Breast Cancer Treatment, Conservation & Reconstructive Surgery Options
Lumpectomy
What is Lumpectomy?
A lumpectomy is simply removal of lump. In most instances it is done for benign breast diseases. In cases of cancer, it is done in a specific manner where a rim of breast tissue is taken off along the lump to decrease chances of cancer coming back. In case of benign (non cancerous) lumps only lump removed. Primary goal is to preserve the natural appearance of the breast as much as possible, while removing the whole lump.
What to Expect from the Treatment?
The procedure is done under general anaesthesia in a sterile operating theatre. You will be admitted as an inpatient for 1 day (sometimes a short stay is enough). A small incision is made to access the lump. Based on location of the lump an effort to keep the scar hidden is made. Rarely lumpectomy is combined with a plastic surgery to prevent any distortion of breast.
You can expect mild discomfort for a few days, easily managed with medication. Normal daily activities are resumed in 24-48 hours.
Frequently Asked Questions About Lumpectomy
Is lumpectomy a major surgery?
It’s considered a minor surgery. Requirement of General Anaesthesia is mainly for patient comfort. Recovery is quick, and it usually doesn’t require long hospitalization.
Will I have a visible scar?
Although at hidden locations in most cases, a small scar remains, but we place incisions strategically to minimize cosmetic impact. The scar is almost invisible over time, depending on your body’s pigmentation tendency.
Do I need chemotherapy or radiation after lumpectomy?
Lumpectomy is done for benign diseases in most cases not requiring any further treatment. If it is done for cancer, lumpectomy is combined with surgery for lymph nodes in armpit (known as breast conservation surgery – described elsewhere). It will depend on the final reports and extent of disease, discussed with you usually 8 days after the surgery.
Can the lump come back after surgery?
For benign lumps, recurrence is rare. For cancer, close follow-up is essential, and the risk depends on many factors like type and grade. (Discussed elsewhere)
Mastectomy
Introduction to the Mastectomy Surgery
Mastectomy is a surgical procedure to remove the whole breast. It is most commonly performed to treat breast cancer or, in some cases, to prevent cancer in high-risk individuals. Modern day cancer surgery has reduced the need of performing a mastectomy for breast cancer significantly reduced. But at times, either the cancer is large or there is extensive skin involvement or the patient doesn’t wish to conserve the breast.
What to Expect?
Mastectomy is usually done under general anaesthesia. It is performed as an inpatient procedure —most patients stay for 1–2 days after the surgery. A drainage tube may be placed temporarily to collect fluid after surgery. Recovery typically takes 2–3 weeks, with return to most routine activities by then.
You will be guided through wound care, drain management (if any), and follow-up protocols. We ensure pain management, early mobilisation, and emotional support.
Types of Mastectomy Offered
At i-BOCC Care, we provide:
- Simple/Total Mastectomy – Removal of entire breast tissue without lymph node dissection.
- Modified Radical Mastectomy (MRM) – Removal of entire breast along with lymph nodes in the armpit, usually for invasive cancers.
- Nipple-Sparing / Skin-Sparing Mastectomy – Preserves most of the breast skin and nipple-areola complex, with immediate whole breast reconstruction.
- Prophylactic Mastectomy – Usually nipple-Sparing and both sides, offered to high-risk patients (e.g., BRCA mutation carriers) to reduce cancer risk.
Each surgery type is carefully selected based on clinical stage, oncological safety, patient choice, and cosmetic goals.
All types of mastectomies could be combined with immediate or delayed reconstruction.
Frequently Asked Questions About Mastectomy
If the whole breast removed, does the patient still need chemotherapy or radiation?
Not always. But this depends on the type, grade, and stage of cancer, rather than type of surgery. Our team will guide you based on your size of tumor, whether lymphnodes are involved or not and whether cancer has spread to other parts of the body (Tumor Node Metastasis – TNM Staging).
Is reconstruction mandatory after mastectomy?
