Lumpectomy Surgery in Ankara, Turkey

Lumpectomy surgery is the procedure of surgically removing tumors or masses detected in the breast together with the surrounding healthy tissue. This method aims to completely clear the diseased area while preserving most of the breast tissue and is frequently performed in early-stage breast cancers.

The recovery process after lumpectomy is shaped by monitoring the surgical area and managing the potential risk of infection. Patients are kept under regular follow-up in the postoperative period to preserve breast aesthetics and prevent complications.

The combination of lumpectomy and radiotherapy is an important strategy in reducing the risk of local recurrence. After surgery, radiotherapy is generally recommended to minimize the likelihood of cancer cells remaining in the remaining breast tissue and to reduce the risk of the disease recurring.

Quality of life after surgery depends on preserving breast sensation and function, addressing aesthetic concerns, and providing psychosocial support. Specialist follow-up and a personalized treatment plan support patients in experiencing a healthy recovery process.

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

What Is Lumpectomy Surgery?

Lumpectomy is a breast-conserving surgical method used in the treatment of breast cancer, in which only the tumor and a small amount of surrounding healthy tissue are removed. Without removing the entire breast, the focus is placed only on the diseased area. While ensuring oncologic safety, the goal is to preserve the aesthetic structure as much as possible. It is usually supported with radiotherapy. It is an effective and safe treatment option frequently preferred in early-stage breast cancers.

Is breast-conserving surgery as safe as removing the entire breast?

This is the most frequently wondered and most fundamental question for patients considering breast-conserving surgery. The answer is clearly “yes,” based on scientific evidence spanning many years. Very large and long-term scientific studies that began in the 1970s (especially the landmark study named NSABP B-06) have clarified this issue.

In these studies, thousands of patients with early-stage (Stage I and II) breast cancer were followed. Some patients underwent surgery in which the entire breast was removed (mastectomy), while another group received treatment in which only the tumor was removed (lumpectomy) followed by radiotherapy.

When these patients were followed for 20 years, the results were very clear for the medical world: It was definitively proven that there was NO DIFFERENCE between the group in which the entire breast was removed and the group in which only the tumor was removed followed by radiotherapy (breast-conserving treatment) in terms of overall survival, disease-free survival, or the risk of the disease spreading to distant organs.

This finding fundamentally changed the approach to breast cancer treatment. We now know that in appropriately selected patients, breast-conserving surgery (lumpectomy) followed by radiotherapy offers oncologic outcomes equivalent to removing the entire breast in terms of cancer control and survival.

Why is the risk of the disease coming back (recurrence) after surgery so important?

Although there is no difference in overall survival between breast-conserving surgery and mastectomy, some differences have been observed in the patterns of “local” recurrence, meaning recurrence in the treated breast or chest wall. After mastectomy, if a recurrence occurs, it generally peaks within the first 2 years after surgery. In contrast, after lumpectomy, the risk of recurrence shows a slow increase over the years and generally reaches its highest point around the 5th year.

There is a very critical point here: Early local recurrences (within the first 5 years) after lumpectomy have much more serious prognostic significance than late recurrences (after 5 years). Scientific studies have shown that women who experience recurrence within the first 5 years unfortunately have lower long-term survival rates compared to those who experience recurrence after 5 years.

This places a very important responsibility on us surgeons and oncology teams: The initial treatment must be excellent. Removing the cancerous tissue during surgery with “clear surgical margins” so that no cells are left behind, and strictly adhering to treatment protocols (especially radiotherapy), are vital to minimizing the risk of early local recurrence. A successful initial treatment is the most important factor that directly affects the patient’s long-term life expectancy.

For whom is breast-conserving surgery (lumpectomy) not a suitable option?

Although breast-conserving surgery is a great option, it is not suitable for every patient. When making a decision, both the status of the disease and the patient’s general health condition are taken into account. Situations in which this treatment cannot be applied are divided into “absolute” and “relative” contraindications.

There are some situations in which this treatment is considered oncologically unsafe or technically not possible:

• Inflammatory breast cancer
• More than one (multicentric) tumor focus in different areas of the breast
• Suspicious calcifications or DCIS spread throughout the entire breast
• Inability to obtain clear surgical margins
• The first trimester of pregnancy (cannot receive radiotherapy)
• Some rare genetic radiation sensitivities (e.g., homozygous ATM mutation)
• Having previously received radiotherapy to the same chest region

Some situations are considered “relative” contraindications. In these cases, breast-conserving surgery is not “forbidden,” but it has risks or difficulties. The decision should be made together by the patient and the treatment team (surgeon, medical oncologist, radiation oncologist).

