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Hyesun Choi

on 4 March 2014

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Transcript of MASTECTOMY

Yousef, Priya, Elly
In Canada, 23,000 women were
diagnosed with breast cancer in 2013.

Approximately 14 Canadian women
has Mastectomy daily.

The Mastectomy has been observed
in Egyptian Mummies that are more
than 5,000 years old.
Anatomy &
Located between the 2nd & 6th ribs.
Types of Surgery
1 - Lumpectomy

2 - Mastectomy

A) Total Mastectomy

B) Radical Mastectomy

*Removal of the lump and some normal tissue around it

*Preservation of pectoralis muscle & lymph nodes

*Most commonly used with small sized tumors

* Using Local Anesthesia (Go Home On Same Day)
*Removal of all the breast tissue and skin,
including nipple and areola

*Preservation of pectoralis muscle & lymph nodes

*Most commonly used with large Non Invasive tumors

* General Anesthesia (Over night Hospital Stay)
* Short-term: Bleeding, Numbness
* Long-term: Breast edema, Breast Fibrosis,
Pulmonary Fibrosis, Chances of BC recurrence,
PMPS, Nerve Injury, Respiratory Problems
Penrose drain usually used
8 – 10 Days With minimal scaring
Surgical Drains
*JP drain usually used
*It is removed when fluid vol. <30 ml over 24 h
Wound Healing
2 Weeks & the scar matures over 12 months
*Short-term: Skin flap, necrosis, seroma, hematoma, infection
*Long-term: Sensory loss, muscle weakness,
Chest wall tightness, Phantom breast sensations,
PMPS, Nerve Injury, Respiratory Problems
*Removal of the breast, axillary lymph nodes
And pectoralis muscle

*Most commonly used with large Invasive tumors

*Breast reconstructive surgery is an option.
Surgical Drains
*2 drains are used (Axilla & Ant to Pecs Muscle)
*It is removed when fluid vol. <30 ml over 7 Days
Wound Healing
2 Weeks & the scar matures over 12 months
*Short-term: Skin flap, necrosis, seroma,
hematoma, infection
*Long-term: Sensory loss, muscle weakness,
lymphedema, PMPS, Nerve Injury,
Respiratory Problems
Studies show that regular breast self-exams, combined with an annual exam by a doctor, improves the chances of detecting cancer early by 90%.
*Ibuprofen, Narcotics
*Radiation Therapy, Chemo Therapy
*Ibuprofen, Narcotics
*No Need for Radiation Therapy
*Breast reconstructive surgery is an option
*Ibuprofen, Narcotics
*No Need for Radiation Therapy
*Pt. is encouraged to ambulate early
TRAM Flap Reconstruction
Tail of Spence extends into the axilla.
Cooper’s ligaments support the breast to the chest wall.
Each breast contains 12-20 lobes.
Lumpectomy VS Mastectomy
Mosby's Pathology for Massage Therapy 2nd edtion, Susan G. Salvo
Therapeutic Exercise 5th Edition, Carolyn Kisner & Lynn Allen Colby


To relieve post-operative pain and edema
To promote the removal of toxins as it assists in the flow of lymph, blood and oxygen
To increase range of motion
To reduce scar tissue
To restore feeling and sensation by stimulating nerve endings
The massage techniques selected
will be individualized according
to the magnitude of the surgical procedures.
Myofascial softening, spreading and
circular compressions on the pectoral region.
Frictioning of sternum and intercostals.
Thumping of the clavicle, sternum and thymus.
Shoulder Traction and Side Pulls.
Racking of Rib Cage combined
with shoulder traction/side pulls.
Sculpting of Rib Cage and Diaphragm.
TALO Sweep (Tricep Axillary, Latissimus, Obliques).
Angel Wing Fluff.
Specific Techniques
Deep pressure massage, vigorous
techniques, joint mobs to the arms on
the side that the breast(s) was removed.
Avoid massage over the area until it has
completely healed.
No frictions if the patient is on anti-
coagulants, anti-inflammatories,
or long term steroid medications.
Other Healthcare Professionals
Homecare nurse/caregiver
Follow up with the physician/nurse post surgery
Around the surgery site, palpate with the back of your hand for the comfort of the patient
Swelling, Scar tissues, Bony (ribs) - if the area that the great was removed
Removal of one or both breasts
Scarring over the surgical area
Removal of lymph nodes on the same side of the affected breast (not in all cases)
Axillary dissection places a patient at risk not only for upper extremity lymphedema but also for loss of shoulder mobility and limited function of the arm and hand.
No full body immersion until incision has fully healed.
If possible, avoid having blood pressure taken on an involved upper extremity or injections in an involved upper extremity.
If lymph nodes were removed, avoid hot baths, whirlpools and sauna that elevate the body’s core temperature.

Therapeutic Exercise
Exercise only at moderate level
Never to the point that the affected arm aches
Monitor upper extremity girth measurements closely.
Adjust the timing of exercise during cycles of radiation therapy or chemotherapy.
Do not perfume aerobic exercises
for 24 -48 hours after a chemotherapy session.
Activities of Daily Living
Return to physical work and recreational activities gradually after completion of chemotherapy or radiation therapy.
Therapeutic Exercise
Activities of Daily Living
As with most cancers, the diagnosis of breast cancer and the ensuing treatments have an enormous emotional impact on patients and their families.
Avoid static, dependent positioning of the involved arm.
Support involved upper extremity on the car’s window ledge or seat back when traveling long distances by car.
Elevate involved limb(s) and perform repetitive pumping exercises frequently during the day.
Avoid vigorous, repetitive activities with the involved limb.
Avoid carrying heavy loads, such as a suitcase, a heavy backpack, or shoulder bag.
Avoid use of heavy weights when exercising.
Monitor diet to maintain an ideal weight and minimize sodium intake.
Massage therapy reduced anxiety and depression and improved immune function, including increased natural killer cell number in women with breast cancer.

Women diagnosed with breast cancer received massage therapy or practiced progressive muscle relaxation. Dopamine levels, natural killer cells and lymphocytes increased from the first to the last day of the study for the massage therapy group.
Hernandez-Reif M et al : Breast cancer patients have improve immune and neuroendocrine function following massage therapy, J Psychsom Res 57:45-52, 2003

Hernandez-Reif M et al : Natural killer cells and lymphocytes and increased in women with breat cancer following massage therapy, Int J Neurosci 115:495-510, 2005
Benefits of Massage
A decrease in depression, anxiety, and pain.
Feeling less depressed and angry with increased energy.
Provide relief of pain

Restore sensation and feeling in the nerve endings
in the area of the amputated breast.
Increase circulation through the breast area
to promote faster healing,
to minimize scar tissue
to achieve the best appearance
to optimize mobility of the shoulder and neck
Enhance Immune system response
Any Question?
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