No. Reconstruction is a choice. Some women opt for flat chest with or without prosthesis in their undergarment, and others want reconstruction. If the decision of reconstruction is overwhelming for you at the time of surgery, you can choose to have it after 1-2 years of treatment completion. You will have support of doctors and cancer survivors in making the decision that suits you best.
Will I need to stay in the hospital?
Yes. Mastectomy is an inpatient surgery, and you may stay for 1–2 nights depending on your recovery and drain output.
Can I live normally with one breast or none?
Absolutely. Many women live full, active lives after mastectomy—with or without reconstruction. We provide counselling and prosthesis options to support your comfort and confidence.
Will I lose arm strength after mastectomy?
Mastectomy itself doesn’t lead to dysfunction of arm or shoulder mobility. If it is combined with lymph node surgery (axillary dissection), there can be stiffness or mild weakness. Physiotherapy and guided exercises significantly reduce this risk.
Is mastectomy done for non-cancerous diseases?
Yes. It could be done to reduce the risk of future cancers in high-risk individuals OR diseases like Phyllodes, which is a benign lesion requiring surgery, if the lump is too big to preserve breast. In both instances lymph node surgery is not required.
Breast-Conserving Surgery (Lumpectomy + Axillary Surgery)
What is Breast-Conserving Surgery (Lumpectomy + Axillary Surgery)?
Breast-conserving surgery (BCS) is a treatment for breast cancer, which is considered GOLD DTANDARD treatment for breast cancers, wherever safe and feasible. The aim is to remove the tumor and a margin of healthy tissue while preserving as much of the breast as possible. It often combines lumpectomy (removal of the lump) with axillary surgery (removal or sampling of lymph nodes under the arm) to check for cancer spread. This approach offers effective cancer control with the added advantage of keeping your breast’s natural appearance and sensation.
What to Expect?
Before Surgery: You will undergo a triple assessment (clinical exam, imaging, and biopsy) to confirm diagnosis and plan surgery. The surgical plan is discussed with you in detail, including cosmetic goals.
During Surgery: Performed under general anesthesia, typically lasting 1.5–3 hours depending on complexity. The tumor is removed with a rim of normal tissue, and axillary surgery (sentinel lymph node biopsy or axillary dissection) is done through the same or a separate incision.
After Surgery: Most patients stay 1–2 days in the hospital. Mild swelling, bruising, or discomfort can occur which is usually self-limiting. A drain may be placed in the axilla to remove fluid, usually removed within a week. (See axillary surgery for details). Return to normal activities in 2–3 weeks; avoid heavy lifting until cleared.
Radiation Therapy is MANDATORY after BCS to reduce recurrence risk, except in very select few cases.
Frequently Asked Questions About Breast-Conserving Surgery (Lumpectomy + Axillary Surgery)
Is breast-conserving surgery as safe as mastectomy?
Yes, when combined with radiation therapy, BCS offers the same survival outcomes as mastectomy for early-stage breast cancer, provided it is done for the right indications. Recent large body of evidence suggests a better survival in women undergoing breast conservation.
Will my breast look normal after surgery?
In most cases, the shape and contour are preserved. If the tumor is large relative to the breast size, oncoplastic techniques (give link) can be used to maintain symmetry.
Will I need chemotherapy after BCS?
Type of surgery doesn’t have any bearing on decision of chemotherapy. Decision depends on your tumor’s stage, tumor’s behaviour and involvement of lymph nodes. Our multidisciplinary team will discuss this in detail after reviewing your complete disease profile and your overall health.
If I have small breasts or the lump is big when I found it, have I lost my chance to preserve the breast?
Not necessarily. If, you are planned to receive chemotherapy as a part of your cancer treatment, Chemotherapy can be given you before surgery to reduce the size of the cancer. It gives a fair chance at preserving breast to many patients.
Axillary Surgery in Breast Cancer
Why is Axillary Surgery Done?