• Active connective tissue diseases such as scleroderma or lupus
• A tumor that is very large relative to the size of the breast
• Genetic predispositions such as BRCA1 or BRCA2

If there is a BRCA gene mutation, can lumpectomy be performed?

This is one of the most frequently asked questions by patients who test positive for this genetic test. Technically, the answer is “yes.” Women who carry high-risk gene mutations such as BRCA1 or BRCA2 are not contraindicated for breast-conserving surgery. Surgery can be performed, and the same oncologic outcomes can be achieved for the current cancer.

However, the real issue here is not the treatment of the current cancer but the future risk.

Being a BRCA carrier unfortunately greatly increases the patient’s lifetime risk of developing a new cancer in the same breast or cancer in the opposite breast. For this reason, genetic counseling must be obtained when planning surgery. Especially in young BRCA carriers (e.g., under 35 years old), even if we treat the current cancer with lumpectomy, due to this high future risk, removing the tissue of both breasts (prophylactic bilateral mastectomy) should be discussed in detail as an option. The decision depends entirely on the patient’s age, risk perception, and personal preferences.

How are non-palpable tumors found during surgery?

A significant portion of breast cancers—especially thanks to screening mammography—are detected as small masses or calcifications that are not yet palpable. The surgeon must find and remove this “invisible” target during surgery. You can think of it like a surveyor finding a treasure. For this, preoperative localization (marking) is performed.

The traditional method is wire localization. It has been the standard method used for many years. On the morning of surgery, in the radiology department, a thin wire is placed into the area where the tumor is located under mammography or ultrasound guidance. One end of the wire is inside the tumor, and the other end is outside the breast. The surgeon finds the target tissue by following this wire. However, this method has disadvantages such as the wire shifting, the discomfort of the patient waiting with a wire outside until surgery, and difficulties in operating room scheduling.

Fortunately, technology has made our lives easier in this regard as well. Wireless localization methods are now being used increasingly. In this technique, days or even weeks before surgery, the radiologist places a tiny “magnetic seed” or “radiofrequency chip (RFID tag)” about the size of a grain of rice into the tumor. This small device stays inside and is not visible from the outside. During surgery, the surgeon uses a special handheld detector to detect this signal and removes the tissue over the target. The absence of a wire provides great comfort for the patient, simplifies planning, and increases surgical precision.

What is oncoplastic surgery and why is it important?

This is one of the most important developments in breast surgery in recent years. Oncoplastic Surgery (OPBCS) is the combination of oncologic surgery principles with plastic surgery techniques.

Its purpose is twofold:

• To remove the cancer in the safest way with much wider healthy tissue (i.e., with better surgical margins).
• While doing this, to immediately repair the deformity, depression, or asymmetry that may occur in the breast and to give the breast a natural, aesthetic form.

The advantage of oncoplastic surgery is not only a “better appearance.” Its main oncologic advantage is this: With the comfort of “I can reconstruct it anyway,” the surgeon can more generously remove the healthy tissue around the tumor. In this way, the likelihood of “positive surgical margins” (i.e., the tumor being at the edge) and thus the need for reoperation (re-excision) decreases significantly.

If the removed tissue is very large and a serious cavity will form in the breast, “Volume Replacement” or “Volume Displacement” techniques are used. In these techniques, the cavity is filled by shifting the breast’s own tissue internally or by transferring healthy tissues nourished by their own blood supply, called “flaps,” from adjacent areas (such as the lateral chest wall or back). Thanks to these methods, in many patients for whom it might previously have been said “breast conservation is not possible; mastectomy is necessary,” it is now possible to achieve both cancer safety and excellent cosmetic outcomes.

What does a “clear surgical margin” mean during surgery?

The surgical margin (or margin) is the most critical concept that determines the success of a lumpectomy surgery. You can think of it like removing a rotten part from inside an apple. You need to remove not only the rotten part but also some healthy apple tissue around it so that no diseased part is left behind.

