Mastectomy Surgery in Ankara, Turkey

Mastectomy surgery is the procedure of surgically removing all or a large part of the breast tissue. This method, which is generally performed in the treatment of breast cancer, is preferred in order to remove cancerous tissue from the body and prevent the disease from spreading.

Radical mastectomy is a more extensive surgical method in which the surrounding lymph nodes are removed along with the breast tissue. Different techniques such as subcutaneous or total mastectomy are selected according to the extent of the disease and the characteristics of the patient.

Post-mastectomy reconstruction may be performed to reshape the breast tissue. This procedure aims to improve patients’ postoperative adaptation and quality of life both aesthetically and psychologically.

In the postoperative period, wound care, pain management, and infection risk must be kept under control. In addition, patients’ receiving psychosocial support and being followed with regular medical check-ups are necessary for a healthy recovery process.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Mastectomy Surgery in Ankara, to get information about Mastectomy Surgery prices, the process, and the hospital where Mastectomy Surgery is performed.

What Is Mastectomy Surgery?

Mastectomy is the surgical removal of the entire breast in the treatment of breast cancer. Depending on the size and location of the tumor and the extent of the disease, different types such as total, skin-sparing, or nipple-sparing mastectomy can be performed. In some cases, both breasts may be removed (prophylactic mastectomy). Postoperative reconstruction (breast reconstruction) may be planned. It is an effective surgical method to ensure oncologic control.

When does mastectomy become the only option?

In breast cancer treatment, the primary goal—if it is oncologically safe (i.e., safe in terms of cancer)—is to preserve the breast (we call this lumpectomy or breast-conserving surgery). However, in some cases this is not possible, and removing the entire breast (mastectomy) becomes both the safest and the only option.

These situations in which preserving the breast is not possible are as follows:

• Multifocal (multicentric) disease (more than one tumor in different quadrants of the breast)
• Suspicious microcalcifications spread over a very wide area
• Inability to obtain clear surgical margins (if the area around the tumor cannot be completely cleared)
• Inflammatory breast cancer (an aggressive type)
• Very extensive ductal carcinoma in situ (DCIS)
• Inability to receive radiotherapy in the first trimester of pregnancy
• Some rare genetic predispositions (extreme sensitivity to radiotherapy)

These situations make mastectomy necessary to minimize the risk of the cancer recurring in the same breast (local recurrence) and to provide the best oncologic control.

If I receive chemotherapy before surgery, does it change my mastectomy decision?

Neoadjuvant Systemic Therapy (NST) means receiving chemotherapy or targeted therapy before surgery. The aim is to shrink the tumor to facilitate surgery and even to clear the lymph nodes in the armpit.

A patient who initially required mastectomy because the tumor was very large may become a suitable candidate for breast-conserving surgery if they respond excellently to this treatment.

However, an important psychological factor comes into play here. Studies show that even among patients who technically become eligible to preserve the breast, a significant proportion (around 30–35%) still prefer mastectomy. The reason is patients’ concerns about local recurrence. Patients may choose mastectomy as a more definitive solution due to worries such as “there may be invisible foci inside the breast that were not affected by chemotherapy” or the thought of “I want complete peace of mind.”

This shows how important it is for the surgeon to manage the “shared decision-making” process by listening not only to technical possibilities but also to the patient’s concerns.

If I have a high genetic risk (such as BRCA), why is mastectomy surgery recommended?

This is different from therapeutic mastectomy; it is called Risk-Reducing Mastectomy (RRM). The aim here is not to treat an existing cancer but to minimize the risk of developing cancer in the future.

Having high-risk genetic mutations such as BRCA1 or BRCA2 increases a woman’s lifetime risk of developing breast cancer many times compared to the normal population.

Risk-Reducing Mastectomy is the most effective preventive strategy against this high risk. It has been proven that this surgery reduces the risk of breast cancer in BRCA carriers by approximately 85% to 100%. This surgery is generally performed bilaterally, meaning on both breasts.

So, if there is cancer in one breast, should the other healthy breast (the contralateral breast) also be removed? If the patient has a proven high genetic risk such as BRCA or was diagnosed with cancer at a very young age such as under 35, performing RRM on the contralateral breast is an option.

However, it has been proven that for a patient who does not have a genetic/familial high risk, removing the other healthy breast does not improve overall survival. National cancer guidelines do not routinely recommend contralateral RRM in this situation.

What preparations and imaging are required before mastectomy surgery?

