🌷 Mastectomy & Breast Surgery
The arm on the operative side changes the rules for the rest of that patient’s life. Positioning, lymphedema and what to teach.
🧬 What is done
| Procedure | Removes |
|---|---|
| Lumpectomy | The tumor and a margin; breast preserved |
| Simple mastectomy | Whole breast; nodes left |
| Modified radical | Whole breast + axillary lymph nodes |
| Sentinel node biopsy | Only the first draining node — far less lymphedema risk |
The lymph nodes are the part that matters for nursing care. Removing axillary nodes removes the drainage route for that arm — permanently.
That is why the affected arm needs lifelong protection, even decades later.
🩺 Immediately after surgery
Positioning
- Semi-Fowler’s with the affected arm elevated on a pillow — above the level of the heart, to drain lymph by gravity
- Turn on the back or unaffected side, never the operative side
🚨 The affected arm — lifelong rules
- No blood pressure cuff on that arm
- No venipuncture, no injections, no IV lines, no finger sticks
- No tight jewelry, watches or sleeves
- No heavy lifting — typically nothing over 5–10 lb initially
- Protect from cuts, burns and sunburn; wear gloves for gardening and washing up
- Use an electric razor for the underarm
Put a sign above the bed. Every clinician who walks in needs to know which arm.
💧 Drain care
- Jackson-Pratt or Hemovac, usually for 1–3 weeks
- Teach the patient to empty, measure and record output
- Recompress the bulb to restore suction after emptying
- Drains usually come out when output falls below about 30 mL/day
- Report sudden increase, bright red bleeding, or foul odor
💪 Exercise — timing matters
- Start early: hand, wrist and elbow movement, ball squeezing — usually within 24 hours
- Wait for shoulder exercises until the surgeon clears them — typically after drains are out, to protect the suture line
- Then progress to wall climbing with the fingers, hair brushing, rope turning
Full shoulder range too early disrupts the incision. Too late causes a frozen shoulder. Follow the surgeon's schedule.
⚠️ Lymphedema and living with it
Lymphedema is swelling of the arm because lymph has nowhere to drain. It can appear months or years later, and once established it is managed rather than cured.
Report: heaviness, tightness, rings or sleeves getting tight, visible swelling, or any redness, warmth or fever — that is cellulitis and needs antibiotics urgently.
Infection in a lymphedematous arm spreads fast because the immune drainage is gone. Never treat a red, warm arm as minor.
✅ Reducing the risk
- Keep the arm elevated when resting
- Skin care — moisturise, treat every scratch promptly
- Compression sleeve as prescribed, including for air travel
- Maintain a healthy weight; gentle regular exercise helps drainage
💐 The part that is not physical
Body image, sexuality and fear of recurrence are central, not peripheral. Look for readiness cues — whether the patient looks at the incision is the classic indicator of beginning acceptance.
Offer, but do not push, information about prostheses, reconstruction and support groups. Let the patient set the pace and the topic.
🎯 NCLEX traps
- No BP, no needles, no constriction on the affected arm — for life
- Elevate the arm; turn to back or unaffected side
- Hand and elbow exercises early; shoulder exercises only when cleared
- Redness and warmth in that arm = infection, treat urgently
- Looking at the incision signals psychological readiness