General Surgery

Breast Conserving Surgery

Two hundred and four women with two or three cancers in the same breast kept that breast, and recurrence at five years was 3.1 percent. Most of the reasons women are told they cannot keep the breast have quietly stopped being true.

About This Department

Two hundred and four women with two or three separate cancers in the same breast kept that breast, and five years later the cancer had come back in it in 3.1 percent of them. Multiple cancers in one breast used to be an automatic mastectomy. This page is about the sentence a lot of women hear too early, which is that they are not a candidate for breast-conserving surgery, and about how many of the reasons behind that sentence have quietly stopped being true.

Free consultation

If you have been told you cannot keep the breast, ask why, and ask when that rule was written

Tumor size against breast size, more than one cancer, a genetic mutation, young age and pre-invasive disease each have a modern answer, and several of those answers changed within the last five years. Send the biopsy report with the receptor results, the grade and the HER2 status, the mammogram and ultrasound reports with the measurements, the breast MRI if you have had one, any genetic test result, and a note of your bra size and breast volume if you have it. A breast surgeon and a radiation oncologist review the file together and tell you whether conservation is genuinely off the table or whether it can be brought back on. No fee, no obligation, and a coordinator replies in your own language.

WhatsApp: +90 549 648 55 11 Send your file for a second opinion +90 549 648 55 11

A list that keeps shrinking

Breast-conserving surgery removes the cancer and leaves the breast. Whether you can have it has never been a single yes or no, and the list of situations that rule it out has been getting shorter for thirty years, one trial at a time. Multiple cancers in the same breast came off the list in 2023. Carrying a BRCA mutation came off it earlier. A cancer too large for the breast can now often be made smaller before anybody operates, and a cancer nobody can feel is a technical problem with four competing solutions rather than a reason to remove the breast.

What has not changed is how often the older version of the list gets recited. A woman is told she needs a mastectomy, she believes it because the person saying it is a doctor, and nobody revisits the sentence. Sometimes the sentence is right. Often it reflects when the person saying it trained, or what the unit in front of you happens to be equipped to do, and neither of those is a fact about your cancer. So the useful move, when you hear that you are not a candidate, is to ask which specific feature of your case disqualifies you, and then to check that feature against what follows on this page. The answer will either hold up immediately or it will not, and either way you will know within a few minutes rather than after the operation. That is worth doing even when you end up agreeing with the first recommendation, because a decision you have tested is easier to live with afterwards than one you accepted while too frightened to ask anything.

What still rules it out

Five situations genuinely close the door, and it is worth naming them plainly before the rest of the page starts opening others.

You cannot have radiotherapy. Conservation and radiotherapy are a pair for most patients, so anything making radiotherapy impossible weakens the whole approach, and the commonest such thing is previous radiotherapy to the same chest wall, for a lymphoma years ago or for an earlier breast cancer.
Disease is spread widely through the breast. Not two or three areas, which is now a different conversation, but suspicious calcification scattered across the whole breast on the mammogram, because nothing can be removed with a margin around it when the abnormality has no edge.
Inflammatory breast cancer. A red, swollen, hot breast with skin like orange peel. This is a distinct disease with a distinct treatment sequence, and it always includes removing the breast.
Margins that will not clear. A second attempt is routine and a third is unusual. If cancer keeps reaching the edge of what is removed, the operation is telling you something about the extent of the disease.
You would rather not. The most legitimate reason on the list and the one nobody should be argued out of. A woman who will spend the next decade dreading every mammogram is entitled to weigh that against the breast, and the job of the surgeon is to make sure the decision is informed rather than to overturn it.

Anything not on that list deserves the question. Size alone is not on it. Age is not on it. A genetic mutation is not on it. Nor is having more than one cancer, nor having a cancer nobody can feel, nor being a man, nor being pregnant.

