastic around their waist and to attach the JP drain to it. The drain is removed once the drainage has decreased. If fluid continues to accumulate under the skin after the drain has been removed; the surgeon can aspirate it painlessly in his office.
The surgery is tolerated well by most patients. There is not a great deal of pain involved. For some patients the emotional aspect of the diagnosis is much more difficult than the physical aspect of the surgery.
In the days following surgery, it is important for you to realize your life can continue to be as rich and full as it was before your surgery. Some patients feel their lives have actually improved after their diagnosis of cancer. Although each woman recovers from a mastectomy or axillary dissection at her own rate, within two weeks after surgery you will be able to resume your normal activities.
You may experience numbness or hypersensitivity under and down the arm associated with the mastectomy or axillary dissection site. With time it will slowly decrease, but it may take a long time for total feeling to return.
Exercising immediately after a mastectomy or axillary dissection will help you ease the tension in your arm and shoulder and will hasten your recovery. It will also prevent the freezing of your shoulder, which can be very painful. Your surgeon, nurse, or physical therapist can show you what exercises to do. Use your arm as you normally would; that is the easiest and best form of exercise.
You might begin with these few simple movements:
You may begin shopping for a permanent prosthesis (an artificial breast form) as soon as the incision site has healed and the swelling and tenderness have subsided, usually in four to six weeks. The expense of a prosthesis is covered, at least partly, by most medical insurance policies. A written prescription from your surgeon will help ensure payment.
After youve had a mastectomy, it may be emotionally overwhelming. You may think about the fact that youve just been treated for a serious disease. You have had an operation that has changed your appearance, perhaps your self-image. You might wonder how the mastectomy will affect your lifestyle and your personal relationships. You may be unsure as how to act toward family and friends.
Every woman reacts to a mastectomy differently. You can take steps to ease your emotional adjustment. Express your feelings to your doctor, clinical coordinator, and the people close to you. This will help your doctor understand what you need to fully recover, and it will help your family and friends to share your difficulties and to help you work through them. Your family and friends can be your strongest supporters, but they may not know how to show their support. You can help them by being open and honest about the way you feel.
Many women find help in support groups, where they can share experiences and learn coping skills. Several studies show that being with others who understand what you are going through can improve the quality of your life. Support groups can help to reduce stress and minimize depression. Having a positive outlook may allow your body to more effectively fight disease.
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