Breast Surgery in Ankara, Turkey

Breast surgery is the specialty field of general surgery that focuses on the treatment of benign and malignant diseases of the breast. This discipline covers a wide spectrum, from benign lesions such as commonly seen cysts and fibroadenomas, to inflammatory conditions and gynecomastia in men. Its primary focus is the treatment of breast cancer with oncological and aesthetic principles. Modern approaches aim not only to eliminate the disease but also to preserve the natural appearance of the breast, keeping the patient’s quality of life at the highest level. Surgical planning is personalized according to each patient’s individual condition.

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

Which Diseases Does Breast Surgery Deal With?

Breast surgery deals with the diagnosis and treatment of a wide variety of conditions affecting the breast. We can basically group these diseases under a few main headings. Each condition requires a different approach and treatment plan.

The main groups of breast diseases covered by surgery are:

• Benign breast diseases
• Malignant breast diseases (breast cancer)
• Inflammatory and infectious conditions of the breast
• Male breast diseases

Each disease within these groups has its own specific symptoms, diagnostic methods, and treatment processes. For example, a benign cyst is usually only monitored, whereas a malignant tumor requires a comprehensive treatment plan. The role of the breast surgeon is to establish the correct diagnosis and determine the most appropriate and personalized treatment pathway for each patient.

What Is the Treatment Approach in Modern Breast Surgery?

In the past, the treatment of breast diseases largely rested on the shoulders of a single doctor, namely the surgeon. However, today this understanding has completely changed. The cornerstone of modern breast surgery is the multidisciplinary team approach. This can be likened to an orchestra; specialists from different medical disciplines, each a master of their own instrument, work in harmony to create the best melody for each patient—namely, the most successful treatment outcome. This approach ensures that no aspect of treatment is overlooked and provides the patient with 360-degree care.

This team includes doctors from different specialties. The indispensable members of the team are:

• Breast surgeon (general surgeon)
• Medical oncologist
• Radiation oncologist
• Plastic surgeon
• Radiologist
• Pathologist
• Genetic counselor
• Supportive care specialists (physiotherapist, psychologist, dietitian)

These specialists regularly come together in “tumor boards” to discuss each patient’s situation in detail. For example, decisions such as whether surgery should be performed before or after chemotherapy, which surgical technique is most suitable for the patient, and whether radiotherapy is needed are made jointly. In this way, the treatment process becomes individualized and the success rate is maximized. This collaboration ensures that the patient receives the best care both physically and psychologically.

Is Every Palpable Lump in the Breast Dangerous and Does It Require Breast Surgery?

Feeling a lump in the breast naturally causes great concern. However, it should not be forgotten that the vast majority of lumps detected in the breast are benign and not cancer. An important part of breast surgery practice is the accurate diagnosis and management of these benign conditions. In many cases, regular follow-up alone is sufficient without the need for surgery.

Common benign breast conditions that do not require surgery include:

• Simple cysts
• Fibroadenomas
• Fibrocystic changes

Simple cysts are smooth, fluid-filled sacs and are especially common in women in their 30s and 40s. They can often be felt as a painful swelling. They do not carry a risk of cancer and do not require treatment. If a cyst grows very large and causes discomfort, draining the fluid with a needle is a procedure that is both diagnostic and relieving.

Fibroadenomas are the most common benign solid lumps in young women. On physical examination, they are felt as a smooth, mobile, rubbery structure. They do not carry a risk of cancer, and in most cases their growth stops, and they may even shrink over time. For this reason, small fibroadenomas with a confirmed diagnosis are usually only monitored. However, if it is larger than 3 cm, grows rapidly, causes pain, or creates significant anxiety in the patient, surgical removal may be considered.

Fibrocystic changes are not actually a disease but a normal response of breast tissue to hormonal fluctuations during the menstrual cycle. They can cause general tenderness, pain, and a lumpy feeling in the breasts. This condition does not increase the risk of cancer and does not require special treatment. Lifestyle changes and simple pain relievers are usually sufficient to manage the pain.

Which Benign Breast Lesions Carry a Cancer Risk and Are Treated Surgically?

Some benign breast lesions are called “high-risk.” This does not mean that they are cancer, but it means that in a person with these lesions, the risk of developing breast cancer in the future is somewhat higher than in the general population. For this reason, such lesions are usually removed surgically both to establish a definitive diagnosis and to eliminate the risk.