Shrinking the cancer first

Where the tumor is simply too big for the breast, the oldest and best-tested route back to conservation is to treat it before operating. Chemotherapy, or hormone therapy in some cases, given first rather than afterwards.

The same drugs, in a different order. Nothing is added and nothing is withheld. Treatment that would have followed the operation happens before it, and the tumor shrinks while it is still in the breast where everybody can watch it.

Most tumors respond. Pooling individual data from 4,756 women across ten randomized trials, 69 percent had a complete or partial response to chemotherapy given before surgery. That response is what buys the smaller operation.

And it changes the operation for a lot of them. In those trials, 65 percent of the women treated before surgery kept the breast, against 49 percent of the women given the same drugs afterwards. Sixteen women in every hundred had a different operation because of the order.

There is a cost, and it is local. At fifteen years, the cancer had returned in the same breast or chest wall in 21.4 percent of the women treated first, against 15.9 percent of the others, an absolute difference of 5.5 percent. Distant spread was identical at 38.2 percent against 38.0 percent, and so was death from breast cancer at 34.4 percent against 33.7 percent. The trade is a higher chance of local return against no measurable difference in survival.

Which is why the marker goes in before treatment starts. The authors of that analysis named careful localization as one of the ways to narrow the gap, and the reason is simple. A tumor that melts away leaves nothing for the surgeon to find, so a small metal clip is placed inside it at the time of the first biopsy. Ask whether one has been placed. Most of these trials also used older chemotherapy, with 81 percent of the women receiving anthracycline-based regimens, which is worth knowing when the numbers are being applied to a modern protocol.

Eight refusals, examined

Eight reasons account for most refusals, and each is set here against what the evidence actually says. The sections that follow take the most important of them one at a time.

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

Common reasons for being told the breast cannot be kept, and where the evidence stands
What you were told	Where the evidence stands	What to ask for
The tumor is too big	Treating first raised conservation from 49 to 65 percent across ten randomized trials.	A discussion of drug treatment before surgery, and a clip placed in the tumor at biopsy.
There is more than one cancer	Five year local recurrence was 3.1 percent in 204 women with two or three cancers in one breast.	A breast MRI, and radiotherapy with a boost to every site that was removed.
You carry a BRCA mutation	Guidelines state local control matches non-carriers. The elevated risk is in the other breast.	A separate conversation about the opposite breast, kept separate from the decision about this one.
You are too young	Local control is genuinely worse under forty. Survival is not, and a radiotherapy boost halved the recurrence rate in that age group.	Confirmation that a boost dose is planned, and the reasoning behind any mastectomy recommendation.
It is only pre-invasive disease	Conservation is standard. In good-risk disease, radiotherapy cut fifteen year recurrence from 15.1 to 7.1 percent.	The grade, the size and the margin, since those three decide whether radiotherapy is worth it.
Nobody can feel the cancer	A solved problem. Wires, magnetic seeds, radioactive seeds and ultrasound guidance all work.	Which localization method this unit uses, and whether a marker can be placed on a different day.
You are a man	87.4 percent of men have a mastectomy against 38.3 percent of women, and the survival comparison in localized disease showed no significant difference.	An explanation of why conservation is not being offered, given how small the male tumor usually is.
You are pregnant	Thirty women had conservation in the first trimester with radiotherapy delayed until after delivery, and no perioperative complications.	A unit that treats pregnancy-associated breast cancer regularly, with obstetrics in the same meeting.

Carrying a BRCA mutation

A positive genetic test frequently arrives in the same fortnight as the diagnosis, and it lands like an instruction. Many women hear it as a reason to remove both breasts immediately. The joint guideline from the American oncology, radiation oncology and surgical oncology societies puts it differently. Carriers may be considered for breast-conserving therapy, with control of the cancer they actually have running similar to non-carriers, and radiotherapy is not contraindicated in this group. A systematic review of 25 studies reached the same place, finding no difference in recurrence in the treated breast, in the other breast, or in survival between wide local excision with radiotherapy and mastectomy, with the mutation predicting only the risk in the opposite breast.

