Breast-conserving surgery (lumpectomy or partial mastectomy) is a surgical technique designed to remove the cancerous tumor while preserving most of the natural breast tissue. The goal is to achieve complete cancer removal with clear margins while maintaining the breast’s shape and appearance as much as possible. This procedure is an essential treatment option for many patients with early-stage breast cancer.

A lumpectomy begins with precise imaging—mammography, ultrasound, or MRI—to locate the tumor and determine its boundaries. During surgery, the surgeon removes the tumor along with a rim of healthy tissue, known as the surgical margin, to ensure all cancer cells are excised. The removed tissue is then sent for pathological analysis to confirm margin status.

Breast-conserving surgery is most suitable for patients with:

• Early-stage or localized tumors

• Tumors smaller relative to breast size

• Favorable biological markers

• Single-focus lesions (not multicentric)

• Good cosmetic potential after tissue removal

After tumor removal, surgeons may reshape or rearrange the remaining breast tissue to prevent contour deformities—an approach known as “oncoplastic tissue rearrangement.” This step is not the same as full oncoplastic surgery but supports better cosmetic outcomes.

The lumpectomy procedure typically requires follow-up radiation therapy to reduce the risk of local recurrence. Radiation helps eliminate microscopic cancer cells that may remain in the breast, making breast-conserving therapy as effective as mastectomy in many cases.

Benefits of breast-conserving surgery include:

• Preservation of natural breast appearance

• Shorter recovery time compared to mastectomy

• Less psychological impact

• Comparable cancer control rates when combined with radiation

Side effects, although generally mild, may include temporary bruising, swelling, pain, or changes in breast shape. Some patients may require a second surgery if margins are not clear, or if pathology reveals more extensive disease than initially expected.

At OFM Hospital, breast-conserving surgery is planned through a multidisciplinary approach, ensuring that oncologic safety, aesthetic considerations, and long-term outcomes are optimized for each patient.

Mastectomy is the surgical removal of breast tissue and is recommended when breast-conserving surgery is not suitable or when patients choose a more definitive treatment. The goal of mastectomy is to eliminate cancer with the highest oncologic safety while evaluating opportunities for immediate or delayed reconstruction. The type of mastectomy selected depends on tumor size, location, breast anatomy, genetic risk, and patient preference.

There are several recognized types of mastectomy:

⭐ 1. Total (Simple) Mastectomy

All breast tissue, including the nipple–areola complex, is removed while the lymph nodes and chest muscles are typically preserved.

Recommended for:

• Widespread or multifocal cancer

• Ductal carcinoma in situ (DCIS) involving large areas

• Patients who prefer removal of the entire breast to reduce recurrence risk

⭐ 2. Skin-Sparing Mastectomy

Most of the breast skin is preserved while the underlying breast tissue is removed.
This approach creates an ideal foundation for immediate reconstruction with implants or autologous tissue.

Recommended for:

• Patients planning immediate reconstruction

• Early-stage breast cancer

• Situations where the nipple cannot be safely preserved

⭐ 3. Nipple-Sparing Mastectomy

The nipple–areola complex remains intact, and only the deeper breast tissue is removed.
When oncologically safe, this method offers the most natural aesthetic outcome.

Recommended for:

• Early-stage cancer located away from the nipple

• Favorable imaging results showing no involvement of nipple ducts

• Patients who value maintaining breast appearance

⭐ 4. Modified Radical Mastectomy

Involves removal of the entire breast tissue along with axillary lymph nodes.
Chest muscles are preserved.

Recommended for:

• Patients with lymph node–positive cancer

• Locally advanced disease

• Tumors spreading into the skin or chest wall

⭐ 5. Radical Mastectomy (Rarely Used Today)

Includes removal of the breast, lymph nodes, and chest muscles.
Now reserved only for exceptional cases involving extensive local invasion.

🩺 Choosing the Right Mastectomy Technique

The choice is made after evaluating:

• Tumor location and multifocality

• Breast size relative to tumor size

• Patient’s genetic risks (e.g., BRCA mutations)

• Planned radiation therapy

• Overall aesthetic and reconstructive goals

Many patients considering mastectomy are also candidates for immediate reconstruction, which helps preserve body image and reduce the emotional impact of surgery.