The decision for mastectomy requires a multidisciplinary approach; planning should include consultations with a plastic surgeon, medical oncologist, and radiation oncologist.

As a routine, mammography and ultrasound of both breasts are required. Breast MRI is not necessary for every patient, but it can be used to monitor response to preoperative chemotherapy or to fully understand the extent of the disease.

Beyond imaging, the patient’s overall health status is vital, especially if breast reconstruction is being planned. The main factors affecting the risk of complications are:

Smoking (the most important risk factor that impairs wound healing)

• Uncontrolled diabetes
• High Body Mass Index (obesity)
• Hypertension

Previous surgeries through areas such as the abdomen for repair with the patient’s own tissue (flap)

What are the types of mastectomy?

Mastectomy is basically classified according to the amount of tissue removed and whether the skin is preserved.

• Simple (Total) Mastectomy: All breast glandular tissue, a large part of the overlying skin, the nipple, and the areola are removed. Generally, no extensive intervention is performed in the armpit.
• Modified Radical Mastectomy (MRM): In addition to simple mastectomy, this is the systematic removal of the axillary lymph nodes (Axillary Lymph Node Dissection).
• Skin-Sparing Mastectomy (SSM): The breast tissue and nipple are removed, but most of the breast skin is preserved. This skin envelope serves as a “pocket” for reconstruction (breast reconstruction) and is almost always combined with immediate reconstruction.
• Nipple-Sparing Mastectomy (NSM): This is the latest evolution of mastectomy techniques. While all breast tissue is removed, both the skin envelope and the nipple are preserved. The breast tissue is removed through a small incision made in a less visible area such as the inframammary fold. This technique provides superior cosmetic outcomes.

Is everyone a suitable candidate for nipple-sparing mastectomy (NSM) surgery?

No, although NSM offers the best cosmetic result, it is not suitable for every patient. Ideal candidates are generally those undergoing surgery for prophylactic (risk-reducing) purposes or those with small tumors located away from the nipple.

Traditionally, a high BMI, significant breast ptosis, or having previously received radiation therapy were considered barriers to NSM. Because radiotherapy impairs blood circulation to the nipple, the risk of tissue death (necrosis) was thought to be very high.

However, current studies have shown that even in selected patients who have previously received radiation, this procedure can be performed safely with careful surgery.

Today, the situations considered absolute contraindications for NSM are as follows:

• Inflammatory breast cancer
• Proof that cancer cells involve the nipple
• The two most important risks that patients should know are:
• Risk of partial or complete tissue death (necrosis) in the nipple.
• Risk of partial or complete loss of sensation in the nipple (because the nerves cannot be preserved).

How is the decision made regarding the axillary lymph nodes during mastectomy surgery?

If there is no suspicious lymph node in the armpit on the patient’s preoperative examination and ultrasound, the standard approach is Sentinel Lymph Node Biopsy (SLNB), i.e., “Sentinel Node” biopsy. In this procedure, the “sentinel” node, into which the tumor first drains, is found with a special blue dye or radioactive substance injected into the breast during surgery, and only those 1–3 nodes are removed.

So what if cancer is found in the sentinel node?

In the past, in this situation all lymph nodes in the armpit (ALND) were removed, which led to a high risk of lymphedema (arm swelling).

We now know that (especially in those receiving breast-conserving surgery and radiotherapy) even with 1–2 positive sentinel nodes, clearing the entire armpit (ALND) may not always be necessary.

In mastectomy patients, (as in studies such as AMAROS), in the presence of 1–2 positive nodes, no oncologic difference has been found between clearing the armpit (ALND) and giving only radiotherapy (radiation therapy) to that area. Since radiotherapy carries a lower risk of lymphedema, this is an important alternative.

When is radiotherapy (radiation therapy) needed after mastectomy surgery?

Postmastectomy Radiation Therapy (PMRT), i.e., radiation therapy after mastectomy, is performed to reduce the risk of the cancer recurring in the chest wall or regional lymph nodes. The PMRT decision is made according to the final stage in the pathology report.

Clear indications and situations to consider are as follows:

• Four or more positive axillary lymph nodes (ge4): This is the most definite and strongest indication for PMRT. It is strongly recommended.
• One to three positive lymph nodes (1–3): This is considered a “gray zone.” PMRT “should be strongly considered.” The decision is individualized according to the patient’s other risk factors (tumor size, lymphovascular invasion, degree of aggressiveness).
• T3N0 (Tumor > 5 cm, Node Negative): Even if the armpit is clear (N0), if the primary tumor is very large (greater than 5 cm), especially if there are additional risk factors, PMRT may be considered.

