cancer

1. BREAST DISORDER &
MASTECTOMY

2. • Objectives
 Introduction & Definition .
 Overview of the breasts anatomy and physiology .
 Discuss differences between types of Mastectomy .
 Manifestations “sign & symptoms” for Mastectomy .
 Discuss risk factors for breast cancer and how to minimize those
risks .
 Discuss complications of breast cancer .
 Discuss medical , surgical & nursing management .
 What are the treatment options for breast cancer ?
 Discuss diagnostic tests used for breast cancer .
 Discuss prognosis of breast cancer.
 Discuss pre/postoperative nursing diagnosis and interventions .

3. Introduction
■ Breast cancer is cancer that develops from breast tissue and it
described as malignant or benign cell growth in the breast.
■ Breast cancer is the most common type of cancer is fatal in
women in the United States.
■ Management of breast cancer may be included surgical
management (Mastectomy) or medical management or Radio or
chemo Therapy.
 Definition of
Mastectomy :-■ It is surgical treatment and it is the removal of all of the
tissue from one or both breasts or removal of the injured
part “tumor” only after early detection or removal of tumor
with lymph nodes .

5. List of Abbreviations
ASIR: Age specific incidence rate
ASR: Age standardized rate
DCO: Death certificate only
HCV: Hepatitis C virus
IARC: International Agency for
Research on Cancer
ICD-10: International Statistical
Classification of Diseases
and related health problems,
10th revision
NCRP: National Cancer Registry
Program of Egypt
NHL: Non-Hodgkin Lymphoma
SEER: Surveillance, Epidemiology,
and End Results Program.

7. • Breast A & P
■ Breast is located between
the 2nd & 6th ribs over the
pectoralis muscle, from the
sternum to the mid-axillary
line.
■ The area of the breast
tissue is called (tail of
Spence) that, extends into
the axilla.
■ Each breast contains 12-20
lobes.
■ Breast functions: the most
importance of the breast is
production of milk for infant.

10.  Types
Breast cancer can develop in the ducts that carry milk to
the nipple, the lobules that produce milk, or the tissue in
between. Learn about the different types of breast
cancer, including non-invasive, invasive, and metastatic
breast cancers, and others.
• Ductal catcinoma in situ “DCIS”
• Invasive ductal carcinoma “IDC”
• Invasive Lobular Carcinoma “ILC”
• Inflamatory breast cancer
• Male breast cancer
• Metastatic breast cancer

13. Metastisis breast cancer

14.  Types of mastectomy
■ Total (simple) mastectomy - the entire breast is removed, but muscles under the
breast and lymph nodes are kept in place.
■ Lumpectomy - a lumpectomy involves the removal of a tumor and surrounding
tissue, and leaves the breasts largely intact .
■ Double mastectomy - both breasts are removed as a preventive measure; this is
often used for high-risk patients who have specific genetic markers that make
breast cancer more likely.
■ Quadrantectomy - is a partial mastectomy that involves the removal of more
breast tissue than a simpler lumpectomy, but which still spares the majority of the
breast tissue.
■ Nipple-sparing mastectomy - this relatively new procedure leaves the skin,
nipple, and peripheral breast tissue intact.
■ Skin-sparing mastectomy - the breast tissue and nipple are removed, but the
skin is left to reconstruct the breast in the same operation.
■ Radical mastectomy - the entire breast, underarm lymph nodes, and chest wall
muscles are removed.

15. Total Mastectomy

16. Breast Sparing Surgery: Lumpectomy &
Partial Mastectomy

17. Radical Mastectomy

18. Modified Radical Mastectomy

20.  Risk factors
• Personal Health History
• Family Health History
• Certain genes Changes
• Radiation Therapy to the Chest
• Reproductive and Menstruation
History
• Race
• Being Overweight or Obese after
Menopause
• Lack of Physical Activity
• Alcohol Use
• Smoking
• Age
• Lose excess weight.
• Be physically active.
• Limit your intake of alcohol.
• Breastfeed your baby.
• Quit smoking.
• Talk to your doctor about the
risks and benefits of
hormone replacement
therapy (HRT).
• Reduce exposure to
chemicals
 Minimizing Your Risk

21.  Manifestations “sign & symptoms”

22. Complications
 Infection
 Lymphedema
 Hematoma/Seroma
Formation
 Allergic Reaction

23.  Management
o Diagnostic Procedure :-
*SBE (self-breast examination)
*Mammography
o Treatment

24. Self Breast Examination
o Self Breast Exams are an important way to find a breast cancer
early.
o Not every cancer can be found this way, but it is critical to become
familiar with your breasts in order to identify an abnormality
o SBE should be done once a month approximately 1wk after your
menstrual period
o Lumps
• most women have lumps or lumpy areas in the breast
that may be the result of Fibroadenomas or Cysts
• 8 out of 10 lumps removed from the breast are benign
• Upper/outer area(armpit) - most prominent
lumps/bumps
• Lower half - sandy/pebbly beach
• Underneath nipple - collection of large grains
• Other parts - lumpy bowl of oatmeal

25. Steps to a Self Breast Exam:
Step 1
 Look in the mirror, shoulders
straight and arms on your hips.
 Look for size, shape, and colour
of breasts, is there any
distortion or swelling present
 Changes to report: dimpling,
puckering, bulging of the skin,
change in nipple position,
inverted nipple, redness,
soreness, rash or swelling.

26. Step 2
■ Raise your arms above
your head and look for
the same changes.

27. Step 3
Still standing at the mirror, look for any
discharge/fluid coming from your nipples.
Changes to report: any fluid coming out of 1 or
both nipples (unless you are lactating). Could be
watery, milky, yellow or bloody.

