Breast cancer surgery: Everything you need to know before making a decision.
- ป้าหมอนุช
- 3 days ago
- 11 min read
Breast cancer surgery is the primary treatment for breast cancer, with four main types: lumpectomy (breast-conserving), mastectomy (total mastectomy), nipple/skin-sparing mastectomy, and oncoplastic surgery (cosmetic surgery combined with cancer treatment). Numarak Hospital offers all these types of surgery performed by five specialized breast surgeons, utilizing internationally recognized technologies including Scout Radar Localization (including TAD), IORT — Intrabeam 600, Hologic 3D Mammogram, Hidden Scar Technique, and Video-Assisted Surgery.
What is breast cancer surgery?
Breast cancer surgery aims to remove the cancerous tumor from the breast and assess its spread to the axillary lymph nodes. It is the primary treatment for almost all stages of breast cancer, from stage 0 (DCIS) to stage 3, and in some stage 4 patients with oligometastatic disease.
Surgery is often part of a multimodal treatment plan that combines surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, and hormone therapy, depending on the characteristics of the tumor, the stage of the disease, the type of cancer cells (HR+, HER2+, TNBC), and the patient's needs.
Factors determining the type of surgery:
Size and location of the tumor.
Breast size (tumor-to-breast ratio)
Number of tumor masses (single vs multifocal/multicentric)
Biopsy results and molecular subtype.
Preoperative MRI and mammogram results.
Patient's needs (breast augmentation, appearance).
Family history and genetic testing (BRCA1/2)
4 Types of Breast Cancer Surgery
2.1 Lumpectomy — Breast-conserving surgery
Lumpectomy, or Breast-Conserving Surgery (BCS), is a surgical procedure that removes only the tumor along with surrounding normal tissue, preserving the shape of the breast. It is suitable for patients with small to medium-sized tumors that are proportionate to the breast.
strength:
Preserving your breasts is important for self-image and mental well-being.
Minor surgery, faster recovery.
The treatment outcome is comparable to mastectomy in terms of overall survival when combined with radiation therapy.
Limitations:
This must be followed by radiation therapy (Whole Breast Radiation for 3-6 weeks or IORT in the operating room).
It is not suitable if the tumor is too large (tumor-to-breast ratio > 20%) or if there are multiple tumor locations (multicentric).
A second surgery is required if the margin is not cancerous.
2.2 Mastectomy — Total breast surgery.
Mastectomy is the surgical removal of an entire breast. It is suitable for patients with large or multiple tumors, a BRCA mutation, or a history of radiation therapy to the chest.
When is it necessary?
Large tumors (> 5 cm) or a high tumor-to-breast ratio.
Multicentric tumor (multiple tumors located far apart)
Inflammatory breast cancer
Patients with BRCA1/BRCA2 mutations (prophylactic mastectomy may be considered).
Patients who are not suitable for radiation therapy (e.g., previous chest radiation therapy, scleroderma, pregnancy).
2.3 Nipple-Sparing / Skin-Sparing Mastectomy
Breast surgery techniques have been developed to preserve the appearance of breasts as close to their original state as possible.
Skin-Sparing Mastectomy: This procedure preserves the breast skin and removes only the nipple, areola, and breast tissue.
Nipple-Sparing Mastectomy: Preserves both the skin and the nipple/areola — only the inner breast tissue is removed. Suitable for patients where the tumor is far from the nipple and has not spread to the skin.
This technique is suitable for immediate reconstruction to achieve a breast appearance close to the original.
2.4 Oncoplastic Surgery — Cancer surgery combined with cosmetic procedures.
Oncoplastic surgery is a surgical technique that combines the principles of surgical oncology (safe removal of cancer) and plastic surgery (breast reshaping) in the same procedure, allowing patients to achieve good cancer treatment outcomes while maintaining an aesthetic appearance.
Applicable techniques:
Volume Displacement — Uses remaining breast tissue to fill in the area that was removed.
Volume Replacement — Uses tissue from a surrounding area (e.g., Lateral Thoracic Flap).
Therapeutic Mammoplasty — Breast cancer surgery combined with breast lift (for large or sagging breasts)
Contralateral Symmetrisation — Adjusting the normal breast to be symmetrical.
At Numarak Hospital, our breast surgery team can perform oncoplastic surgery directly in most cases, without needing to consult a separate plastic surgeon — allowing patients to receive comprehensive care all in one place.
Lymphatic gland management
Axillary lymph node assessment is a crucial part of breast cancer staging and treatment planning, and there are three main techniques.