At OFM Hospital, each mastectomy plan is customized by breast surgeons, reconstructive surgeons, oncologists, and radiologists to ensure the highest level of cancer control while respecting the patient’s cosmetic expectations and long-term well-being.

Evaluating lymph node involvement is one of the most important steps in breast cancer surgery. The lymph nodes under the arm (axilla) are often the first place where breast cancer may spread. Accurate assessment helps determine the stage of the disease, the need for additional treatments, and long-term prognosis. Two main surgical approaches are used: sentinel lymph node biopsy and axillary lymph node dissection.

⭐ Sentinel Lymph Node Biopsy (SLNB)

The sentinel lymph node is the first lymph node that drains the area where the tumor is located. If cancer spreads, this node is typically affected first.

➤ How it is performed

A tracer substance—blue dye, radioactive material, or both—is injected near the tumor. The surgeon identifies the sentinel node using a detector and removes it for pathological examination.

➤ Advantages

• Minimally invasive

• Fewer complications compared to full axillary dissection

• Lower risk of lymphedema (arm swelling)

• Accurate staging with minimal tissue removal

➤ When it’s recommended

• Early-stage breast cancer

• Clinically negative lymph nodes

• Patients undergoing lumpectomy or mastectomy

• DCIS cases requiring mastectomy

If the sentinel node is free of cancer, no further lymph node surgery is usually needed.

⭐ Axillary Lymph Node Dissection (ALND)

This procedure removes multiple lymph nodes from the axilla.

➤ When it’s required

• Sentinel node biopsy shows metastasis

• Multiple nodes are clinically or radiologically suspicious

• Locally advanced breast cancer

• Inflammatory breast cancer

• Cases where radiation alone is insufficient for control

➤ Risks to manage

Although effective, ALND carries higher risks of:

• Lymphedema

• Numbness or tingling

• Shoulder stiffness

• Seroma formation

For these reasons, it is reserved for cases where full nodal evaluation is essential.

⭐ Integrated Oncologic Planning

The choice between SLNB and ALND depends on tumor biology, imaging findings, and individual patient factors. In many cases, modern guidelines prioritize SLNB to minimize morbidity without compromising cancer control.

Axillary surgery decisions are made collaboratively by breast surgeons, radiologists, medical oncologists, and radiation oncologists to ensure an evidence-based and personalized treatment plan.

At OFM Hospital, lymph node surgery is performed with precision and minimal invasiveness, focusing on accurate staging while preserving arm function and quality of life.

Surgical margins—the rim of healthy tissue removed around a tumor—are one of the most important determinants of oncologic safety in breast cancer surgery. The purpose of margin evaluation is to ensure that no cancer cells remain at the edges of the removed tissue, reducing the risk of local recurrence and the need for additional surgery.

During lumpectomy or mastectomy, the surgeon removes the tumor together with a defined margin of normal-looking tissue. This specimen is then examined by a pathologist to assess whether the margin is negative (clear) or positive (cancer cells present at the edge).

⭐ Types of Margins

• Negative (Clear) Margin: No cancer cells at the outer edges. Indicates complete removal.

• Close Margin: Cancer cells are near, but not at, the edge. May require re-excision depending on guidelines.

• Positive Margin: Cancer cells reach the edge of the tissue. Additional surgery is typically required.

Margin requirements may differ depending on the type of cancer—for example, invasive carcinoma, DCIS, or multifocal disease.

⭐ Role of Intraoperative Decision-Making

During surgery, surgeons may use various tools to improve accuracy:

• Intraoperative Imaging

Specimen X-rays or ultrasound to confirm that the tumor and calcifications are fully removed.

• Frozen Section Analysis

Rapid pathology assessment of margin status during the operation, allowing immediate re-excision if needed.

• Cavity Shaving

Removing additional thin layers of tissue from the surgical site to reduce the risk of positive margins.

These approaches help minimize re-operations and improve long-term outcomes.

⭐ Comprehensive Pathology Evaluation

After surgery, the full specimen undergoes detailed pathology analysis, which includes:

• Tumor size and exact location

• Tumor grade and growth pattern

• Lymphovascular invasion

• Hormone receptor and HER2 status

• Margin distance in all directions

These findings guide the need for radiation, chemotherapy, or hormone therapy.