High-risk lesions that may require surgical intervention include:

• Atypical hyperplasia
• Intraductal papillomas
• Phyllodes tumors
• Radial scars

Atypical hyperplasia is a condition in which the cells within the milk ducts or milk glands both increase in number and take on an appearance different from normal. This condition can increase the risk of developing cancer in the future by 4–5 times. When atypical hyperplasia is diagnosed by needle biopsy, complete surgical excision of this area is usually recommended. This is because sometimes, right next to this lesion, there may be a small focus of cancer in an area the needle did not sample. Surgery is performed to eliminate this possibility.

Intraductal papillomas are small wart-like structures that form within a milk duct. The most typical symptom is bloody or clear nipple discharge, usually coming from a single duct. Although a single papilloma is generally low risk, surgical removal both stops the discharge and allows a definitive diagnosis through pathological examination.

Phyllodes tumors are a rare type of tumor that can be both benign and malignant. Due to their tendency to recur, they need to be widely excised along with a margin of healthy breast tissue. Radial scars are lesions with a star-like appearance under the microscope and can sometimes be found together with cancer; therefore, surgical removal is generally recommended.

Could the Cause of Breast Pain and Discharge Be an Infection, and How Does Breast Surgery Treat It?

Symptoms such as breast pain, redness, swelling, and increased warmth are often signs of an infection. These conditions may require urgent medical intervention, and breast surgery also plays an important role in the treatment of such inflammatory conditions.

Mastitis is an inflammation of breast tissue that is especially common in breastfeeding women. It usually occurs when the milk ducts become blocked and then a bacterial infection develops. The first step of treatment is usually oral antibiotics. Continuing to breastfeed helps the milk to drain and speeds recovery.

If mastitis is not treated effectively or if treatment is delayed, the infection can progress and turn into a breast abscess. An abscess is a pocket of pus that accumulates within the breast and must be drained. In the past, breast abscesses were usually drained in the operating room under general anesthesia by making an incision. However, the modern approach today is ultrasound-guided needle drainage of the abscess. This method protects the patient from general anesthesia and a surgical incision, is less painful, leaves no scar, and the recovery process is much faster. Needle drainage can be repeated at intervals of a few days until the abscess disappears completely and is supported with antibiotic therapy. Open surgical drainage is now preferred only in rare cases where needle treatment fails or the abscess is very large.

What Does Breast Surgery Do for Breast Enlargement in Men (Gynecomastia)?

Breast diseases are not exclusive to women. Men also have breast tissue, and various conditions can occur. The most common is gynecomastia, a benign enlargement of the breast glands in men. It may occur due to reasons such as puberty, aging, certain medications, or hormonal imbalances. Gynecomastia often stands out more as an aesthetic and psychological problem than a medical one and may negatively affect a person’s social life and self-confidence.

When lifestyle changes or treatment of the underlying cause does not resolve the problem, the permanent and effective solution is surgery. The goal of gynecomastia surgery is to remove excess breast tissue and fat to create a flatter, tighter, and more masculine chest contour. The surgical technique used varies depending on which tissue is responsible for the enlargement:

• Liposuction: If the enlargement is mainly due to fatty tissue, excess fat is suctioned out through very small openings made in the breast area.
• Excision (Surgical Removal): If the enlargement is due to firm and dense glandular tissue, this tissue must be surgically removed. This procedure is usually performed through a semicircular incision made along the lower edge of the nipple, so the scar is almost invisible.
• Combined Technique: In most patients, both liposuction and excision techniques are used together to achieve the best result. While fatty tissue is removed with liposuction, firm glandular tissue is surgically removed to create the ideal chest shape.

What Is the Role of Breast Surgery in the Diagnosis of Breast Cancer?

In suspected breast cancer, the first and most critical step is to make the correct diagnosis. This is possible by taking a tissue sample from the suspicious area and examining it pathologically—namely, by biopsy. In the past, biopsy was a surgical procedure performed directly in the operating room, but today this approach has largely been abandoned. Modern breast surgery aims to establish the diagnosis with less invasive, more comfortable, and faster methods.