3.1 Sentinel Lymph Node Biopsy (SLNB)
Sentinel node biopsy (removal of the first lymph node receiving lymph drainage from the tumor) using blue dye + radioactive tracer or ICG fluorescence — suitable for clinically node-negative patients.
Remove only lymph nodes 1-4.
It significantly reduces the risk of lymphedema (swollen arm).
If the results are normal, no further lymph node dissection is required.
3.2 Axillary Lymph Node Dissection (ALND)
Total lymph node dissection at Level I-II of the armpit is used in cases of clinically positive lymph node enlargement or when SLNB (Senior Scalpel Node) reveals multiple cancers.
Removed 10+ lymph nodes.
Higher risk of lymphedema.
Use only when necessary.
3.3 TAD — Targeted Axillary Dissection (New Technique)
TAD (Targeted Axillary Dissection) is an advanced technique for patients who are initially found to have enlarged lymph nodes (Initially Node-Positive) and then receive neoadjuvant chemotherapy until the lymph nodes shrink — to ensure that the previously cancerous lymph nodes are truly gone.
TAD procedure:
Prior to neoadjuvant chemotherapy, a scout radar reflector marker is implanted at the lymph node where cancer was found during a biopsy.
After chemotherapy is complete — in the operating room — use the Scout Radar handheld probe to locate the reflector and specifically remove that lymph node.
Work done in collaboration with SLNB — including editing other Sentinel Nodes.
If all responses are pathologic complete (pCR), ALND can be bypassed.
Benefits of TAD: Improved accuracy in post-chemo staging; reduced errors in lymph node assessment (false negative rate < 5% compared to SLNB alone at ~13% in this group — from Caudle et al. JCO 2016 and ACOSOG Z1071 trial).
Numarak Hospital uses Merit Medical's Scout Radar Localization System for both breast lump identification and TAD (Transcranial Aspiration).
The technology that Namarak uses in breast cancer surgery.
4.1 Scout Radar Localization
Merit Medical's Scout Radar Reflector is a technology for locating small, non-palpable tumors using a 12-millimeter device — replacing traditional wire localization methods.
Advantages of Scout Radar versus Wire Localization:
No wires protruding from the breast — no need for same-day surgery.
Reflector installation can be done up to 30 days in advance — flexible with scheduling.
No restrictions on posture before surgery — more comfortable for the patient.
High accuracy — Radar handheld probe pinpoints location within millimeters.
Applicable for pre-surgical MRI follow-up.
Used for TAD in lymph nodes — a better novel alternative to Wire/Magseed.
4.2 IORT — Intrabeam 600 (Radiation Therapy for Operating Rooms)
Intraoperative Radiation Therapy (IORT) involves irradiating the breast in the operating room immediately after tumor removal. The Zeiss Intrabeam 600 machine delivers low-energy X-rays (~20 Gy) to the tumor bed over a period of 20-30 minutes in the operating room.
Academic evidence — TARGIT-A Trial:
The TARGIT-A Trial (Vaidya et al., BMJ 2020) — a randomized trial comparing IORT with Whole Breast Radiation Therapy (WBRT) after lumpectomy in 2,298 patients — found that:
5-year Local Recurrence Rate: IORT 2.11% vs WBRT 0.95% — non-inferior margin met
Breast Cancer Mortality: IORT 2.6% vs WBRT 1.9% — Equivalent
Overall mortality: Decreased in the IORT group (3.9% vs 5.3%) due to lower non-breast cancer deaths.
Long-term cardiac toxicity is less than with WBRT.
Who is IORT suitable for?
Ages 45 and above.
Tumor size ≤ 3.5 cm (T1-T2 early)
HR+ (Estrogen Receptor Positive)
Single tumor focus
No lymph node enlargement (clinically node-negative).
It does not have EIC (Extensive Intraductal Component) characteristics.
The clear advantage: Patients complete radiation therapy in a single operating room day — no need for the 3-6 weeks of radiation treatment required with conventional WBRT.
4.3 Hologic 3D Mammogram (Preoperative Planning)
Before surgery, the surgical team uses images from Hologic 3D Mammogram + Genius AI Detection for planning — seeing the size, edges, and location of the tumor in 3D, allowing for accurate decisions about whether to perform a lumpectomy or mastectomy. Read more: What is a 3D Mammogram?
4.4 Hidden Scar Technique + Video-Assisted Surgery
The Hidden Scar Technique involves placing the surgical incision in a naturally hidden location on the body, such as around the nipple (periareolar), inframammary fold, or axillary fold — making the scar invisible when wearing clothing or swimwear.