⭐ Why Margins Matter

Clear margins significantly reduce the risk of local recurrence and are considered the cornerstone of breast-conserving therapy. They also determine the necessity for additional surgery and influence patient counseling.

At OFM Hospital, breast surgeons work closely with experienced pathologists to ensure precise margin assessment, integrating intraoperative technologies and postoperative pathology findings into each patient’s personalized treatment plan.

Breast reconstruction restores breast shape after cancer surgery and plays a significant role in emotional recovery, body image, and long-term quality of life. Reconstruction may be performed immediately during cancer surgery or delayed until after chemotherapy or radiation. The best choice depends on tumor characteristics, planned treatments, and patient preference.

There are three main categories of reconstruction:

⭐ 1. Implant-Based Reconstruction

This approach uses silicone or saline implants to create a new breast mound.

➤ How It’s Done

• Performed immediately after mastectomy or in a delayed stage

• Implant placed either under or above the pectoral muscle

• May require a temporary tissue expander to stretch the skin

➤ Advantages

• Shorter surgery and recovery

• Predictable size and shape

• No second donor-site incision

➤ Ideal For

• Patients with enough healthy skin post-mastectomy

• Those who prefer a less invasive option

• Individuals with contraindications to flap surgery

⭐ 2. Autologous (Flap) Reconstruction

Uses the patient’s own skin, fat, and sometimes muscle to build a natural-feeling breast.

➤ Common Flap Types

• DIEP flap: Lower abdominal fat and skin preserved with blood vessels

• TRAM flap: Abdominal tissue including part of the muscle

• Latissimus dorsi flap: Tissue from the upper back

• PAP / TUG / SGAP flaps: Options for patients with limited abdominal tissue

➤ Advantages

• Most natural look and feel

• Long-lasting results

• Better tolerance to radiation effects

➤ Ideal For

• Patients with sufficient donor tissue

• Those seeking an implant-free option

• Individuals who value long-term stability

⭐ 3. Hybrid (Combined) Reconstruction

Combines a small implant with autologous tissue to optimize breast shape, volume, and projection.

➤ Benefits

• More natural contour than implant alone

• Better volume than flap alone

• Flexible for complex reconstructive needs

⭐ Nipple–Areola Reconstruction

If the nipple cannot be preserved during cancer surgery, it can be recreated using:

• Local tissue flaps

• Skin grafts

• 3D medical tattooing

This final step provides a more natural appearance and completes the reconstructive process.

⭐ Factors That Influence Reconstruction Choice

• Cancer stage and location

• Need for radiation therapy

• Tissue quality and skin thickness

• Breast size and body shape

• Patient expectations and lifestyle

• Medical conditions affecting healing

A multidisciplinary discussion ensures that reconstruction is integrated safely with chemotherapy, radiation, and long-term follow-up.

At OFM Hospital, breast and reconstructive surgeons work together to create personalized reconstruction plans, focusing on natural aesthetics, oncologic safety, and long-term satisfaction.

Recovery after breast cancer surgery is shaped by the type of operation performed, whether lymph nodes were removed, and whether reconstruction was done during the same procedure. The healing period aims to ensure comfort, protect surgical results, and prepare patients for additional treatments such as radiation, chemotherapy, or hormone therapy.

In the first few days after surgery, patients may experience swelling, tightness, mild pain, and temporary bruising around the breast or underarm area. Pain control, proper wound care, and restricted movement help the healing process. If drains were placed—common after mastectomy or axillary surgery—they are removed once fluid output decreases. Most patients resume light daily activities within one to two weeks, depending on the extent of surgery.

When lymph nodes are removed, patients may feel numbness, underarm stiffness, or limited shoulder mobility. Early, gentle exercises guided by a physiotherapist help restore movement and reduce the risk of adhesions. Preventive measures are also taken to minimize lymphedema, a potential complication after axillary surgery.

For patients who received reconstruction, recovery may be slightly longer, especially with autologous flap techniques. Surgeons monitor circulation in the reconstructed tissue, manage donor-site healing, and evaluate breast symmetry during follow-up visits.

