Brief Note on Mastectomy

In this article, we will discuss Brief Note on Mastectomy. So, let’s get started.

Mastectomy

Indications

• Benign breast masses
• Noninvasive breast tumours
• Invasive breast tumours (malignant)

Types of Mastectomy

• Lumpectomy or wedge resection or tylectomy or tumourectomy
• Radical halsted’s operation (axillary lymph nodes + Pectoralis major)
• Simple mastectomy
• Extended simple mastectomy (Patey’s) no PM involvement
• Quadrantectomy (tumour segment +axillary nodes)

Complications

• Bleeding from the surgical site
• Seroma – collection of fluid (lymph or serum) at the operative site
• Wound infection
• Possible skin slough a wound edges
• Thrombophlebitis of the axillary vein
• Numbness of the back of the upper arm usually due to sacrifice of a nerve to the skin (intercostal brachial cutaneous nerve).
• Weakness of the latissimus dorsi or serratus anterior muscles due to compromise of the thoracodorsal or long thoracic nerves, rare.
• Armoedema (swelling) is common but usually mild
• Limited range of motion of the shoulder. This occurs early after surgery, is limited and totally recoverable.

Management

• HRT (hormonal replacement therapy)
• Tamoxifen
• Chemotherapy
• Cyclophosphamide, methotrextate and 5-fluorouracil
• Breast reconstruction
• Silicone prosthesis
• Musculocutaneous Maps
• LD or TRAM lap

Physiotherapy

• Avoid early shoulder mobilization
• Adduction for 48 hours then 60 degree abduction
• Redivao drain used
• Oedoma management (elevation, compression, FUP & STM)
• If any brachial plexus injury, treat as LMN lesion
• Usual PT protocol

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