Video-Assisted Breast Surgery (VABS):
Using a small endoscope passed through a 2-3 cm incision hidden in the armpit or around the nipple, the surgeon sees a clear, magnified image, allowing for precise surgery in a confined space. Suitable for:
Nipple-Sparing Mastectomy requiring a hidden scar.
Skin-Sparing Mastectomy + Immediate Reconstruction
Patients who prioritize aesthetic outcome.
Both techniques help patients achieve cancer treatment results comparable to traditional methods, along with improved appearance and a faster return to self-confidence.
The breast surgery team at Numarak Hospital.
A multidisciplinary team of five breast surgeons working collaboratively with oncologists.
Assoc. Prof. Yaowanuch Kongdan, M.D.
Breast Surgeon + Surgical Oncologist · Founder and Director of Numarak Hospital · President of the Thai Breast Cancer Society (TBS) · Expertise: Oncoplastic Surgery, Hidden Scar Technique, IORT
Asst. Prof. Dr. Thongchai Sukrayothin
Breast Surgeon + Surgical Oncologist · Expertise: Complex Breast Surgery, Advanced Breast Cancer Surgery, Reconstruction
Asst. Prof. Dr. Mawin Wongsaysuwan
Breast Surgeon · Expertise: Breast-Conserving Surgery, Oncoplastic Surgery, Video-Assisted Surgery
Dr. Paweena Leudthai
Breast Surgeon · Expertise: Breast Surgery, Sentinel Lymph Node Biopsy, TAD with Scout Radar
Dr. Sermsri Pongratanakul
Breast Surgeon · Expertise: Breast Surgery, Patient-Centered Care, Survivorship
The team also includes Dr. Mathuros Sukwanich, an oncologist, who oversees the treatment plan including chemotherapy, targeted therapy, and hormone therapy following surgery.
Breast cancer surgery procedure.
Pre-operative
Consultation: Consultation with a breast surgeon + physical examination + surgical planning.
Imaging: 3D Mammogram, Ultrasound, MRI (as needed)
Biopsy + Pathology: Confirm cancer type + molecular markers (ER/PR/HER2/Ki-67)
Staging Workup: Chest CT, Bone Scan, PET-CT (for patients who require it)
Anesthesia Consult: Assess readiness before anesthesia administration.
Scout Radar Placement: Reflector implantation is performed 1-30 days prior to surgery (if used).
Surgery day
Arrive at the hospital in the morning — no food or water for 6-8 hours before surgery.
Injecting a dye or radioactive tracer for SLNB.
Entering the operating room — General Anesthesia
Planned surgery (Lumpectomy/Mastectomy/Oncoplastic) — Surgery time: 1-4 hours, depending on complexity.
IORT (if used) — Radiation therapy in the operating room for 20-30 minutes after tumor removal.
Cover the wound and insert a drainage tube if necessary.
Moved to a recovery room for 1-2 hours, then moved to an inpatient room.
After surgery
Hospitalization is 1-3 days, depending on the type of surgery.
Wound care + drain management
Pain management — using pain medication and blocking administered by an anesthesiologist.
Begin moving your arms as instructed to prevent frozen shoulder.
Recovery Timeline — When will recovery occur?
Days 0-2 (Hospital)
Recovering from anesthesia, able to walk, eat, and manage pain with medication.
Week 1
Go home. Care for the wound. Remove the drain (typically after 5-7 days). Return for follow-up. Begin initial physical therapy.
Weeks 2-4
Final pathology results are available; pT/pN staging is identified; adjuvant treatment (chemotherapy/radiation/hormone therapy) is planned; and the patient can return to light work.
Months 1-3
Begin adjuvant therapy as planned. Return to normal work (depending on the nature of the work). Resume light exercise. Care for the affected arm to prevent lymphedema.
Months 6-12
Follow-up every 3-6 months · 3D mammogram for monitoring · Adjust hormone medication based on side effects · Return to normal life.
Why choose breast cancer surgery at Numarak?
Breast specialist hospital — focused expertise, not just one of many departments.
5 breast surgeons + 1 oncologist — a multidisciplinary team approach.
Scout Radar + IORT + Hologic 3D + Hidden Scar + VDO-assisted — Comprehensive, world-class technology.
TBS Authority — Assoc. Prof. Yaowanuch is the President of the Breast Cancer Society of Thailand.
Patient Journey Coordinator (PJC) — This role involves caring for patients from screening to the completion of treatment.
Second Opinion — For those who want an opinion from another specialist.
KBank 0% installment plan for 6-10 months — for surgical and chemotherapy expenses.
The philosophy of "like visiting a friend's house" — High Tech, High Touch
Frequently Asked Questions (FAQ)
Is breast cancer surgery painful?