Lymph nodes are small, bean-shaped structures that are part of the body’s lymphatic system, which helps fight infection and filter harmful substances. They act like biological “checkpoints,” trapping bacteria, viruses, and abnormal cells like CANCER, and contain immune cells that respond to these threats. In breast cancer, lymph nodes—especially those in the underarm (axilla)—are important in determining if cancer has spread.
The axilla (armpit) contains lymph nodes that can be the first place breast cancer spreads.
Examining these nodes helps:
- Stage the cancer (understand how far it has spread)
- Guide treatment decisions (e.g., whether chemotherapy or radiotherapy is needed)
- Prevent recurrence in some situations
Conventionally, during breast cancer surgery, all the lymph nodes in axilla are removed. But some of these lymph nodes also take care of arm and their removal can lead to swelling in the arm, called lymphedema. This surgery also leads to dysfunction in shoulder movement of few patients.
1. Sentinel Lymph Node Biopsy (SLNB)
What is SLNB?
A minimally invasive procedure to remove only the first few lymph nodes (“sentinel” nodes) that directly drain the breast. These are most likely to contain cancer if it has spread.
How it’s done?
A small amount of blue dye and/or a radioactive tracer is injected near the tumour. The surgeon identifies the sentinel nodes during surgery and removes them.
Advantages:
- Smaller incision
- Less pain
- Lower risk of swelling (lymphedema) compared to full dissection
- Lower risk of shoulder dysfunction
When it’s done?
Mainly in early breast cancer, when none of the tests suggest involvement of lymphnodes by cancer this surgery is done. These sentinel nodes are evaluated during the operation itself. If they are negative for cancer, no further axillary surgery is needed. But if nodes are involved a complete axillary dissection is done to reduce the risk of leaving behind cancer in non-sentinel nodes.
2. Axillary Lymph Node Dissection (ALND)
What is ALND?
Removal of most lymph nodes from the armpit (usually 10–20 nodes).
When it’s done:
- If cancer is found in multiple sentinel nodes
- If nodes are enlarged and confirmed to have cancer before surgery
- Sometimes as a part of mastectomy for advanced disease
Drawbacks
- Higher risk of swelling in the arm (lymphedema)
- Numbness or tingling due to nerve irritation
- Longer recovery
Summary
Not every patient needs a full axillary dissection. Modern approaches aim to remove only as many nodes as necessary to get accurate staging while reducing side effects. Before surgery you can discuss:
- Whether SLNB or ALND is appropriate for you
- How to reduce risks of swelling and stiffness
- When to start physiotherapy
Frequently Asked Questions About Axillary Surgery
Will I have pain after surgery?
Some soreness or numbness under the arm is common for a few weeks. Pain is usually manageable with prescribed medicines.
How long will recovery take?
Most patients resume light activities within a week, but full recovery and return to all activities may take 2–3 weeks, depending on how compliant you are with post-surgery exercises and what type of axillary surgery you had.
Can I still have blood tests or injections on the operated arm?
It’s generally advised to avoid them on the operated side to reduce lymphedema risk, but if done properly sometimes it can be done AND definitely yes in emergency situation.
Will axillary surgery influence my cancer treatment plan?
Yes — the results help your doctor decide if you need additional treatments like chemotherapy, radiotherapy, or hormonal therapy.
Is axillary surgery always necessary?
Not always. In very few selected early cancers, if imaging and biopsy suggest low risk, your doctor may recommend skipping axillary surgery to avoid side effects.
How will I know if I develop lymphedema later?
Watch for swelling, heaviness, or tightness in the arm or hand. Report symptoms early to your care team so treatment can begin promptly.
Oncoplasty
What is Oncoplastic Breast Surgery?
Oncoplastic breast surgery is a modern surgical technique that combines breast cancer removal (oncology) with plastic surgery principles.
The aim is to:
- Remove the cancer with safe margins.
- Preserve or restore the natural breast shape and symmetry.
- Minimise visible scarring.
This approach often means cancer surgery and reconstruction are done in the same operation, reducing the need for multiple procedures.
What to Expect?
Before Surgery
- Assessment: Detailed examination, imaging, and discussion about surgical options.