28. Step 4
■ Lie down on the bed and palpate
breasts using pads of a few
fingers.
■ Use a firm smooth touch in a
circular motion.
■ Cover entire breast – collar bone
to top of stomach, armpit to
sternum.
■ Make sure to follow a pattern so
to cover all area of the breasts.

29. Step 5
■ Sit or stand and
palpate the breast in
the same manner as
step 4.
■ Changes to report:
lumps, bumps,
irregularities

30. Mammography
■ Breast imaging technique
■ Identifies non-palpable masses and diagnoses palpable
masses
■ Procedure takes approximately 15 minutes
■ Breast is compressed from top to bottom, and side to side
■ New and old mammograms are compared
■ Radiation exposure is equivalent to 1 hour in the sun
■ Canadian Cancer Society recommends women to have a
mammogram every 2 years between 50 & 69 years of age.
■ Women at high risk and under 50 should speak with the HCP

31. Galacto-graphy
Is a diagnostic procedure that, involves injections , of less
than 1ml of radiopaque material through a cannula inserted
into ductal opening of the areola and that, followed by
mammogram.
MRI
Is highly sensitive test of breast and useful diagnostic adjunct
mammography.
Disadvantage
1- High cost 2- Patient potential phobia
3- Can't always distinguish between (benign – Malignant)
4- Contra for pt with implanted metal devices(Aneurysm clips,
pacemaker…..) so, must be remove it to avoid skin burns.

32.  Diagnosis for Breast Cancer
■ Procedures for tissue analysis:
o Percutaneous Biopsy
• Fine-Needle Aspiration
• Core Needle Biopsy
• Guided Core Biopsy
o Surgical Biopsy
• Excisional Biopsy
• Incisional Biopsy

33. Needle Biopsy Excisional Biopsy

34. Treatment
• Surgery
• Chemotherapy
• Radiation
• Adjunctive Therapy
• Alternative Therapy

35. Prognosis
■ Two most important factors when determining the
prognosis of breast cancer:
• Size of tumour
• Spread of tumour
• Excessive number of copies of certain genes
• Excessive amounts of the genes protein products

36. Deficient knowledge
Anxiety
Fear
Risk for ineffective coping
Decisional conflict
Preoperative Nursing Diagnosis

37. Preoperative Nursing
Interventions
Provide education and preparation for surgical
treatments
Reduce fear and anxiety and improve coping
ability
Promote decision-making ability

38. During operation
Position patient supine with arm abducted 90 degree .

39. Postoperative Nursing
Diagnoses
Acute pain
Disturbed sensory perception
Disturbed body image
Risk for impaired adjustment
Risk for ineffective coping for individual and
family
Deficient knowledge
Risk for sexual dysfunction
Risk for infection

40. Postoperative Nursing Interventions
Relieving pain and discomfort
Managing postoperative sensations
Promoting a positive body image
Promote positive adjustment and coping
Improving sexual function
Monitor for complications

41. Nursing diagnosis intervention
Fear/Anxiety related to change in health
status
1-Check out and explore what information patient has about
diagnosis, expected surgical intervention, and future therapies.
Note presence of denial or extreme anxiety.
2-Ascertain purpose and preparation for diagnostic tests.
Impaired Skin Integrity related to Surgical
removal of skin/tissue; altered circulation,
presence of edema, drainage; changes in
skin elasticity, sensation; tissue destruction
(radiation)
Maintain in semi-Fowler’s position on back or unaffected side;
avoid letting the affected arm dangle.
Acute Pain related to Surgical procedure;
tissue trauma, interruption of nerves,
dissection of muscles
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
4.Situational Low Self-Esteem related
to Biophysical: disfiguring surgical
procedure
Identify role concerns as woman, wife, mother, career woman,
and so forth.
Impaired Physical Mobility related to
Neuromuscular impairment; pain
discomfort; edema formation
Encourage patient to use affected arm for personal hygiene
(feeding, combing hair, washing face).

42. Nursing diagnosis Intervention
Deficient Knowledge related to Information
misinterpretation
Discuss necessity for well-balanced, nutritious meals and
adequate fluid intake.
Risk for Injury related to Muscle weakness
,Altered mobility and Sensory and perceptual
disturbances due to anesthesia
1-Encourage participation in self-help programs, such as
assertiveness training, positive self-image
2-Assist client during periods of ambulation when
necessary
Activity Intolerance . Ascertain ability to stand and move about and degree of
assistance necessary/ use of equipment
. Provide a quiet environment and encourage use of
stress management
. Promote comfort measures and provide for relief of
pain..
. Encourage client to maintain positive attitudes; suggest
use of relaxation techniques, such as
visualization/guided imagery as appropriate
Risk for Ineffective Breathing Pattern .
.
.
Risk for Infection . Stress proper hand washing technique

43.  Exercise after mastectomy

50. Squeeze a ball big arm circles
exerciseillustration
Wall-Push-Up-exercise gesturedrawing

53. • Client need to do exercise after first 24 hrs of
operation .
• Care of client :-
*B p-not on affect side
*R each for recovery
*Elevate affected side flextion & extention initialy “squeeze a
ball”
*A bduction & external rotation should not be initial
exercise
*S BE once a month about one week after period

56. Day, R. A., Paul, P., Williams, B., Smeltzer, S. C., & Bare, B.
G. (2010). Textbook of Canadian medical-surgical nursing
(2nd ed). Philadelphia, Pennsylvania: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
www.breastcancer.org
www.cancer.ca
www.cancer.gov
www.myoclonic.com
www.BreastCancer.org
References

57. Thank you