Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Mastectomy


Related Terms

  • Breast Excision
  • Lumpectomy

Specialists

  • General Surgeon
  • Oncologist
  • Pathologist
  • Radiology Oncologist

Comorbid Conditions

  • Bleeding disorders
  • Immunosuppression
  • Obesity

Factors Influencing Duration

Factors that might influence the length of disability include the extent and spread of the disease, the surgical procedure performed, the type of anesthesia used, whether the operation was also coupled with reconstructive surgery, and the age and general health of the individual. Adjuvant chemotherapy or radiotherapy following surgery may increase duration.

Medical Codes

ICD-9-CM:
85.20 - Excision or Destruction of Breast Tissue, Not Otherwise Specified
85.22 - Resection of Quadrant of Breast
85.23 - Mastectomy, Subtotal
85.24 - Excision of Ectopic Breast Tissue, Excision of Accessory Nipple
85.33 - Unilateral Subcutaneous Mammectomy with Synchronous Implant
85.34 - Other Unilateral Subcutaneous Mammectomy; Removal of Breast Tissue with Preservation of Skin and Nipple; Subcutaneous Mammectomy NOS
85.35 - Bilateral Subcutaneous Mammectomy with Synchronous Implant
85.36 - Other Bilateral Subcutaneous Mammectomy
85.41 - Unilateral Simple Mastectomy; Mastectomy: NOS, Complete
85.42 - Bilateral Simple Mastectomy; Bilateral Complete Mastectomy
85.43 - Unilateral Extended Simple Mastectomy; Extended Simple Mastectomy NOS; Modified Radical Mastectomy; Simple Mastectomy with Excision of Regional Lymph
85.44 - Mastectomy, Bilateral Extended
85.45 - Unilateral Radical Mastectomy; Excision of Breast, Pectoral Muscles, and Regional Lymph Node {Axillary, Clavicular, Supraclavicular]; Radical Mastectomy NOS
85.46 - Bilateral Radical Mastectomy
85.47 - Unilateral Extended Radical Mastectomy; Excision of Breast, Muscles, and Lymph Nodes [Axillary, Clavicular, Supraclavicular, Internal Mammary and Mediastinal]; Extended Radical Mastectomy NOS
85.48 - Bilateral Extended Radical Mastectomy

Overview

© Reed Group
A mastectomy is a surgical operation to remove breast tissue (breast parenchyma) and, in some cases, connecting lymph nodes and structural tissue. The most common indication for a mastectomy is breast cancer. The most prevalent type of breast cancer is infiltrating ductal carcinoma, which accounts for 75% of breast cancers and tends to spread (metastasize) to the lymphatic system (Wright). About 15% of breast cancer cases are diagnosed as infiltrating lobular carcinoma, which consists of small tumor cells that metastasize first to the axillary lymph nodes under the arm (Wright). These types of breast cancer are both treated surgically with mastectomy. Less common types of breast cancer (e.g., tubular carcinoma, mucinous carcinoma, and medullary carcinoma) are less invasive and rarely metastasize, but they may also be treated with some type of mastectomy.

Several types of mastectomy are performed, including partial (segmental), total (or simple), modified radical, and radical. The type of mastectomy performed depends upon the tumor size and location, the type of cancer, the stage of the cancer and whether it has spread (metastasized) to the lymph nodes, and a woman's personal wishes. Although in the past a radical mastectomy was commonly performed when any type of breast cancer was diagnosed, it is seldom performed today due to the associated disfigurement, diminished arm mobility, and arm swelling (lymphedema) that result. The availability of effective chemotherapeutic and radioactive therapies has also reduced the need for radical mastectomy.

For the majority of women, breast reconstruction is possible at the time of or after a mastectomy.

Source: Medical Disability Advisor



Reason for Procedure

This procedure is used to treat breast cancer or precancerous lesions that may develop into breast cancer. It is indicated in individuals whose breast cancer is located in the central portion of the breast, in individuals with a very large tumor or multiple tumors, in individuals with locally advanced disease, and as a preventative measure for high-risk individuals.

Source: Medical Disability Advisor



How Procedure is Performed

General anesthesia is administered during a mastectomy. An intravenous line (IV) is placed to deliver medications during surgery. An ECG is used to monitor heart rate. Vital signs are monitored electronically throughout the procedure. The procedure typically takes from 1 to 3 hours.

A lumpectomy removes abnormal tissue or a tumor (lump) from the breast and a small amount of normal surrounding tissue. It is a breast-conserving surgery.

A total or simple mastectomy removes the entire breast, skin, and nipple-areolar complex, but no lymph nodes. It is sometimes followed by sentinel lymph node biopsy to detect early invasive cancer and can be combined with axillary lymph node dissection if cancer cells are found.

A partial or segmental mastectomy removes the lesion and some surrounding tissue, the lining over the chest muscles below the tumor, and usually some of the lymph nodes of the axilla, to capture cancerous cells that may have migrated.

A modified radical mastectomy removes the breast, nipple-areolar complex, most or all of the axillary lymph nodes, the lining over the chest muscles, and sometimes part of the chest wall muscles. A 6- to 8-inch incision is required. Modified radical mastectomy is used for large tumors greater than 5 centimeters, in cases in which reconstruction and regional control cannot be accomplished by other breast-conserving procedures, and for women who do not desire a breast-conserving procedure.

A skin-sparing mastectomy removes the nipple, areola, and breast tissue through a much smaller ("keyhole") incision. This is a relatively new surgical technique and may be an option for selected patients. The procedure can be performed as a total (simple) mastectomy or as a modified radical mastectomy. Most of the skin is preserved (90%), and scarring is negligible. A plastic surgeon performs reconstruction after the procedure, using tissue from the abdomen or from a muscle in the back (latissimus dorsi).

A radical mastectomy removes the entire breast, axillary lymph nodes, overlying skin, nipple-areolar complex, and the chest wall muscles (pectoralis major and minor muscles).

A subcutaneous mastectomy removes some of the breast tissue, leaving the skin and the nipple-areolar complex intact. This is performed as a preventative or prophylactic measure in persons who are deemed at high risk for the development of this disease and as a treatment for breast cancer in selected individuals.

After a mastectomy, skin is closed with stitches (sutures) that will disintegrate or with non-dissolving stitches, staples, or clips that will be removed 7 to 10 days after the procedure. Typically a tube is inserted to drain blood and fluid from the area. The tube is removed sometime from a few days to a couple of weeks after the procedure. A pressure dressing is sometimes placed over the operative site to minimize postoperative oozing. Pain medications are given as needed.

Source: Medical Disability Advisor



Prognosis

Most women recover well from mastectomy. The extent of postsurgical discomfort and disability depends on the type of mastectomy, the stage of cancer, and if reconstructive surgery was done simultaneously. Typically, full recovery is expected in 3 to 6 weeks.

Occasionally, breast cancer recurs after mastectomy; the 20-year risk of recurrence after mastectomy is 3% to 5%; after lumpectomy with radiation, it is 15% to 20% (Neumayer). However, with early diagnosis and appropriate treatment, the 10-year survival rate of breast cancer is over 90% with either mastectomy or lumpectomy (Neumayer).

Source: Medical Disability Advisor



Rehabilitation

Although there has been some argument as to its effectiveness, rehabilitation therapy following a mastectomy has proven beneficial for some individuals. Therapy can begin once the individual has physician approval.

The focus of therapy should be on improving arm circulation and shoulder mobility, preventing postural deformities and muscle tension, and gaining shoulder strength. There are also special considerations for individuals who have had the lymph nodes removed in order to prevent lymphedema.

To prevent lymphedema, the extremity should be elevated above the level of the heart while sleeping and as often as possible during the day. Manual massage and isometric and isotonic pumping exercises are also necessary. Manual lymph drainage is a treatment available through certified practitioners of the technique; it helps to encourage the normal flow of lymph in the lymphatic system following surgery and to prevent lymphedema.

Exaggerated deep-breathing exercises can be performed to ease the feeling of tightness in the chest and to fully expand the lungs.

Source: Medical Disability Advisor



Complications

Complications might include postoperative infection; lymphedema (arm pain, swelling, and limited movement); hematoma; and emotional problems such as grief, depression, anxiety, and body-image issues. Loss of the intercostobrachial nerve during dissection of axillary nodes may result in numbness in the upper arm and under the arm of the surgical site.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Following recuperation, possible work restrictions and accommodations include temporary transfer from duties involving strenuous physical activity. Daily activities should be resumed as soon as possible, but vigorous exercise should be avoided for about 6 weeks. Some individuals may be treated with adjuvant chemotherapy or radiotherapy after surgery and may require time off for treatments and recovery from treatments.

Source: Medical Disability Advisor



References

Cited

Neumayer, Leigh A. "Mastectomy." eMedicine Health. Eds. Melissa Conrad Stoppler, et al. 28 Sep. 2007. WebMD, LLC. 25 Sep. 2009 <http://www.emedicinehealth.com/mastectomy/article_em.htm>.

Wright, Mary Jo, Krzysztof Moroz, and R. Edward Newsome. "Breast Cancer." eMedicine. Eds. Christian Paletta, et al. 10 Sep. 2009. Medscape. 24 Sep. 2009 <http://emedicine.medscape.com/article/1276001-overview>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.