- Planning: Measurements and photographs to plan the incision and reshaping.
- Medical Preparation: Blood tests, fitness assessment, and anaesthesia review.
During Surgery
- Cancer Removal: Wide local excision to completely remove the cancer, with preservation of as much as breast tissue possible.
- Reshaping: Tissue rearrangement, reduction, or use of tissue from surrounding body parts (flaps) to restore breast shape.
- Symmetry: Sometimes, surgery may also be done on the other breast for a balanced look.
After Surgery
- Hospital Stay: Usually 1–3 days.
- Recovery: Initial swelling, bruising, and mild discomfort for 1–2 weeks.
- Return to Activity: Gentle movements from day 1; most daily activities resume in 2–3 weeks.
- Follow-Up: Stitches removal (if not dissolvable), wound check, and pathology discussion.
Frequently Asked Questions About Oncoplasty
Will oncoplastic surgery affect my cancer treatment?
No. It is designed to remove cancer completely and safely, without compromising your oncological outcome.
Will my breast look the same as before?
It may look slightly different in size or shape, but the goal is to achieve the most natural appearance possible. Based on location of cancer, the scar could be hidden is some cases, but not all.
Will I need surgery on my other breast?
Sometimes yes, for symmetry, especially if a large volume of tissue is removed from the affected side.
Is this suitable for all breast cancers?
Most early and some locally advanced cancers can be treated this way, but suitability depends on tumour size, location, and breast size.
Will I have more scars?
Scars are placed strategically, often hidden in natural folds or along the areola, and usually fade over time. If the excision is large and filling up the defect is >/= 30% of breast tissue, usually tissue from surrounding body parts might be required, leading to some additional scars.
How long until I see the final cosmetic result?
Swelling can take weeks to settle, and scars continue to fade for 6–12 months. Also, most patients receive radiotherapy after Oncoplasty which further interferes in this process.
Breast Reconstruction
What is Breast Reconstruction?
Breast reconstruction is a type of surgery done to rebuild the shape and look of the breast after a mastectomy, when preserving the breast was not an option or you choose to not preserve it. The goal is to restore confidence, body image, and balance. Reconstruction is not the same as cosmetic breast surgery—it is part of cancer recovery and can be done at the same time as mastectomy (immediate) or later (delayed). Importantly, breast reconstruction does not increase the risk of cancer coming back and does not interfere with cancer treatment or follow-up. It is noteworthy that breast reconstruction is optional and has no contribution to cancer treatment per se.
Types of Breast Reconstruction
Implant-based reconstruction:
Using silicone or saline implants to create the breast shape, with tissue covering it.
Autologous reconstruction:
Using your own tissue (from the tummy, back, or thigh) to make a natural breast.
Combination methods
A mix of implant and tissue for the best cosmetic outcome.
Nipple and areola reconstruction
Can be done later to complete the appearance.
Some women choose not to have reconstruction and opt for a smooth, flat chest or use external breast prosthesis.
What to Expect?
Pre-operative Counselling
- A detailed discussion with your breast surgeon and plastic surgeon about your options.
- Understanding your medical condition, body type, lifestyle, and personal preferences.
- Clarity on timing: immediate vs. delayed reconstruction.
- Setting realistic expectations: symmetry, scars, and cosmetic outcomes.
Peri-operative Care (During Surgery & Hospital Stay)
- Surgery duration depends on the type of reconstruction (implant is shorter, tissue-based is longer).
- Hospital stay may range from 3–7 days.
- Pain management, wound care, and physiotherapy will be part of recovery.
Post-operative Cosmetic Outcomes
- The reconstructed breast may not look or feel exactly like the natural breast, but modern techniques give very natural results.
- Scars fade over time but do not disappear completely.
- You may need minor corrective procedures later for symmetry.
- Most women regain confidence and comfort in their body image.
Frequently Asked Questions About Breast Reconstruction
If I undergo mastectomy, is it mandatory to undergo breast reconstruction?
