Post-Mastectomy Breast

Question 1

What should you inspect for when examining a post-mastectomy breast?

Answer 1

• Asymmetry
• Scar- describe
• Surrounding skin and axilla
• Evidence of radiotherapy?
• Pec major present? Ask patient to press her hips
• Arm lymphoedema

Question 2

What should you palpate for when examining a post-mastectomy breast?

Answer 2

• Remaining breast
• Axilla
• Supraclavicular fossa

Question 3

What should you do to complete an examination of a post-mastectomy breast?

Answer 3

• Spine: Palpate for tenderness and masses
• Abdomen: Look for hepatomegaly
• Lungs: Percuss and auscultate for mets

Question 4

What are the types of mastectomy?

Answer 4

1. Simple mastectomy: Removal of breast alone- most common. Still need to manage axilla
2. Other: Not performed as no increased survival benefit:
   
   1. Modified radical: Breast, pec minor, axilla
   2. Radical: Breast, pec minor and major, axilla
   3. Extended radical: Radical + internal mammary LNs

Question 5

What are indications for mastectomy?

Answer 5

• Patient preference
• Multifocal disease
• Large lump in small breast >4cm
• Large area of DCIS e.g. >4cm
• Nipple involvement

NB: Breast conservation is usually carried out wherever possible

Question 6

How many drains are put in post-mastectomy, and where are they placed?

Answer 6

• Typically 2
• Axilla and surgical site
• Left in 3-5 days or until draining <50ml/day
• Can go home with drains in situ with district nurse support