Mastectomy- Types, Uses & Procedure -2021

Mastectomy- Types, Uses & Procedure -2021
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Mastectomy

Mastectomy is defined as surgical removal of breast.

 

Radical mastectomy

It involves removal of the breast, the pectoralis muscles, chest fascia and the ipsillateral axillary lymph nodes. It also includes  chemotherapy and radiation therapy.

 

Modified radical mastectomy

The entire breast, fascia over the chest muscle, and axillary lymph nodes are removed.

The pectoralis muscles remains intact.

 

Simple mastectomy

It involves surgical removal of the entires breast, but the lymphatic system and pectoralis muscles are preserved.

 

Post operative complication

1. Incisional pain

– A transverse incision  made across the chest wall.

– Movement of the arm and tightening of skin along the incision causes pain.

– Radiotherapy and delayed wound healing further increases pain.

 

2. Cervical and shoulder girdle pain

– Muscle spasm, muscle guarding around the neck and shoulder.

– Frozen shoulder, lymphedem of hand is common after mastectomy.

 

3. Pulmonary complications

– Postoperative thrombo emboli

– DVT

– Pneumonia

– Retention of airway secretion

 

4. Lymphedema

– It results are to

– Removal of axillary lymph nodes

– Radiotherapy

– Obstruction of lymphatic vessels

– Reduced functional activites and immobility

 

5. Chest wall adhesion

– It result due to

– Surgery

– Wound infections

– Radiation fibrosis

 

6. Decreased ROM and weakness of upper limb

– Decreased shoulder and cervical mobility

– Weakness of adductors,  pectoralis major of shoulder.

– Weakness of serratus anterior, trapezium and levator scapulae

– Frozen shoulder

– Decreased  hand grip strength due to lymphedema.

 

7. Fatigue and decreased endurance

8. Psychological imbalance

 

Indications

Benign growth of breast

Carcinoma of breast

 

Types of carcinoma

Sclerous carcinoma

Duct carcinoma/ infiltrating duct carcionoma

Paget’s disease of nipple

 

Physiotherapy management

Aims

To prevent post opertive complications

To relieve pain

To regain shoulder ROM and function

To strengthen weakned muscle

To prevent respiration and pulmonary complication

To relieve lymphedema

Reassurance to the patient

 

Means of physiotherapy treatment

1. To relieve pain

– Proper positioning

– Pillow supports

– Pressure dressing

– Analgesics

 

2. Prevent pulmonary complications

– Deep breathing exercises

– Coughing and huffing technique with incisional support

– Ankle/toe, log exercise

– Calf pumping exercise to prevent DVT and circulatory complications

– Elevation of involved limb.

 

3. Prevent lymphedema

– Elevation of the affected upper extremity on pillows

– Pressure bandages, crepe bandage

– Elastic stocking

– Pumping exercise of arm

– Early ROM exercise

– Pneumatic compression can be given

– Mannual lymphatic drainage massage (stroking,efflurage)

– Skin care

 

4. Prevent postural deformities

– Proper positioning in bed both preoperatively and post operatively

– Mildline and symmetrical postioning of shoulder and trunk

– Postural awarness with use of mirror

– Asking the patient in sitting and standing scapular retraction exercises

– Scapular retraction exercises

 

5. To relieve muscles spasm and guarding

– Active ROM of cervical spine

Shoulder shrugging exercise

– Shoulder circle exercise

– Gentle massage to cervical spine

– Moist hear, scar tissue mobilization

– Promote relaxation

 

6. To regain mobility of upper limb

– Active assisted and active ROM exercises of shoulder elbow and hand.

– After the incision is healed self stretching can be taught .

– Gentle grade I mobilization of shoulder can be given

 

7. Regain strength and power of upper limb

– Isometric exercise of shoulder

– Progessive resistance training  program using Mc Queen or DeLorme’s technique.

– Scapular and glenohumeral stabilization exercises in standing by pushing against the wall.

– Hand gripping exercises

– Use of upper extremity for functional activites

 

8. Improve tolerance

– Aerobic exercises

– Distance walking, cycling, staircases climbing, treadmill walking.

 

9. To improve respiratory function

– Deep breathing exercises

– Airway clearance techniques

– Coughing and huffing techniques.


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