The removed breast tissue (specimen) is sent to the pathology laboratory. The pathologist stains the outer surface of this tissue with a special ink. Then the tissue is cut into sections and examined under a microscope. The goal is: Are cancer cells touching this “inked edge” (i.e., the ink) or not?

• Negative Surgical Margin: There is some healthy breast tissue between the cancer cells and the inked edge. The cancer does not touch the ink. This indicates that the surgery was successful and the tumor was completely removed.
• Positive Surgical Margin: Cancer cells are in contact with the inked edge (the ink). This means the “tumor is at the edge,” and there is a high likelihood that cancerous tissue remains in the breast. This situation usually requires a second surgery (re-excision).

Here, there is a small but important difference depending on the type of cancer:

• Invasive Cancer Margin: If the tumor is invasive cancer (even if it includes DCIS), the internationally accepted standard is: “No ink on tumor.” In other words, no oncologic difference has been demonstrated between having 1 mm, 2 mm, or 5 mm of healthy tissue between the cancer cell and the inked edge. As long as it does not “touch” the edge, the margin is considered “negative” and sufficient.
• Pure DCIS (Ductal Carcinoma In Situ) Margin: If the removed tumor is only DCIS (i.e., pure in-duct cancer that has not spread beyond the duct), the standard is stricter. Because DCIS can spread irregularly within the milk ducts. In this case, obtaining at least a 2 mm clear margin is targeted. A 2 mm clear margin is considered to minimize the risk of recurrence.

Can it be understood during surgery whether the surgical margin is clear?

The success of surgery is to remove it with a clear margin “in one go.” The obligation to reoperate (re-excision) is both a major source of stress for the patient and causes delays in subsequent treatments such as radiotherapy. Therefore, surgeons try to check the margins during surgery.

The best-known and traditional way is “Frozen Section (FSA)” examination. Pieces are taken from the removed tissue or from suspicious-looking edges and, while the surgery continues, they are rapidly frozen and sent to the pathologist. The pathologist examines under the microscope and informs the surgeon within 15–20 minutes as “margin clear” or “margin positive.” If positive, the surgeon removes a little more tissue from that area. This method is reliable, but it prolongs the surgery time and sometimes the freezing process can make the permanent pathology assessment more difficult.

With advances in technology, devices such as “Wide-Field Optical Coherence Tomography (OCT),” which can scan the edges of the removed tissue at the cellular level during surgery, are also being developed. These new methods aim to increase the chance of performing a clean surgery in one session by providing the surgeon with an instant and high-resolution “margin map” before sending to the pathologist.

Why are the axillary lymph nodes checked?

One of the first routes breast cancer can use to spread in the body is the lymph nodes in the armpit (axilla). Therefore, part of the surgery is to check whether the cancer has reached these “transfer stations.” This is called “staging” and directly affects subsequent treatment decisions (such as whether chemotherapy is needed).

In the past, almost all of the lymph nodes in the armpit (level I and II dissection) were removed in nearly every patient who underwent breast cancer surgery. This was necessary for staging, but it caused a very serious side effect: lymphedema (arm swelling), arm pain, and limitation of movement.

Now, in patients whose armpit appears clean clinically (by examination and ultrasound) (cN0), we use a much smarter and more protective method called “Sentinel Lymph Node Biopsy (SLNB).”

In this method, the “sentinel” or “guard” lymph nodes—the first nodes to which lymph fluid flows from the cancerous breast, and thus the first nodes cancer cells would reach—are identified. During surgery, a special blue dye and/or a low-dose radioactive substance is injected into the breast. These substances follow the lymphatic pathways and stain/mark the first sentinel node(s). The surgeon removes only these 1–3 marked “sentinel” nodes through a small incision and sends them to the pathologist.

If the sentinel nodes are clean, the probability that cancer has spread to other nodes is below 1%. No further procedure is performed in the armpit. The patient is spared an unnecessary surgery and the risk of lymphedema.

If cancer is found in the sentinel nodes, then the situation must be evaluated in detail.

If cancer is found in the sentinel lymph node, is the entire armpit cleared?

This is one of the most important questions that has changed medicine in the last 10 years. For years, the rule was: “If there is cancer in the sentinel node, all lymph nodes in that armpit (ALND) must be removed.” This placed the patient back at risk of lymphedema.