Status after preoperative chemotherapy: In these patients, the PMRT decision is usually made according to the clinical stage before treatment.

When is immediate breast reconstruction performed at the same time as mastectomy?

There are two main timings:

• Immediate / Simultaneous Reconstruction:

This is generally the preferred method. As soon as the mastectomy surgery ends, while the patient is still under anesthesia, the plastic surgeon takes over in the same session and starts the reconstruction procedure (with an implant or the patient’s own tissue). Its advantages are reducing the total number of surgeries required, providing a better aesthetic appearance, and being psychologically much more positive because the patient does not go through a “breastless” period.

• Delayed Reconstruction:

Mastectomy surgery is performed and the chest wall is closed. The patient’s oncologic treatments (chemotherapy or radiotherapy) are completed. After all these treatments are finished, 6 to 12 months later, when the patient has fully recovered, breast reconstruction is performed with a separate surgery. This may be a safer option in cases where the risk of complications is high in immediate reconstruction (smokers, those with uncontrolled diabetes) or where these complications have the potential to disrupt cancer treatment (chemotherapy/radiotherapy).

What is the difference between “under the muscle” and “over the muscle” (prepectoral) techniques in implant placement with mastectomy?

When reconstruction is performed with an implant, there are two main planes for the “pocket” in which the implant will be placed:

• Subpectoral (“Under the Muscle”): This is the traditional method. The implant is placed under the large ‘pectoral’ muscle on the chest wall. This can cause more pain after surgery and can cause the breast to move when the patient flexes the muscle (“animation deformity”).
• Prepectoral (“Over the Muscle”): This is the modern approach. The implant is placed directly under the skin, i.e., on top of the pectoral muscle. Since the muscle is not cut, postoperative pain is significantly less, arm functions return faster, and animation deformity does not occur.

The Most Critical Difference: Radiotherapy and Capsular Contracture

Capsular contracture is the thickening and hardening over time of the capsule the body forms around the implant, distorting the shape of the breast. This is the most important long-term aesthetic problem, and radiotherapy (PMRT) greatly increases this risk.

Studies have shown that in patients receiving PMRT, capsular contracture rates in the over-the-muscle (PBR) group are significantly lower than in the under-the-muscle (SBR) group.

These findings strongly support that in high-risk patients expected to receive PMRT, prepectoral (over-the-muscle) reconstruction should be considered as a priority.

What does the Enhanced Recovery After Surgery (ERAS) protocol mean for mastectomy?

ERAS (Enhanced Recovery After Surgery) is an evidence-based care protocol that means “Faster Recovery After Surgery.”

In mastectomy surgery, the main focus of ERAS protocols is to minimize the use of opioid (morphine and derivatives) painkillers. Opioids can slow recovery by causing nausea and constipation.

Instead, “Multimodal Analgesia” is used: Non-opioid painkillers (such as paracetamol and NSAIDs) that act through different mechanisms and regional nerve blocks are used together. This enables patients to experience less pain, less nausea, to get out of bed sooner, and to be safely discharged in a shorter time.

What are drains placed after mastectomy used for, and when are they removed?

Mastectomy creates a large “dead space” by lifting the breast off the chest wall. Drains are thin tubes that prevent fluid accumulation (seroma) in this space and help the skin adhere to the underlying chest wall.

Drains usually remain for 1 to 3 weeks. The decision on when to remove them is made according to the volume of fluid output. The standard criterion is for the drainage volume to drop below 20 to 30 milliliters (cc) in 24 hours, and for this low volume to persist for two days.

If drains are removed before they fall below this threshold, fluid rapidly accumulates inside and leads to large, painful seromas. Keeping them longer than three weeks is also undesirable because it increases the risk of infection.

What is done if seroma (fluid collection) or hematoma (blood collection) occurs after mastectomy surgery?

• Seroma:

This is fluid accumulation in the surgical cavity after drains are removed and is the most common complication after mastectomy.

Management: If the seroma is small and does not cause pain, discomfort, or restrict arm movement, no intervention is performed. These small seromas are absorbed by the body over time. Only large, painful, or tension-causing seromas are drained with a needle. Especially in patients with an implant (prosthesis), unnecessary aspiration is avoided due to the risk of infection.