⭐ Integration With Adjuvant Treatments

Breast cancer treatment often includes therapies beyond surgery. The timing and coordination of these therapies are essential:

• Radiation Therapy

Usually follows breast-conserving surgery or mastectomy in cases with lymph node involvement.
Surgeons plan incisions and reconstruction techniques to ensure radiation can be delivered safely and effectively.

• Chemotherapy

May be given before or after surgery. Postoperative chemotherapy typically begins once healing is adequate—usually within 3–6 weeks—unless complications delay recovery.

• Hormone Therapy and Targeted Therapy

Used for hormone receptor–positive or HER2-positive cancers. These medications do not affect surgical healing and are integrated seamlessly into long-term treatment plans.

⭐ Potential Postoperative Risks

Although complications are minimized with modern techniques, patients are monitored for:

• Infection or wound-healing problems

• Seroma (fluid buildup)

• Hematoma

• Implant-related complications (for reconstructed cases)

• Lymphedema

• Changes in breast contour or sensation

Early recognition and intervention improve outcomes and reduce long-term effects.

⭐ Follow-Up and Support

Patients are guided through:

• Regular surgical check-ups

• Physical therapy

• Pain and symptom management

• Emotional and psychological support

• Education on scar care, arm care, and lifestyle adjustments

At OFM Hospital, the recovery process is managed through a coordinated system involving surgeons, oncologists, physiotherapists, nurses, and support teams, ensuring a smooth transition from surgery to the next stage of cancer treatment.

Long-term follow-up is a critical part of breast cancer care, ensuring early detection of recurrence, monitoring treatment effects, and supporting overall health and quality of life. After surgery and adjuvant therapy are completed, patients enter a structured surveillance program designed to track recovery, maintain breast health, and address any late complications.

Follow-up visits typically occur every few months in the first years and gradually transition to annual check-ups. These visits include a physical examination, evaluation of surgical areas, review of symptoms, and assessment of any changes in breast tissue or lymph nodes. Patients who underwent breast-conserving surgery require annual mammography of the treated breast (and the opposite breast), while those with mastectomy without reconstruction may need imaging only if concerning symptoms arise. Patients with implant or flap reconstruction may require intermittent MRI or ultrasound depending on clinical findings.

Monitoring also focuses on treatment-related effects, such as lymphedema, hormonal therapy side effects, bone density changes, menopausal symptoms, and long-term cosmetic outcomes. Patients who received radiation or chemotherapy are evaluated for heart health, lung function, and overall metabolic wellness as part of survivorship care.

⭐ Recurrence Surveillance

Breast cancer recurrence can occur in the breast, chest wall, lymph nodes, or distant organs. Follow-up aims to identify signs early:

• New lumps or skin changes

• Persistent pain in the breast or chest area

• Swelling in the arm or underarm

• Unexplained weight loss or fatigue

• Changes in bone pain, cough, or neurological symptoms

Routine blood tests and imaging beyond recommended intervals are not required unless symptoms suggest a problem. This avoids unnecessary radiation and false-positive findings.

⭐ Risk-Reduction Strategies

Several lifestyle and medical strategies can help reduce the chance of recurrence or new cancers:

• Medication-Based Prevention

Hormone receptor–positive patients may benefit from long-term endocrine therapy such as tamoxifen or aromatase inhibitors.

• Genetic Counseling for High-Risk Patients

Individuals with BRCA1/BRCA2 mutations or strong family history receive personalized screening and preventive options.

• Healthy Lifestyle Measures

• Maintaining a healthy weight

• Regular physical activity

• Limiting alcohol

• Balanced diet rich in vegetables and lean protein

• Avoiding smoking

These habits improve survival and reduce recurrence risk.

• Breast Reconstruction Monitoring

Implant-based reconstructions require periodic assessment for capsular contracture or implant integrity, while flap reconstructions require surveillance of tissue health and symmetry.

⭐ Emotional and Psychosocial Support

Breast cancer survivorship includes emotional recovery. Follow-up care may involve:

• Support groups

• Psychological counseling

• Sexual health counseling

• Body image and confidence support

• Social and family support programs

These services help patients regain routine life, confidence, and emotional balance.

At OFM Hospital, long-term follow-up integrates surgical, oncologic, radiologic, and psychological care. This coordinated approach ensures that patients remain healthy, informed, and supported far beyond the initial treatment period—helping them maintain long-term well-being and reduce future cancer risks.