The main biopsy methods used today are:

• Fine-needle aspiration biopsy (FNAB)
• Core needle biopsy
• Vacuum-assisted biopsy
• Surgical biopsy

Fine-needle aspiration biopsy is the least invasive method, but since it can only obtain a cell sample, it cannot provide detailed information about the type of cancer and carries a risk of an insufficient sample. Therefore, its use is quite limited today.

Core needle biopsy is considered the gold standard method today. Under local anesthesia and guided by ultrasound or mammography, tissue samples are taken from the suspicious mass. Because this method preserves tissue architecture, it allows the pathologist to evaluate important information that directly affects the treatment plan, such as whether the cancer is invasive, its type, and its grade.

Vacuum-assisted biopsy uses a thicker needle and a vacuum system to obtain more tissue samples through a single entry. It is especially valuable in diagnosing clusters of small calcifications (microcalcifications) seen on mammography.

Surgical biopsy, meaning the complete removal of the suspicious lesion by surgery, is now used only in special cases where needle biopsy results are inconclusive or inconsistent with imaging findings.

Which Surgical Treatment Methods Are Used in Breast Cancer?

Surgery is one of the main pillars of breast cancer treatment. Thanks to major scientific studies, we now know that in early-stage breast cancer, there is no difference in survival between removing the entire breast (mastectomy) and removing only the tumor area followed by radiotherapy to the remaining breast (breast-conserving surgery). Therefore, the decision is no longer only a medical necessity but also a personal decision made by taking into account the patient’s expectations, body perception, and lifestyle.

There are two main surgical approaches:

• Breast-Conserving Surgery (BCS): In this method, the aim is to remove the cancerous tissue along with a margin of healthy tissue while preserving the rest of the breast. This operation, also known as “lumpectomy,” is almost always performed together with adjuvant radiotherapy (radiation therapy).
• Mastectomy: In this method, all breast tissue that is cancerous or at risk of cancer is removed.

The choice between these two options depends on the size of the tumor, whether it is in more than one area of the breast, the patient’s breast size, genetic risk factors, and the patient’s own wishes. For example, in a very small breast, a large tumor may not yield a good cosmetic result with breast-conserving surgery, whereas the same-sized tumor in a large breast can be conserved easily. The surgeon helps the patient make this important decision by explaining the advantages and disadvantages of both methods in detail.

What Is Breast-Conserving Surgery (Lumpectomy), and Who Is It Suitable For?

Breast-conserving surgery (BCS) is an approach that aims to preserve the natural shape and appearance of the breast as much as possible while treating cancer. This operation is generally an ideal option for patients in whom the tumor is small relative to breast size and located in a single focus. The basic principle of the operation is to remove the tumor with “clear surgical margins,” meaning that no tumor cells remain at the edges of the removed tissue.

If the tumor is too small to be felt by hand, before surgery the radiologist places a very thin wire or a small marker (clip, radioactive seed, etc.) at the tumor site under ultrasound or mammography guidance. During surgery, the surgeon uses this marker as a guide to find and remove the correct tissue. The removed specimen is sent to pathology during or after surgery to confirm that the surgical margins are clear. If tumor cells are detected at the margins, a second operation may be required to clear the remaining cancerous tissue. An integral part of BCS is radiotherapy applied to the remaining breast tissue after surgery. This treatment significantly reduces the risk of the disease recurring in the same breast by destroying microscopic cancer cells that may have remained in the breast.

What Is a Mastectomy, and Which Types Does Breast Surgery Perform?

Mastectomy is the operation to remove all breast tissue. Unlike the radical operations performed in the past in which the chest muscles were also removed, modern mastectomy techniques are much less traumatic and are generally planned to provide a basis for aesthetic reconstruction (breast reconstruction).

The main types of mastectomy performed today are:

• Simple (total) mastectomy
• Skin-sparing mastectomy
• Nipple-sparing mastectomy
• Modified radical mastectomy

A simple mastectomy is the removal of all breast tissue together with the nipple, areola, and the overlying skin. A skin-sparing mastectomy is a technique in which the nipple and areola are removed while most of the breast skin is preserved. This is especially ideal when reconstruction with an implant or the patient’s own tissue is planned in the same session because it creates a natural skin envelope.