Fortunately, the groundbreaking scientific study called ACOSOG Z0011 changed this rule. This study showed:

If the patient;

• Is undergoing breast-conserving surgery (lumpectomy) and will definitely receive radiotherapy to the whole breast,
• Has a T1 or T2 tumor (i.e., smaller than 5 cm),
• Has a clean armpit examination before surgery (cN0),
• And only 1 or 2 sentinel lymph nodes were found to have cancer on pathology,

There is NO NEED to remove the other lymph nodes in the armpit for these patients!

This result initiated the era of “de-escalation” (reducing treatment). The reason is that it was proven in this patient group that clearing the entire armpit does not provide a survival advantage compared to giving radiotherapy alone. The radiotherapy delivered to that region also treats the remaining potentially risky nodes (if any). This approach has spared thousands of women from unnecessary axillary surgery morbidity (lymphedema, limitation of movement, pain).

Is axillary management different in those who receive preoperative (neoadjuvant) chemotherapy?

Yes, it is very different. The Z0011 rule mentioned above (i.e., the luxury of not touching the armpit with 1–2 positive nodes) is not valid for patients who receive preoperative chemotherapy (NAC).

If a patient received chemotherapy before surgery to shrink the cancer, axillary management becomes a much more sensitive issue. Especially in patients known to have cancer in the axillary lymph nodes before chemotherapy (proven by needle biopsy), these nodes may appear to have been “cleared” after chemotherapy. However, this “clearing” can be misleading.

In this high-risk group, standard sentinel node biopsy is not sufficient, because lymphatic pathways affected by chemotherapy can yield “false negative” results (i.e., appearing as if there is no cancer when there is).

The modern approach is “Targeted Axillary Dissection (TAD).” In this technique:

Before chemotherapy, the lymph node known to be cancerous is identified with ultrasound and a small “clip” (marker) is placed inside it.

The patient receives chemotherapy.

During surgery, the surgeon removes both the standard sentinel nodes (with blue dye/radioactive substance) and that clipped target node (with a special detector).

This dual approach is the most reliable method for staging the armpit after chemotherapy and minimizes the false-negative rate.

Which treatments are required after lumpectomy?

Lumpectomy is only the first and important step of treatment. Cancer treatment is a team effort, and other treatments follow surgery.

Adjuvant Systemic (Drug) Treatments:

These are treatments that enter the bloodstream and target hidden cancer cells (micrometastases) in the body (if present). They are planned by the Medical Oncology department after surgery (or sometimes before). Treatment is personalized according to the pathological characteristics of the tumor (hormone receptor status, HER2 status, stage) and may include:

• Chemotherapy
• Hormone therapy (anti-estrogen medications)
• Targeted smart drugs (if HER2-positive)
• Immunotherapy

Adjuvant Radiotherapy (Radiation Therapy):

This is the “non-negotiable” part of breast-conserving surgery. What makes breast-conserving treatment equivalent to mastectomy is the combination of lumpectomy + radiotherapy. Even if the surgeon removes the tumor with a clear margin, invisible, microscopic cancer cells may remain in the remaining breast tissue. Radiotherapy delivers controlled radiation to the entire breast (or sometimes only to the tumor bed) to destroy these hidden cells and greatly reduce the risk of the disease recurring in the same breast.

What is “partial breast irradiation” (APBI) in radiotherapy?

Standard radiotherapy is in the form of “Whole Breast Irradiation” (WBI) and usually lasts 3 to 6 weeks, requiring coming to the hospital every day.

In recent years, an option called “Accelerated Partial Breast Irradiation” (APBI) has emerged. The rationale of APBI is this: Most recurrences (80–90%) after breast-conserving surgery occur in the area where the original tumor was removed (the tumor bed). So, instead of irradiating the whole breast, let’s irradiate only this high-risk area (the former tumor cavity and 1–2 cm of surrounding tissue).

This method can be applied either with special devices (e.g., brachytherapy) or with modern external radiotherapy machines and can shorten the treatment duration to 1–2 weeks, or sometimes even to 5 days.

However, APBI is not suitable for everyone. It is recommended only for a highly selected, low-risk patient group based on evidence that it is as safe as WBI. Suitable candidates for APBI generally have the following characteristics.

