radical mastectomy

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mastectomy

 [mas-tek´to-me]
surgical removal of breast tissue, usually for treatment of malignant breast tumors, although occasionally this may be advisable for benign tumors, other diseases of the breast such as fibrocystic disease of the breast, or prophylaxis. Patients with breast disorders should be informed about all the options for treatment including alternatives to mastectomy. Types of mastectomy include the simple or total mastectomy and radical, modified radical, and extended radical mastectomies.
Patient Care. The psychological aspects of the breast must always be considered in the care of women who face the prospect of loss of breast tissue through surgery. The breast is symbolic of femininity, motherhood, and sexual attractiveness for some individuals. Psychological problems likely to be associated with mastectomy include disturbance in self-concept related to changes in body image, self-esteem, role performance, and personal identity. Newer, less mutilating surgical procedures and cosmetically successful reconstructive plastic surgery (mammaplasty) to replace surgically removed breast tissue have diminished some of the emotional trauma formerly associated with mastectomy.

Following mastectomy the patient is likely to experience such physical problems as pain, numbness, tingling, and weakness related to nerve damage and muscle atrophy. Additionally, the patient is subject to lymphedema and collections of serous fluid (seroma) associated with interruption of the flow of lymph.

In addition to routine postoperative care to prevent pulmonary and circulatory complications, the patient must be watched for the development of localized edema, especially if lymph nodes have been removed. In order to provide adequate drainage of serosanguineous fluid that could delay healing of the operative site, the surgeon may insert a flat, narrow drain with multiple openings. The device is part of a portable self-contained closed-suction system that exerts negative pressure. Systems of this kind include Hemovac and Reliavac.

The patient receives routine postoperative care, including coughing and deep-breathing exercises, to prevent respiratory complications and early ambulation to avoid circulatory stasis. When helping the patient from bed it is important to realize that her sense of balance may be impaired because of changes in upper body structures and some hesitancy to use the arm on the operative side to support herself and maintain balance.

Postoperative care should include periodic assessment of sensations (e.g., “phantom breast” sensations) and of functional limitations in the chest wall and affected arm. Additionally numbness, patterns of weakness, and paresthesias are evaluated. The patient should be taught how to recognize and report these symptoms and any changes noted, as they could indicate progressive nerve damage.

Impairment of lymph flow increases the risk of infection. Loss of sensation could predispose the patient to injury from burns, cuts, and other accidental trauma. Venipunctures are not done and blood pressure cuffs are not applied on the arm on the affected side. Prior to discharge the patient is given instruction in ways to avoid trauma: for example, do not carry a heavy handbag or other heavy articles with the affected arm, avoid excessive exposure to sun, do not pick or cut cuticles, and consult the physician or nurse before having vaccinations or injections in the affected arm. Exercises to improve mobility and lymphatic drainage are begun while the patient is in the hospital and continued by her after discharge. These exercises are described and illustrated in the booklet “Help Yourself to Recovery,” which is available from local offices of the American Cancer Society. The Cancer Society also has self-help support groups, called Reach for Recovery, for women following mastectomy.

The woman is encouraged to continue follow-up care, including a clinical breast exam every 3 to 4 months for the first 3 years, then every 6 months for 2 years, and thereafter every 6 to 12 months. Annual mammograms should be obtained and the woman should perform breast self-exams monthly.
Halsted mastectomy radical mastectomy.
partial mastectomy removal of the tumor, along with varying amounts of surrounding normal tissue. See also lumpectomy and quadrantectomy. Called also segmental mastectomy.
radical mastectomy removal of the breast, pectoral muscles, axillary lymph nodes, and associated skin and subcutaneous tissue in treatment of breast cancer.
In a radical mastectomy, breast tissue, nipple, underlying muscles, and lymph nodes are removed. From Ignatavicius and Workman, 2001.
radical mastectomy, extended supraradical mastectomy; surgical removal of the internal mammary chain of lymph nodes, the entire involved breast, the underlying chest muscles, and the lymph nodes in the axilla.
radical mastectomy, modified surgical removal of the entire involved breast, and many lymph nodes in the axilla. The underlying chest muscles are removed in part or are left in place after removal of axillary lymph nodes.
In a modified radical mastectomy, breast tissue, nipple, and lymph nodes are removed, but muscles are left intact. From Ignatavicius and Workman, 2001.
segmental mastectomy partial mastectomy.
simple mastectomy surgical removal of the entire involved breast; the underlying chest muscles and axillary lymph nodes are not removed. More recently called total mastectomy.
In a simple mastectomy, breast tissue and (usually) nipple are removed, but lymph nodes are left intact. From Ignatavicius and Workman, 2001.
subcutaneous mastectomy excision of breast tissue with preservation of overlying skin, nipple, and areola so that the breast form may be reconstructed.
supraradical mastectomy extended radical mastectomy.
total mastectomy simple mastectomy.

rad·i·cal mas·tec·to·my

excision of the entire breast including the nipple, areola, and overlying skin, as well as the pectoral muscles, lymphatic-bearing tissue in the axilla, and various other neighboring tissues.

radical mastectomy

n.
A mastectomy that includes excision of the entire breast, underlying pectoral muscles, and regional lymph nodes.

radical mastectomy

surgical removal of an entire breast; pectoral muscles; axillary lymph nodes; and all fat, fascia, and adjacent tissues as one surgical treatment for breast cancer. Edema of the arm on the affected side is the rule because the axillary lymphatic structures that drain the lymph from the arm are removed during surgery. A pressure dressing is usually applied and left in place until bleeding and drainage have decreased. A drain is usually left in the wound for several days. Compare modified radical mastectomy, simple mastectomy. See also lumpectomy, mastectomy.

radical mastectomy

A mastectomy that completely removes the breast, as well as the skin, subcutaneous tissue, axillary lymph nodes and muscle from the anterior thoracic wall.

Radical mastectomies were once used to treat extensive breast cancer, but has been abandoned in view of the increased complications associated therewith and lack of improved survival.

radical mastectomy

Halsted radical mastectomy A mastectomy that removes the breast in toto, as well as skin, subcutaneous tissue, axillary lymph nodes, and muscle from the anterior thoracic wall. See Halsted radical mastectomy. Cf Modified radical mastectomy.

rad·i·cal mas·tec·to·my

(rad'i-kăl mas-tek'tŏ-mē)
Excision of the entire breast, including the nipple, areola, and overlying skin, as well as the pectoral muscles, lymphatic-bearing tissue in the axilla, and various other neighboring tissues.
Synonym(s): Halsted operation (2) .

Halsted,

William Stewart, U.S. surgeon, 1852-1922.
Halsted clamp
Halsted curved mosquito forceps
Halsted hemostat
Halsted incision
Halsted law - transplanted tissue will grow only if there is a lack of that tissue in the host.
Halsted mattress sutures
Halsted operation - excision of the breast as well as the pectoral muscles, lymphatic-bearing tissue in the axilla, and various other tissues. Synonym(s): radical mastectomy
Halsted suture - a suture used for exact skin approximation.