Postmastectomy Care Management and the Potential for Burnout During Reconstruction

Potential complications

Many factors play into the potential risks for complications, such as the type of surgery and if radiation was administered to the breast before reconstruction. Complications can include lymphedema, infection, tissue necrosis, seroma, pain, and depression.

Lymphedema occurs when lymph nodes are removed or damaged during surgery, causing a blockage in the lymphatic system.¹ Symptoms include swelling, discomfort, and limited mobility in the affected area. Prevention can include avoiding activities that may put additional strain on the affected area, such as lifting heavy objects, and to wear compression garments as prescribed.

Possibility for infection is another complication, which can occur in the incision site or in the surrounding tissue.² The nurse’s role in prevention involves assessment of the operative area, which can start in the operating room and continues throughout recovery.

Tissue necrosis is a postmastectomy complication that occurs when blood supply to the tissue is inadequate, leading to the death of the tissue. It often incurs the need for further surgery.¹

Seromas can occur when fluid accumulates in the space from which the breast tissue was removed.⁴ Symptoms of seroma include swelling, discomfort, and a feeling of fullness in the affected area.

Pain is common after surgery. In addition to nurse education on how to manage postoperative pain, patients need to know how to safely take their pain medications and the side effects of those medications. Other pain management interventions include rest, massage, and physical therapy.

Physical therapy may be prescribed to help patients regain strength and mobility in the affected area. It can help patients regain mobility and range of motion after surgery, and helps reduce surgical complications. Physical therapy can also help reduce pain and discomfort and prevent complications such as lymphedema. Nurses should work closely with the physical therapist to ensure that the patient’s therapy is tailored to their individual needs and that they are progressing appropriately.⁴

Undergoing a mastectomy can have a significant impact on a patient’s emotional and mental well-being. Women with breast cancer have an increased risk of depression, and multiple surgeries can exacerbate their emotional distress. Nurses should be prepared to provide emotional support, and help identify those who may be at increased risk of reconstructive burnout such as those with preexisting medical comorbidities (eg, diabetes), those who’ve had radiation therapy, and those undergoing reconstruction with tissue expanders.²

References

1. Ghazal ID, Eleweke C, Aladesanwa FO, Onabajo BO. Post-mastectomy breast reconstruction: an overview of the state of the art, challenges, and prospects. Int Surg J. 2023;10(2):348-354. doi:10.18203/2349-2902.isj20230283       
2. Halani SH, Jones K, Liu Y, Teotia SS, Haddock NT. Reconstructive burnout after mastectomy: implications for patient selection. Plast Reconstr Surg. 2023;151(1):13e-19e. doi:10.1097/PRS.0000000000009776
3. Koralewska A, Domagalska-Szopa M, Siwiec J, Szopa A. The influence of external breast prostheses on the body postures of women who have undergone mastectomies. J Clin Med. 2023;12(7):2745. doi:10.3390/jcm12072745
4. Yuksel SS, Chappell AG, Jackson BT, Wescott AB, Ellis MF. “Post mastectomy pain syndrome: a systematic review of prevention modalities.” JPRAS Open. 2022;31:32-49. doi:10.1016/j.jpra.2021.10.009