19306 Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation)

Name of the Procedure:

Mastectomy, Radical (Urban Type Operation)
Common names: Radical mastectomy, Urban mastectomy

Summary

A radical mastectomy, particularly the Urban type, is an extensive surgical procedure for removing breast tissue along with the pectoral muscles, and axillary and internal mammary lymph nodes.

Purpose

• Medical Condition:* Primarily performed to treat advanced breast cancer.
• Goals:* To remove cancerous tissues and prevent the spread of cancer to other parts of the body.

Indications

• Symptoms/Conditions:* Diagnosed cases of advanced or aggressive breast cancer, particularly where cancer has spread to muscles and lymph nodes.
• Patient Criteria:* Patients suitable for this procedure usually have not responded well to other treatments such as chemotherapy or radiation.

Preparation

• Pre-procedure Instructions:* Patients may be advised to fast for several hours before the surgery. Medication adjustments (especially blood thinners) might be required.
• Diagnostic Tests:* Routine blood tests, mammograms, MRI, and possibly a pre-operative biopsy, might be used to assess the extent of the cancer spread.

Procedure Description

• Steps Involved:*
  1. The patient is placed under general anesthesia.
  2. An incision is made to access the breast, pectoral muscles, and nearby lymph nodes.
  3. The surgeon removes the breast tissue, entire pectoral muscles, and axillary (underarm) and internal mammary lymph nodes.
  4. The incision is closed with sutures, and a drainage tube may be inserted.
• Tools/Equipment:* Scalpel, retractors, electrocautery device, sutures, and drainage tube.
• Anesthesia/Sedation:* General anesthesia is used to ensure the patient is unconscious and pain-free during the surgery.

Duration

The procedure typically lasts between 2 to 4 hours.

Setting

Radical mastectomies are performed in a hospital setting, specifically in an operating room.

Personnel

Healthcare professionals involved include:

• Surgeons (specializing in oncology or breast surgery)
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common Risks:* Infection, bleeding, pain at the surgical site, and scarring.
• Rare Risks:* Anesthesia complications, damage to nearby nerves or blood vessels, chronic pain, and lymphedema (swelling due to lymph fluid).

Benefits

• Expected Benefits:* Effective removal of cancerous tissues, potentially reducing the risk of cancer spread and improving survival rates.
• Realization Time:* Benefits may be realized immediately in terms of removing cancerous growths, but long-term outcomes for cancer prevention and overall health may take months to assess.

Recovery

• Post-procedure Care:* Pain management with medication, wound care, and usage of drainage tubes. Physical therapy may be recommended to regain mobility.
• Recovery Time:* Initial recovery may take a few weeks, but full recovery can take several months. Follow-up appointments are necessary for monitoring progress and managing any complications.

Alternatives

• Other Treatment Options:* Lumpectomy (breast-conserving surgery), modified radical mastectomy, chemotherapy, radiation therapy, hormone therapy.
• Pros and Cons of Alternatives:* Less invasive options like lumpectomy offer quicker recovery but might not be suitable for advanced-stage cancer. Chemotherapy and radiation can target cancer cells throughout the body but may have significant side effects and may not be as immediately effective as surgery.

Patient Experience

• During the Procedure:* The patient will be under general anesthesia and will not feel any pain.
• After the Procedure:* Post-operative pain and discomfort are common but manageable with medication. The patient may experience fatigue, temporary swelling, and restricted movement in the affected area. Emotional support and counseling might be necessary to address body image issues and emotional distress.

Pain management includes prescribed analgesics, and physical therapy can help with muscle flexibility and strength.