Your mutation is a statement about your other breast and about the years ahead. It says nothing about whether this cancer can be removed while the breast stays. Keeping those two questions apart is the single most useful thing a carrier can do in the first fortnight.

How big the risk in the other breast actually is deserves a proper look. In a series of 501 women having conservation, of whom 63 carried a mutation, there was no significant difference in overall survival, in disease-free survival, or in recurrence in the treated breast between carriers and non-carriers over roughly five years of follow-up. A cancer in the opposite breast was a different story, appearing significantly more often in carriers, and the mutation was the only independent risk factor for it, with a hazard ratio of 7.89. So the honest framing is that removing both breasts is a decision about the future and about the healthy side, taken with time and with a genetic counselor, and it does not have to be bolted onto a decision about the cancer you already have. Nothing about waiting a few months to decide on the healthy breast makes the treated side more dangerous, and several women who take that time end up choosing surveillance and a yearly scan instead of surgery.

Being young

Age is more complicated than the others, because the concern behind it is real. Young women do have more trouble with local control after conservation, and pretending otherwise would be dishonest. What is not true is the conclusion usually drawn from it.

What the age gradient looks like

A European trial that randomized 5,569 women to an extra radiotherapy dose to the tumor bed, or to no extra dose, produced the clearest picture of it. Five year local control ran at 82 percent for women aged thirty-five or under, 85 percent between thirty-six and forty, 92 percent between forty-one and fifty, 96 percent between fifty-one and sixty, and 97 percent above sixty. Age was the only independent predictor of local control once tumor size, grade, receptors, margins and the volume removed were all accounted for. The same trial showed what to do about it. In women aged forty or under, the extra radiotherapy dose cut five year local recurrence from 20 percent to 10 percent. So the finding that young women do worse locally is also the finding that tells you what to do about it, which is to make sure a boost is in the radiotherapy plan and to ask the question directly if nobody has mentioned one.

What it does not mean

None of that means a mastectomy helps you live longer. A recent single-center cohort of 414 women diagnosed at forty or under, average age thirty-five and followed for a median of about six years, found no statistically significant difference in five year overall survival or in recurrence-free survival between conservation and mastectomy, and no difference after adjusting for stage, subtype and mutation status. Sixty-four percent of those women had a mastectomy anyway. Most recurrences in that cohort were distant rather than local, which is the pattern explaining everything above, since young breast cancer is more likely to come back somewhere and taking the breast off does not change where.

More than one cancer

Until recently, two separate cancers in the same breast meant a mastectomy, and the rule rested on almost nothing. A single-arm American trial tested it directly. Women aged forty and over with two or three biopsy-proven cancers in one breast had every site removed with clear margins, then whole breast radiotherapy with an extra dose to each site that had been removed. Two hundred and four women were treated to protocol and followed for a median of about five and a half years.

Six recurrences. A five year rate of 3.1 percent, comfortably under the 8 percent the trial had set in advance as the point where conservation would have been judged unacceptable. Age, number of sites, receptor status and stage made no difference to the risk.

One finding in that trial is worth carrying into your own consultation. Fifteen women were treated without a breast MRI beforehand, and their five year recurrence rate was 22.6 percent against 1.7 percent among the 189 who had one. That is a small group and the comparison was exploratory rather than planned, so it should not be read as a precise number. It does say something clear about the direction, and it is the reason MRI belongs in this specific situation even though the next section is fairly skeptical about MRI in general.

Pre-invasive disease only

Ductal carcinoma in situ is cancer cells confined inside the ducts, and it cannot spread while it stays there. Conservation is the standard operation for it. The argument is about what follows the operation.