• Hematoma:

This is the accumulation of blood in the surgical area. It causes swelling, pain, and bruising. Small hematomas are usually absorbed on their own. Surgical intervention may be required for large hematomas or situations suggesting active bleeding.

What is the risk of surgical site infection (SSI) after mastectomy surgery, and why is long follow-up required?

Surgical site infection (SSI) is one of the most serious complications, especially in patients who undergo reconstruction (breast reconstruction).

Infection risk varies by the type of surgery:

• Infection rate after mastectomy alone: ~5%
• Infection rate after mastectomy with an implant: ~10%
• Infection rate after mastectomy with a flap (own tissue): ~11%

These data clearly show that immediate reconstruction (implant or flap) nearly doubles the infection rate.

The Most Striking Finding: The Need for Extended Follow-up

Data show that about half (more than 50%) of these infection cases occur after the standard 30-day postoperative follow-up period ends, within the period up to 180 days (i.e., from month 1 to month 6).

Especially patients who undergo immediate reconstruction must be followed for a much longer period, and patients must be clearly educated about late signs of infection (redness, swelling, fever, discharge).

Frequently Asked Questions

How does the recovery process progress after mastectomy surgery?

Although recovery after mastectomy varies from person to person, it generally takes 2–4 weeks. Pain, swelling, and fatigue are normal in the first days. Wound care and the exercises recommended by the doctor speed up recovery.

Which complications may develop after mastectomy surgery?

Infection, bleeding, seroma (fluid accumulation), lymphedema, and wound-healing problems may occur. More rarely, limitation of shoulder movement and nerve damage may develop.

For whom is mastectomy surgery recommended?

Mastectomy may be recommended for people diagnosed with breast cancer, those who do not respond to treatment, or those with genetic risks such as BRCA. In some patients, it may also be performed for preventive purposes.

Is an implant or reconstruction possible after mastectomy surgery?

Yes. The use of a breast implant or surgical reconstruction is possible. These procedures can be performed in the same session as the surgery or at a later time.

How is quality of life affected after mastectomy surgery?

Physical changes and psychological effects may occur. However, with appropriate rehabilitation, aesthetic solutions, and psychological support, quality of life can largely be preserved.

What should be considered after mastectomy surgery?

It is important that wound care is performed correctly, the arm is not overstrained, and signs of infection are monitored. Doctor follow-ups and exercises should not be neglected.

How can the risk of lymphedema be reduced after mastectomy surgery?

Avoiding straining the arm, preventing skin injuries, exercising regularly, and being under specialist supervision reduce the risk of lymphedema. Early-detected lymphedema is easier to treat.

Does the risk of cancer recurrence continue after mastectomy surgery?

Even though breast tissue is largely removed, there is still a very low risk of recurrence. Regular follow-up and imaging minimize this risk.

When should exercises be started after mastectomy surgery?

Light exercises are usually started within the first week after surgery. The range of motion is increased gradually. The doctor’s guidance is essential.

Is sexual life affected after mastectomy surgery?

Emotional and physical changes may affect sexual life. With partner support, psychological counseling, and reconstruction options, a healthy sexual life can be maintained.

How Long Does Mastectomy Surgery Take?

Mastectomy surgery usually takes between 1 and 3 hours. The duration may vary depending on the type of mastectomy performed (for example, total, skin-sparing, bilateral) and additional procedures (such as lymph node removal, reconstruction). Together with anesthesia preparations and postoperative observation time, the length of hospital stay may be extended.

Which Doctor or Department Should One Go to for Mastectomy?

The specialist to consult for mastectomy is a general surgeon.

How many days does it take to recover from mastectomy surgery?

After mastectomy, the hospital stay is usually 1–3 days. Most patients can return to daily living activities within 2–4 weeks. However, the full recovery process may take several months depending on the surgical technique used, whether breast reconstruction was performed, and additional treatments such as chemotherapy/radiotherapy.

Is mastectomy surgery risky?

Mastectomy is a major surgical procedure, but it is safely performed by experienced surgical teams. Possible risks include bleeding, infection, wound-healing problems, and lymphedema. The level of risk may vary depending on the patient’s overall health condition and any additional procedures performed.

Can blood be drawn from the arm on the side of the mastectomy?

If axillary lymph nodes were removed during mastectomy, drawing blood from the arm on the same side is generally not recommended. This may increase the risk of lymphedema. Unless absolutely necessary, blood pressure measurement and injections should also not be performed on this arm.