Breast Cancer Surgery

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 Breast cancer surgery is the removal of cancerous tissue from the breast — but that single sentence understates the complexity and the options available to you. Surgery is almost always the cornerstone of breast cancer treatment, and the approach is not one-size-fits-all.

Your surgical plan depends on several factors: the type and stage of your cancer, the size and location of the tumor, your breast anatomy, your overall health, and — critically — your personal goals and preferences. A good surgical consultation doesn't hand you a plan. It walks you through your options and helps you arrive at the right one for you.

DCIS — Ductal Carcinoma In Situ
DCIS is a non-invasive breast cancer — abnormal cells contained within the milk ducts that have not spread into surrounding tissue. It is highly treatable, and surgery is typically the primary treatment. Depending on the extent of DCIS, the options range from lumpectomy with radiation to mastectomy. The goal is complete removal with the lowest risk of recurrence and the best possible aesthetic outcome.

Early-Stage Invasive Breast Cancer
Stage I and Stage II breast cancers are invasive — meaning cancer cells have grown beyond the ducts or lobules into surrounding breast tissue — but have not spread extensively beyond the breast. This is where the full spectrum of surgical options is most relevant: lumpectomy, oncoplastic lumpectomy, skin-sparing mastectomy, and nipple-sparing mastectomy are all potentially on the table depending on your specific situation.

Lumpectomy (Breast-Conserving Surgery)
Removes the tumor and a margin of surrounding healthy tissue while preserving the breast. When performed with oncoplastic techniques, the breast is simultaneously reshaped to minimize deformity and preserve contour. Lumpectomy is typically followed by radiation therapy.

Mastectomy
Complete removal of breast tissue. Skin-sparing and nipple-sparing approaches preserve the breast envelope and, where appropriate, the nipple-areolar complex — allowing for immediate reconstruction with a significantly better aesthetic result than traditional mastectomy. Not every patient is a candidate for nipple-sparing mastectomy, and candidacy is evaluated individually.

Oncoplastic Surgery
The integration of cancer surgery and aesthetic surgical techniques in a single operation. Rather than treating the cancer first and addressing appearance later, oncoplastic surgery plans for both simultaneously — resulting in better aesthetic outcomes without compromising oncologic ones.

 Breast cancer surgery is not a commodity. Two surgeons can perform a lumpectomy on the same patient and produce dramatically different results — in margin status, in breast appearance, in the need for re-excision, and in how a patient feels about her body when treatment is complete.

The surgeon you choose determines not just whether the cancer is removed, but how completely it is removed, how your breast looks and feels afterward, how many operations you need, and how quickly you can move forward with your life.

A surgeon trained only in oncology may remove the cancer effectively but leave a deformity that requires a separate reconstructive procedure. A surgeon trained only in cosmetic surgery cannot safely manage the oncologic complexity of the case. The rare surgeon trained in both can plan the cancer surgery with the aesthetic outcome already accounted for — and that changes everything about the result.

Dr. Palakodeti holds board certification in both general surgery (FACS) and cosmetic surgery (FAACS) — a combination held by very few breast surgeons. He is a member of the American Society of Breast Surgeons, and has surgical privileges locally in the BGKY area and in Nashville, TN. What this means for you practically: when Dr. Palakodeti removes your tumor, he is simultaneously planning your reconstructive and aesthetic outcome. The incision is placed with purpose. The tissue is handled with the final result in mind. If you need a mastectomy, reconstruction is planned before you enter the operating room — not as an afterthought scheduled months later.

You do not have to choose between a surgeon who is good at removing cancer and a surgeon who cares about how you look and feel when it's done. Dr. Palakodeti is both.

• Patients with a new breast cancer diagnosis — DCIS through early-stage invasive — seeking a surgical consultation
• Patients who have received a surgical recommendation elsewhere and want a second opinion before proceeding
• Patients who have been told mastectomy is their only option and want to explore whether breast conservation is possible
• Patients who want to understand their reconstructive options before making a decision about mastectomy
• Patients who are BRCA-positive or have a strong family history and are considering prophylactic surgery

The consultation
Your first appointment is a conversation, not a procedure. Bring your imaging, biopsy results, and any prior reports. Dr. Palakodeti will review your records, perform a focused examination, and walk you through your surgical options — breast conservation versus mastectomy, reconstruction choices, symmetry considerations, and what recovery looks like for each path. Plan for 45 to 60 minutes. You will leave with a clear picture of your options and a recommendation, not a rushed decision.

Surgical planning
Once you decide on a surgical approach, the team coordinates the details — facility scheduling, pre-operative appointments, anesthesia, and any additional consultations needed (medical oncology, radiation oncology, genetics). Dr. Palakodeti works with your full care team to ensure the surgical plan fits within the broader treatment picture.

The operation
Most procedures are performed on an outpatient basis. You go home the same day. Operative times vary by procedure — lumpectomy is typically shorter; mastectomy with reconstruction takes longer. Your care team will give you a realistic estimate during your pre-operative appointment.

Recovery
Recovery timelines depend on the procedure. Lumpectomy patients typically return to normal activity within one to two weeks. Mastectomy with reconstruction involves a longer recovery — usually two to four weeks before returning to light activity, with full recovery over several months. Drains, activity restrictions, and wound care instructions are reviewed in detail before you leave the facility.

Pathology and next steps
Final pathology results typically return within five to seven business days. Dr. Palakodeti reviews your results and communicates them to you directly, along with any implications for additional treatment such as radiation or medical oncology follow-up.

Dr. Palakodeti welcomes second opinion consultations. Bring your records, imaging, and any prior surgical recommendations. A second opinion is not a sign of distrust toward your original provider — it is a responsible part of making a major decision. Many patients who come for second opinions proceed with the original recommendation, but with greater confidence.