What radiotherapy is worth here

An American trial randomized 636 women with what it defined as good-risk disease, meaning found on a mammogram, up to two and a half centimeters, removed with margins of at least three millimeters, and low or intermediate grade. Half had radiotherapy after the operation and half were observed. Followed for a median of about fourteen years, recurrence in the same breast at fifteen years was 7.1 percent with radiotherapy against 15.1 percent without it, while invasive recurrence, which is the kind that matters most, ran at 5.4 percent against 9.5 percent. Tamoxifen independently reduced recurrence as well.

How to read those numbers

Authors of that trial were careful, and their own sentence is worth quoting in substance. These results are not an absolute indication for radiotherapy, and they should inform a shared decision instead of dictating one. The average lesion in that study measured six millimeters. Eighty-five percent of the observed women had no recurrence at fifteen years. So a woman with small, low grade, widely excised pre-invasive disease is choosing between two defensible plans and not between a right one and a wrong one, which is a very different consultation from the one most patients are given.

Finding what cannot be felt

Screening finds cancers nobody can feel, which creates a purely practical problem. The surgeon has to remove something invisible and impalpable, with a margin around it, without taking half the breast. Four methods compete, and the differences between them are smaller than the marketing suggests.

The wire, and what replaced it

Wire localization places a fine wire into the lesion under imaging on the morning of surgery, and the surgeon follows it. It works, it has worked for decades, and its drawbacks are logistical rather than oncological, since the wire has to go in on the day and sticks out of the breast until the operation. Newer markers avoid that. A magnetic seed, a radioactive seed or a radar reflector can be placed days or weeks in advance, and the surgeon finds it with a probe. A Cochrane review of eight randomized trials and 1,273 patients found no clear evidence that any guided technique beat another for margins or reoperation, with the one significant result favoring the wire over radioactive seeds for successful localization.

What the newer evidence adds

A randomized trial of 400 women comparing radioactive seeds with wires found negative margin rates of 80 percent and 85 percent, a difference that was not statistically significant. Patients preferred the seed decisively, reporting less anxiety and less pain and greater overall satisfaction, and the seed costs more. Magnetic seeds have the better recent data, with a review of 16 studies and 8,794 patients finding a significantly lower re-excision rate than wire localization and a smaller piece of breast removed, though the difference in margin status itself did not reach significance. Ultrasound guidance, where the lesion is visible on ultrasound, performed best of all against wires for positive margins in a network analysis of 18 trials. The practical version of all this is short. Ask which method your unit uses and whether the marker can go in on a separate day, because that single logistical detail is what most patients actually notice.

What MRI adds and costs

An MRI before surgery sounds like an unqualified good and patients frequently ask for one, but the evidence is more divided than that, and understanding why protects you from a scan that changes your operation for the worse.

It did not reduce second operations

A British randomized trial across 45 hospitals assigned 1,623 women scheduled for wide local excision to have an MRI or not. The reoperation rate was 18.75 percent with MRI and 19.33 percent without, a difference of 0.58 percent with a confidence interval running from minus 3.24 to 4.40. Local recurrence and quality of life did not differ either.

And it sent some breasts to the operating room unnecessarily

Within that same trial, among the women in the MRI group who went on to have a mastectomy, the pathology afterwards suggested the mastectomy had been avoidable in 16 of 58, which is 27.6 percent. On the evidence of the removed breast, more than a quarter of the MRI-driven mastectomies in that trial had been unnecessary.

Scanning the other breast has the same problem

Pooling 22 studies covering 3,253 women, MRI of the opposite breast raised a suspicion in 9.3 percent and found a cancer in 4.1 percent, which means the positive predictive value was 47.9 percent. Roughly half of what it flagged was not cancer, and each of those findings arrived in a fortnight when the woman was already deciding about surgery.

Where it clearly earns its place

Lobular cancer, a large gap between what the mammogram shows and what the surgeon feels, assessing response to drug treatment given before surgery, and mapping several cancers in one breast. That last one is where the multiple cancer trial found its striking difference. MRI is not the problem here. MRI answers a question, so it earns its place whenever somebody actually has one.