Nipple-sparing mastectomy is the most advanced technique. In this operation, the nipple and areola are preserved along with the breast skin. The breast tissue is removed through an incision made in a less visible area such as the inframammary fold or the side. It offers the best possible aesthetic result but can only be performed in selected, low-risk patients where the tumor is sufficiently far from the nipple. Modified radical mastectomy is a method, now used more rarely, in which a large portion of the axillary lymph nodes is also removed in addition to a simple mastectomy.

Why Are the Axillary Lymph Nodes Important During Breast Surgery?

The first place breast cancer is likely to spread is usually the axillary lymph nodes (axilla) on the same side. Therefore, the status of the axillary lymph nodes must be evaluated in order to accurately determine the stage of the cancer and decide whether additional treatment (such as chemotherapy) is needed. The surgical approach in this area has also undergone a revolutionary change in recent years.

In the past, almost every woman who underwent breast cancer surgery had all of the axillary lymph nodes removed (axillary lymph node dissection – ALND). Although this procedure was effective in controlling cancer, it could cause side effects that seriously reduced quality of life, such as lymphedema (chronic and painful swelling of the arm), numbness, weakness, and restricted movement in the arm.

Today, for patients with no suspicious lymph nodes in the axilla on preoperative examination and imaging, the standard approach is sentinel lymph node biopsy (SLNB). In this technique, a special blue dye or a radioactive substance is injected into the breast tissue during surgery. These substances follow the lymphatic pathways and mark the “sentinel” lymph node(s), which are the first lymph nodes reached by the tumor’s lymph flow. Through a small incision in the axilla, the surgeon finds and removes only these 1–3 marked sentinel lymph nodes. If no cancer cells are found in these nodes, the other lymph nodes are considered clean, and no further procedure is performed. In this way, 70–80% of patients are protected from the serious side effects of removing all axillary lymph nodes. ALND is now performed only in selected patients in whom extensive cancer is detected in the sentinel lymph node or in whom axillary cancer is known at the outset.

What Does Oncoplastic Breast Surgery Mean?

Oncoplastic surgery is a modern philosophy that combines breast cancer surgery with the aesthetic principles of plastic surgery. The main aim of this approach is to maximize the aesthetic appearance of the breast while performing breast-conserving surgery (lumpectomy), removing the cancerous tissue safely with wide margins. It is used especially to prevent or correct deformities such as indentation or shape distortion that may occur in the breast after the removal of larger tumors.

Thanks to oncoplastic techniques, breast-conserving surgery can now be performed safely in many patients for whom it was previously thought that preserving the breast was not possible. While removing the tumor, the surgeon reshapes the remaining breast tissue to give the breast a more lifted and aesthetic form. Often, to achieve perfect symmetry, a procedure such as reduction, lift, or augmentation is also performed on the other breast in the same session. As a result, oncoplastic surgery is a patient-centered approach that helps the patient preserve body integrity and self-confidence while being cured of cancer.

Is It Possible to Create a New Breast After Mastectomy Through Breast Surgery?

Yes, it is definitely possible. The procedure of creating a new breast to replace the one lost after mastectomy is called breast reconstruction. This is an important part of the treatment process that helps a woman regain her body image and self-confidence. Reconstruction can be performed at the same time as the mastectomy (immediate) or months or years later after cancer treatments are completed (delayed).

There are two main reconstruction methods:

• Implant-based reconstruction
• Autologous reconstruction (using the patient’s own tissue)

Implant-based reconstruction is the most commonly used method. It is usually a two-stage process. In the first operation (during mastectomy), a temporary tissue expander is placed under the chest muscle. Over several months, this expander is gradually inflated with saline at regular intervals so that the overlying skin slowly stretches and a pocket is created for the permanent implant. In a second, simpler operation, the expander is removed and replaced with a permanent silicone implant.

Autologous reconstruction (using the patient’s own tissue) is a more complex operation. In this method, skin, fat, and blood vessels taken from the patient’s own body—most commonly the abdomen (DIEP flap), back (LD flap), or buttock area—are used to create a new breast. Although it requires a longer operation and recovery period, the resulting breast has a more natural feel and appearance because it is entirely living tissue, it gains and loses weight with the patient’s body, and it is permanent for life. Both methods have their own advantages and disadvantages, and the most suitable method is decided together with the patient.

Frequently Asked Questions