No. Breast reconstruction is a personal choice. Some women decide not to undergo reconstruction and remain flat after mastectomy. In such cases, they may use an external breast prosthesis (a soft, removable breast form worn inside the bra). The important thing is to choose what makes you most comfortable.
Will reconstruction delay my cancer treatment?
Usually, no. Reconstruction is planned along with your cancer treatment so that it does not interfere with chemotherapy or radiotherapy.
Can breast cancer come back in a reconstructed breast?
Yes, cancer can return in the chest wall or skin, but reconstruction itself does not increase that risk. Regular follow-ups remain important.
Will the reconstructed breast feel natural?
Both types of reconstructions are meant to feel as natural as possible, but it may differ patient to patient. However, the reconstructed breast itself does not have the same sensation as before mastectomy.
How long does recovery take?
Most women return to light activities within 2–3 weeks for implants, and tissue-based reconstruction might take a bit longer. Complete recovery varies with individual health and lifestyle.
Non-Surgical Treatments
What is Non-Surgical Treatment?
Non-Surgical Management of Breast Cancer
Surgery is the Definitive treatment for breast cancer (Stage I – III) with most benefit in preventing any recurrences in future and cure the disease, although not always the first treatment. Most healthy women need additional non-surgical treatments, based on type of breast cancer and stage of disease. These treatments help reduce the risk of cancer coming back, shrink tumors before surgery, or treat cancers that have spread.
1. Chemotherapy
- Uses specific medicines specialised in killing fast-growing cancer cells.
- Can be given before surgery (neoadjuvant) to shrink the tumor or after surgery (adjuvant) to reduce recurrence risk.
- Given in cycles through a vein, usually over a few weeks.
- Side effects: hair loss, nausea, fatigue, low blood counts (most are temporary and manageable).
2. Radiotherapy
- High-energy X-rays target the breast or chest wall to destroy any possible remaining cancer cells.
- Mandatory after after breast conservation surgery or mastectomy (if high risk).
- Usually given daily for 3–5 weeks.
- Side effects: skin redness (like sunburn), mild fatigue, swelling.
3. Hormonal (Endocrine) Therapy
- For cancers that are hormone receptor-positive (most common type).
- Blocks estrogen or progesterone, which fuel cancer growth. Given as daily tablets (e.g., Tamoxifen, Aromatase inhibitors) for 5–10 years.
- Side effects: hot flashes, joint pains, mild risk of bone thinning (monitored with tests).
4. Targeted Therapy
- Works against specific cancer cell proteins.
- Example: HER2-positive cancers benefit from drugs like Trastuzumab / Pertuzumab.
- Usually given through IV infusions, often with chemotherapy.
- Side effects: usually milder than chemotherapy.
What to Expect?
- Treatment plans are personalized – not every woman needs all these treatments.
- Oncologists discuss benefits, side effects, and duration before starting.
- Supportive care (anti-nausea medicines, growth factors, counselling) helps manage side effects.
Victory lies in a United front, when Treatments Unite Survival Strengthens
fighting cancer from every angle.
Frequently Asked Questions About Non-Surgical Treatments
Do all women need chemotherapy?
No. It depends on the stage, tumor biology, and risk factors. Some may only need hormonal or targeted therapy.
Will radiotherapy affect my daily life?
Most women can continue regular activities. Sessions are short (15–20 minutes), though mild fatigue is common.
Are these treatments safe in the long term?
Yes, doctors balance benefits with risks. Long-term side effects are monitored, and most women recover well.
Takeaway:
Non-surgical treatments play a vital role in curing breast cancer, preventing recurrence, and improving survival. With modern advances, treatments are safer, more targeted, and better tolerated than before.
Final Note
Breast cancer treatment is not one-size-fits-all. With the expertise of Dr. Ashutosh Tondare at i-BOCC Care, patients receive care that is advanced, holistic, and compassionate.
Disclaimer: This content is for educational purposes only and should not be treated as medical advice. Always consult a qualified cancer specialist for personalized diagnosis and treatment.