• Older age (generally over 40 or 50)
• Small tumor size (e.g., 2 cm)
• Low-risk pathology (Grade 1–2, hormone-positive)
• Negative axillary lymph nodes
• Clear surgical margins (APBI cannot be done if there is a positive margin)
• No genetic mutations such as BRCA

What is the most common issue encountered after surgery?

As with any surgery, some complications may be seen after lumpectomy and axillary procedures, but these are usually manageable conditions.

The most common condition after breast and axillary surgeries is “Seroma.” This is not an infection or a dangerous condition. It is the accumulation of serum, serous fluid, and lymph fluid in the cavity at the surgical site as part of the body’s healing process. Seroma development is related to the extent of the surgery (risk increases especially if axillary dissection was performed), the techniques used, and the patient’s constitution.

Most small seromas are absorbed by the body on their own within a few weeks or months. If the seroma becomes very large, painful, or prominent enough to stretch the skin, this fluid can be easily drained in outpatient conditions by simply entering with a syringe (needle).

What determines success in breast-conserving surgery?

Breast-conserving surgery is an extremely safe oncologic standard treatment that preserves quality of life. However, the success of this treatment is a “package” and depends on all of the following components being complete.

• Correct patient selection
• Flawless surgical technique (clear margins)
• Oncoplastic surgery when needed
• Smart, evidence-based axillary management (avoiding unnecessary dissection)
• Complete completion of radiotherapy treatment
• Receiving the required systemic (drug) treatments

Frequently Asked Questions About Lumpectomy

In which cases is lumpectomy surgery preferred?

Lumpectomy is performed especially in early-stage breast cancer to remove the tumor together with a margin of healthy tissue. Since it preserves breast integrity, it is also frequently preferred in patients with aesthetic concerns.

Is radiotherapy mandatory after lumpectomy?

Yes. Since microscopic cancer cells may remain in the remaining breast tissue after lumpectomy, radiotherapy is applied in most patients as a standard complementary treatment.

Is the entire breast removed during lumpectomy?

No, only the tumor and a limited amount of surrounding healthy tissue are removed. Most of the breast is preserved, and in this respect it differs from mastectomy.

Is the aesthetic appearance preserved after lumpectomy surgery?

Generally yes. Especially in small tumors and in patients with sufficient breast volume, the aesthetic appearance can be preserved successfully.

Why is the pathology report important after lumpectomy?

The pathology report provides critical information such as the type and size of the tumor, the cleanliness of the surgical margins, and lymphovascular involvement. These findings are decisive in radiotherapy and additional treatment decisions.

Is lymph node sampling performed after lumpectomy?

Yes. Typically, sentinel lymph node biopsy is performed to assess the status of the axillary lymph nodes. If necessary, additional nodes may also be removed.

How soon can one return to work after lumpectomy?

Patients can often return to light work within 1 week. The severity of complaints, limitation of arm movements, and individual healing speed affect this period.

How long do pain and swelling last after lumpectomy?

Mild pain, tenderness, and swelling decrease within a few days. With ice application, appropriate painkillers, and wound care recommendations, complaints are generally easily controlled.

Does a new lump form in the breast after lumpectomy?

There is a possibility of recurrence, so regular mammography and doctor follow-ups are important. However, new lumps do not always mean cancer; fat necrosis or scar tissue may also occur.

Is psychological support necessary after lumpectomy?

Yes. The cancer process can be emotionally challenging. Psychological counseling and support groups help patients manage the process in a stronger and more balanced way.

How Long Does Lumpectomy Surgery Take?

Lumpectomy surgery usually takes between 1 and 2 hours. This duration may vary depending on the size and location of the tumor and the amount of tissue to be removed. The procedure is typically performed under general anesthesia, and patients may be discharged the same day. If a lymph node biopsy is performed, the surgery time may be slightly longer.

Which doctor or department should one go to for lumpectomy?

The specialist to consult for this procedure is a general surgeon experienced in breast surgery.

How is lumpectomy surgery performed?

Lumpectomy is a breast-conserving surgical procedure in which the cancerous or suspicious mass in the breast is removed together with a certain amount of surrounding healthy tissue. It is usually performed under general anesthesia. The surgeon determines the location of the mass using imaging methods performed beforehand and removes it by targeting only the tumorous area. When necessary, the axillary lymph nodes are also evaluated in the same session. After surgery, the overall shape of the breast is largely preserved in most patients, and the aesthetic appearance is minimally affected.