During the surgery, general anesthesia will be used, so you will not feel anything. After the surgery, you may experience mild to moderate pain, which the medical team will manage with pain medication and anesthesia block techniques. Most patients can manage their pain well and go home within 1-3 days.
How long does the surgery take?
Depending on the type of surgery, Lumpectomy + SLNB takes 1.5-2.5 hours, Mastectomy takes 2-3 hours, and Oncoplastic Surgery or Mastectomy + Immediate Reconstruction takes 3-5 hours. Adding IORT (Intensive Care Therapy) adds another 20-30 minutes.
How many days will I need to stay in the hospital?
Lumpectomy usually involves a 1-night stay (sometimes the same day). Mastectomy requires 2-3 nights. Mastectomy + Reconstruction requires 3-5 nights, depending on individual recovery time.
Lumpectomy vs. Mastectomy: Which is the better choice?
The overall survival rates are comparable if treatment is performed according to standard protocols. Lumpectomy is suitable for small to medium-sized tumors that are proportionate to the breast, and should be followed by radiation therapy. Mastectomy is suitable for large tumors, multiple tumors, or those with the BRCA gene. The choice depends on tumor size, molecular subtype, and patient preferences. The medical team will discuss the decision with the patient to reach a consensus.
If I have a mastectomy, can I get breasts again?
Yes — there are options for immediate reconstruction (done during cancer surgery) or delayed reconstruction (done later) using a tissue expander + implant or autologous tissue (such as a DIEP flap). Nipple-sparing mastectomy preserves the skin and nipple, resulting in a near-original appearance.
Can IORT replace conventional radiation therapy?
In the eligible patient group (age 45+, small tumor, HR+, single focus, node-negative), the TARGIT-A Trial showed that a single IORT session in surgery could replace 3-6 weeks of WBRT, with a small difference in local recurrence rates (2.11% vs 0.95% over 5 years) and the advantage of lower overall mortality from non-breast cancer deaths. For patients who do not meet the criteria and still require conventional radiation therapy, the medical team will assess each case individually.
How is Scout Radar better than Wire Localization?
Scout Radar can be implanted up to 30 days in advance. It has no wires protruding from the breast, making it convenient for patients. It can be used with TADs in lymph nodes and offers accuracy equal to or better than wires that require placement on the same day as surgery.
Do all patients need chemotherapy after surgery?
Not all patients require chemotherapy after surgery. Post-surgical chemotherapy depends on pathologic staging (pT/pN), molecular subtype (HR+, HER2+, TNBC), the size and number of lymph nodes affected by cancer, and the oncotype DX score (in HR+ patients). Some patients may not need chemotherapy at all—hormone therapy alone will suffice. The medical team will develop an individualized plan.
When can I return to work?
Minimally strenuous work (office work) – return in 1-2 weeks. Strenuous work – 4-6 weeks. Mastectomy or reconstruction surgery may take longer. The medical team will provide personalized guidance based on the type of work and recovery time.
How much does breast cancer surgery cost?
Namarak Hospital's philosophy is "Excellent value every day, no promotions" — costs depend on the type of surgery, the technology used, and the number of hospital stays. KBank offers 0% interest installment plans for 6-10 months on treatment costs. Please inquire for details at 02-059-0245 or LINE @namarak. Our team is happy to provide consultation before you make a decision.
About Numarak Hospital
Numarak Hospital is a specialized breast and breast cancer hospital located on Phetchaburi Road, Bangkok. It was founded by Assoc. Prof. Dr. Yaowanuch Kongdan and a team of expert physicians under the philosophy of "Like visiting a friend's house" — High Tech, High Touch, combining international-standard technology with compassionate care.
For consultation regarding breast cancer surgery or to request a second opinion, please contact:
Tel: 02-059-0245
LINE: @namarak (page.line.me/vfg3683z)
Note: This information is for general knowledge purposes only and is not personalized medical advice. The appropriate surgical approach depends on the nature of the disease and the individual's physical condition. Please consult a specialist for proper diagnosis and treatment.
References
NCCN Clinical Practice Guidelines in Oncology—Breast Cancer (Version 2.2025)
Vaidya JS, et al. TARGIT-A Trial — IORT vs WBRT. BMJ 2020;370:m2836
Caudle AS, et al. Targeted Axillary Dissection — JCO 2016;34:1072-1078 / ACOSOG Z1071
Merit Medical—Scout Radar Surgical Guidance System
Zeiss Medical—Intrabeam 600 IORT System
Hologic, Inc. — Genius 3D Mammography for Preoperative Planning
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