Removing the healthy breast

Many women who could keep the affected breast instead remove both. The trend is documented, the reasoning is understandable, and the survival data is not what most patients assume.

How much it has grown

Across 496,488 American women with cancer in one breast, 59.6 percent had conservation, 33.4 percent had one breast removed and 7.0 percent had both. That last figure rose from 3.9 percent in 2002 to 12.7 percent in 2012, more than tripling in a decade while the disease itself did not change.

What it bought

Set against conservation, removing both breasts showed no survival advantage. Breast cancer specific survival carried a hazard ratio of 1.08 with a confidence interval of 1.01 to 1.16, and overall survival 1.08 with 1.03 to 1.14, both pointing very slightly the wrong way rather than the right one, and consistently so across receptor status and age groups.

When it does make sense

A confirmed BRCA1 or BRCA2 mutation, a strong family history without a testable mutation, or breasts so dense and difficult to image that surveillance would never be reassuring. Those are real reasons and this page is not arguing against them. What the data argues against is choosing it for a peace of mind that the numbers do not support, in a fortnight when nobody is thinking clearly.

Questions to ask

Six questions, and the first one carries most of the weight.

Which specific feature of my case rules out keeping the breast? A named feature, not a general impression. Then check it against the eight rows in the table above and see whether it survives contact with the evidence.
Would drug treatment before surgery change the answer? Worth asking whenever the reason given is size, and worth asking again if the answer is a quick no.
Has a clip been placed in the tumor? Essential if any treatment is happening before the operation, and easy to forget until the tumor has vanished and nobody can find where it was.
What is my radiotherapy plan, and does it include a boost? Particularly if you are under forty, where the boost halved local recurrence, and particularly if more than one site is being removed.
If my cancer cannot be felt, how will it be found on the day? Wire, magnetic seed, radioactive seed, radar reflector or ultrasound guidance. The oncological differences are small. The logistical differences are not.
Am I being offered a mastectomy because of my cancer or because of this unit? Blunt, and reasonable. Some conservation depends on techniques and equipment that not every hospital has, and you are entitled to know which situation you are in.

Recovery and flying home

Recovery from conservation is short, and the parts that take time are the ones attached to it rather than the operation itself.

Days one and two. Home the same day or after one night. Soreness rather than pain, a supportive bra day and night, and bruising that spreads downwards before it fades. Shoulder exercises start immediately if the armpit was operated on.
Weeks one and two. Desk work after a few days, driving once you can brake without hesitating. A wound check before you travel, and the pathology report arriving in about a week.
Flying. Generally cleared at around five to seven days once the wound is dry, and later if the armpit was cleared or a drain is still in place. Ask for the clearance in writing if your airline or insurer wants it.
The months after. Radiotherapy usually begins several weeks after surgery, or after chemotherapy where that is part of the plan. Endocrine therapy, where it is prescribed, runs for years. The scar keeps improving for a year or more, and the breast settles into its final shape over about three months.
What to get in touch about. Redness spreading from the wound, pain increasing after the third day, a fever, discharge, or a breast that swells rapidly and becomes tense. The last of those needs to be seen the same day.

Surveillance afterwards

Keeping the breast means keeping tissue that has to be watched, and for a lot of women that is the real cost of the decision, though how closely it has to be watched turns out to be a question somebody finally tested properly. A British trial randomized 5,235 women across 114 hospitals, all aged fifty or over at diagnosis and free of recurrence three years after curative surgery, to annual mammography or to a less frequent schedule, which for those who had conservation meant every two years.

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

Annual against less frequent mammography in 5,235 women aged fifty or over
What was measured	Result	What it means for you
Survival from breast cancer at five years	98 percent in both arms, with a hazard ratio of 0.92 and a confidence interval of 0.64 to 1.32.	Fewer scans did not cost lives in this population.
Time without recurrence	Hazard ratio 1.00, confidence interval 0.83 to 1.28, meeting the trial's non-inferiority standard.	Recurrences were not being missed by the longer interval in this group of patients.
Overall survival	Hazard ratio 1.07, confidence interval 0.87 to 1.33.	No signal of harm from the reduced schedule, and no signal of benefit from the annual one either.
Quality of life	No detriment recorded from the less frequent schedule.	Fewer appointments did not translate into more anxiety.
Who was studied	Mostly small, lower grade, hormone-positive tumors, in a largely White population, all aged fifty or over.	Does not answer the question for women under fifty or for pre-invasive disease.

Read that alongside the age gradient earlier on this page and the conclusion writes itself. A woman of thirty-six keeping her breast is in a different surveillance situation from a woman of sixty-six, and the trial above was not designed to describe her. Ask what your own schedule is, ask who is arranging it, and get it in writing before you travel home.

Reading a quote

No figure appears on this page, and a number quoted before the plan is settled is answering a smaller question than the one you are asking. Six things belong in writing before you compare two offers. Whether the imaging needed to settle eligibility is inside the number, since a breast MRI is sometimes the difference between a mastectomy and a conservation, and it is frequently quoted separately. Whether localization is included and by which method, given that a magnetic or radioactive seed is a different line item from a wire. Whether the armpit procedure is inside or added, given that a sentinel node biopsy, a full clearance and no armpit surgery are three different operations, and whether the pathology examination of everything removed is included, which is the report the rest of your treatment is built from. Whether a second operation for margins is charged again and at what proportion. And whether drug treatment before surgery, if it is being recommended, is inside this quote or a separate arrangement entirely, because that decision changes the length of your stay by months rather than days.

Your own file moves the total here more than in most operations. Whether treatment is being given before surgery, whether the armpit is being cleared, whether more than one site is being removed and whether reshaping is part of the plan are the four variables that shift it most.

Packages published by Turkish hospitals and medical travel agencies for breast cancer surgery generally include the airport transfer, pre-operative testing, the surgeon and anesthesia fees, the operating room, the planned nights, the pathology, an interpreter and the review before departure. They generally exclude flights, insurance, radiotherapy, drug treatment, a second operation, treatment of a complication and hotel stays past an agreed number. Read what arrives against both lists.

Coming to Istanbul

Ten to fourteen days covers assessment, surgery and the pathology report for somebody arriving with the diagnostic work complete. Where the plan involves drug treatment before surgery, the shape of the trip changes entirely and is worth settling in the first conversation, since some patients have that treatment at home and travel only for the operation. Send the biopsy report before anything else, with the receptor status, the HER2 result, the grade and the Ki67 written out. A report saying only that cancer was found cannot be turned into a plan. Add the mammogram and ultrasound reports with the measurements, any breast MRI, the armpit ultrasound and any node biopsy, the genetic test result if you have had one, and a list of your medications. If a previous surgeon has recommended a mastectomy, send that recommendation too, in whatever form you have it, because the specific reason given is the thing the second opinion has to engage with.

Say in your first message how much the breast matters to you and how you feel about the years of surveillance keeping it involves, because both answers belong in the consultation and a woman who wants the breast gone should be heard as clearly as one who wants it kept. Only one coordinator holds your file from the first message to discharge, and the international patients team works in English, Arabic, French, Russian, Serbian, Romanian and Spanish, with other languages arranged on request. Ask in your first message if you would prefer a female physician. Someone can stay overnight with you on the ward, where the rooms carry a companion bed. Meals from the hospital kitchen cover halal, vegetarian and diabetic diets and a prayer room is available. The international patients office books accommodation for both of you, arranges the airport transfer and daily transport, and prepares the appointment confirmation and the invitation letter naming the hospital and your treating doctor for a medical visa application, around ten days before travel.

