Mastectomy

Mastectomy

Anesthesia type	General
Airway	ETT vs. LMA
Lines and access	PIV
Monitors	Standard monitors
Primary anesthetic considerations
Preoperative	Place IV in non-operative extremity
Intraoperative
Postoperative
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A total mastectomy (simple mastectomy) refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular	Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function.
Respiratory
Gastrointestinal
Hematologic	Chemotherapy can cause anemia and thrombocytopenia.
Renal
Endocrine
Other

Labs and studies

• CBC with diff and platelet count

Regional and neuraxial techniques

• Consider Paravertebral Blocks

Intraoperative management

Monitoring and access

• 20g PIV (non-operative extremity)
• Place BP cuff on non-operative extremity

Positioning

• Supine
• Ipsilateral arm may be prepped into field
• Repositioning may be required
• Avoid brachial plexus stretch

Postoperative management

Disposition

• PACU

Potential complications

• PONV
• Lymphedema
• Seroma
• Pneumothorax

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications