Breast surgery covers the operations used to diagnose and treat breast disease. In breast cancer the aim is to remove the disease safely; in benign conditions it is to relieve symptoms while avoiding unnecessary intervention. Prof. Dr. Müjgan Çalışkan Evren is a professor of general surgery and an oncoplastic breast surgeon who completed her master's degree in breast science at the University of Milan.
This page gives a general overview of the main topics, from the oncoplastic approach to breast-conserving surgery, from mastectomy to axillary management, from reconstruction to postoperative follow-up. The information here is general; personal decisions are made by your physician after considering your examination, imaging and pathology results together.
What is the oncoplastic approach?
Oncoplastic surgery combines the safe removal of breast cancer with plastic surgery principles. The aim is to remove the tumour with an adequate margin of healthy tissue and, within the same operation, preserve the shape, symmetry and natural appearance of the breast as far as possible.
The breast tissue is reshaped, and when needed a procedure on the other breast may be planned for symmetry. Treatment is planned by a physician experienced in general and breast surgery, together with the radiology, pathology and oncology teams. Which technique is appropriate depends on the tumour, the breast anatomy and personal preferences, and is decided after a physician examination.
Breast-conserving surgery
In breast-conserving surgery only the tumour and a surrounding margin of healthy tissue are removed, so most of the breast is kept. In suitable patients, combined with radiotherapy, it is an established option for breast cancer.
- The size and location of the tumour relative to the breast matter.
- Extensive involvement of several areas, or being unable to receive radiotherapy, may limit suitability.
- The removed tissue is examined by pathology; if tumour is found at the edges, further surgery may be needed.
You can read more on the breast-conserving surgery page, and about complementary treatment on the radiotherapy page. Suitability is assessed individually.
Mastectomy and risk-reducing surgery
Mastectomy is the removal of all breast tissue. It is considered when breast-conserving surgery is not suitable or according to the patient's preference. Skin-sparing and nipple-sparing techniques may be possible in selected cases, depending on the location and extent of the tumour.
Risk-reducing surgery is a preventive operation considered for people at high risk of breast cancer, for example with a strong family history or a specific genetic change. It lowers the risk but does not eliminate it. The decision should follow genetic counselling, risk assessment and detailed information. See the pages on mastectomy and risk-reducing surgery for more.
Axillary (underarm) management
In breast cancer, the status of the axillary lymph nodes matters for staging and treatment planning. When clinical and imaging findings do not suggest nodal involvement, sentinel lymph node biopsy is usually preferred. One or a few of the first nodes draining the breast area are removed and examined, so removing all the underarm fatty tissue is often unnecessary.
When involvement is proven, or in certain situations, axillary lymph node dissection may be considered. The goal is to obtain the right information without increasing the risk of arm swelling (lymphoedema) and numbness more than necessary. The team decides together which method is suitable.
Breast reconstruction
Reconstruction rebuilds the breast after mastectomy, or after breast-conserving surgery with a large tissue loss. It can be done in the same operation as the mastectomy (immediate) or after treatments are completed (delayed); timing depends on any additional treatment needed and the person's situation.
- Implant reconstruction: breast volume is created with a silicone or similar prosthesis; the operation is usually shorter.
- Autologous reconstruction: the person's own tissue (for example from the abdomen or back) is used; the operation is more extensive.
Each method has advantages and risks; the choice depends on body build, other health conditions and expectations.
Surgery for benign breast conditions
Most breast lumps are benign, yet every lump should be assessed properly. Fibroadenoma and intraductal papilloma are common examples. Some fibroadenomas can simply be observed; removal is considered for those that grow, cause symptoms or have an uncertain diagnosis.
For an intraductal papilloma, especially with nipple discharge, removal together with the affected duct may be suggested. Non-surgical options also exist for some carefully selected fibroadenomas; details are on the non-surgical fibroadenoma treatment page. Before deciding, the diagnosis should be clarified with ultrasound and, if needed, a biopsy.
Preoperative assessment
Planning begins with a detailed physician examination and history: symptoms, family history, previous operations and current medicines are reviewed. Imaging such as mammography, ultrasound and, if considered necessary, magnetic resonance imaging follows.
If an area looks suspicious, a tissue sample is taken by biopsy and the treatment roadmap is drawn according to the pathology result. In cancer, the features of the disease, the timing of surgery and any additional treatment are discussed by a multidisciplinary team. Asking your questions and learning the options at this stage helps make the decision together. You can request an appointment for an assessment.
Recovery and follow-up
The length of hospital stay and the return to daily life vary with the type of operation. A drain (a thin tube that removes fluid), pain control, wound care and arm exercises are frequent topics in the early period. Following the instructions you receive supports healing.
When the pathology report is ready, the results are reviewed; if needed, radiotherapy, chemotherapy, hormonal or targeted treatment is planned. Follow-up continues for years with regular examinations and imaging. If you notice fever, marked redness, increasing swelling or discharge from the wound, contact your team without delay. For questions you can use the contact page.
Hospital where surgery is performed
Operations are also performed at Biruni University Faculty of Medicine Hospital in Istanbul. For current information about the hospital, please see the institution's own website.