Take home the pathology report itself and not a summary of it, with the final tumor size, the type and grade, the margin status in millimeters, the number of nodes removed and involved, and the full receptor results. Add the operation note, the multidisciplinary meeting conclusion with its recommendation about radiotherapy and drug treatment, and the date the first surveillance mammogram is due. Address the file to a breast oncologist near you and book that appointment before you fly, because keeping the breast commits you to a surveillance schedule that somebody close to home has to run. Once you are back home, your coordinator stays reachable on the same WhatsApp number, so a question about the wound or a line in the report reaches somebody with your notes in front of them. Keep that number well past the point where the wound has healed, because the questions that matter most in this disease arrive months later, when a scan is due or an oncologist at home wants to know precisely what was found and precisely what was recommended.

Breast-conserving surgery FAQ

My tumor is too large. Is that final?

Frequently not. Across ten randomized trials covering 4,756 women, giving the same chemotherapy before surgery instead of after raised the breast conservation rate from 49 percent to 65 percent. Ask whether treatment before surgery would change your answer, and make sure a clip is placed in the tumor first.

Is there a downside to treating the cancer before surgery?

One, and it is local. At fifteen years the cancer had returned in the breast or chest wall in 21.4 percent treated first against 15.9 percent treated afterwards. Distant spread was identical at 38.2 against 38.0 percent, and breast cancer deaths were 34.4 against 33.7 percent.

I have two cancers in one breast. Do I have to lose it?

Not automatically any more. Among 204 women with two or three cancers in one breast, all removed with clear margins and treated with whole breast radiotherapy plus a boost to each site, recurrence at five years was 3.1 percent. A breast MRI beforehand appears to matter a great deal in this specific situation.

I have a BRCA mutation. Should I remove both breasts?

That is a separate decision from this one. Guidelines state carriers may be considered for conservation with local control similar to non-carriers, and a review of 25 studies found no difference in recurrence or survival against mastectomy. The elevated risk sits in the opposite breast, where one cohort put the hazard ratio at 7.89.

I am under forty. Am I safer having a mastectomy?

Local control is genuinely worse when you are young, at 82 percent five year local control under thirty-five against 97 percent over sixty. Survival is a different question, and a cohort of 414 women aged forty or under found no significant difference in overall or recurrence-free survival between conservation and mastectomy.

Do I need radiotherapy for pre-invasive disease?

It is a genuine choice for good-risk disease. In 636 women with small, low or intermediate grade lesions removed with clear margins, fifteen year recurrence in the same breast was 7.1 percent with radiotherapy and 15.1 percent without. The trial's authors described that as informing a shared decision rather than dictating treatment.

Should I ask for an MRI before surgery?

Only where there is a question for it to answer. In a randomized trial of 1,623 women, MRI did not reduce reoperation, at 18.75 percent against 19.33 percent, and among the MRI patients who had a mastectomy, 27.6 percent of those mastectomies looked avoidable on the pathology afterwards.

Should I remove the healthy breast at the same time?

Without a mutation or a strong family history, the survival data does not support it. Across 496,488 women, removing both breasts carried a hazard ratio of 1.08 for breast cancer specific survival against conservation, pointing slightly the wrong way. Its use rose from 3.9 percent to 12.7 percent over a decade regardless.

How often will I need a mammogram afterwards?

Less often than many patients expect, at least over fifty. A trial of 5,235 women aged fifty or over compared annual with less frequent mammography and found five year breast cancer survival of 98 percent in both arms. That trial does not answer the question for younger women.

How long should I stay in Turkey?

Ten to fourteen days where the diagnostic work is already done, covering assessment, the operation and the pathology report. Flying is generally cleared at five to seven days once the wound is dry. A plan involving drug treatment before surgery changes the shape of the trip completely.

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Editor's note

Written by the Biruni Hospital medical editorial team. Reviewed by Prof. Dr. Hatice Deniz BÖLER, General Surgery.

Medically reviewed by

Prof. Dr. Hatice Deniz BÖLER

General Surgery

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