# Mastectomy --- **mastectomy** Sentinel lymph node biopsy (SLNB) is just going straight in from the boob to get the sentinel lymph node. SLN (sentinel lymph node ) is the first lymph node in the lymphatic basin that receives drainage from the tumor; found by injecting radioisotope or blue dye into breast during procedure. Sentinel lymph node receives dye first. LN is then removed and biopsied immediately during the surgery. If positive, ALND is done (saving the patient another trip to OR). SLN status is the most important prognostic indicator in breast cancer. An axillary lymph node dissection (ALND) is surgery to remove lymph nodes from under the arm that contain cancer. The main goal of surgery (mastectomy) is to gain local control of the disease. 4 Types: Breast Conservation Surgery Removal of lesion + SLNB or ALND Total Mastectomy Breast Tissue + nipple/areola (no ALND) Modified Radical Mastectomy Breast tissue + nipple/areola + ALND Underlying muscles left intact Radical Mastectomy Breast Tissue + nipple/areola + ALND + muscles Skin-sparing Mastectomy or Tissue Expanders Mastectomy: Post-operative Nursing Care Pain Psychosocial Concerns Anxiety, coping, body-image, sexuality Peripheral Neurovascular Dysfunction Mastectomy RC: Hematoma or Seroma Monitor for symptoms Treatment RC: Infection ## Complications RC: [[Lymphedema]] Within 5 years post-ALND, 30% of women experience lymphedema; 15% of SLNB patients. Lymphedema, once it develops, can become chronic Prevention: Avoid infection (insect bites, cuts, Treat early, as it is more difficult to treat the further it progresses. Flying can make it worse (per Kara Jones) Risk factors include older age, obesity, C VD, radiation, concomitant infection Transient edema in first month post-op is not lymphedema Exercises, arm elevation Treatment & Prevention: • Avoid infection Compression sleeve/glove Manual lymph drainage PT exercises ___