Breast Cancer Treatments

“City of Hope provides leading-edge, compassionate treatment with a team approach where the patient and her family are at the center of the team.”

Joanne Mortimer, M.D., Baum Family Professor in Women's Cancers

How Is Breast Cancer Treated?

Like every patient, every breast cancer diagnosis is different. Getting treated for breast cancer at City of Hope means having access to the latest in advanced cancer care, as well as a team of physicians who will personally consult with you and your loved ones to determine the best treatment options for you.

Some of the most common treatments for breast cancer are surgery, medications, radiation therapy and hormone therapy. Which course of care is right for you will depend on several factors, including what type of breast cancer you have, what stage it is at and what your desired outcomes are.

The City of Hope Difference

City of Hope’s breast cancer care time combines leading-edge surgical and therapeutic treatments with access to the most advanced technologies. This allows us to offer patients outstanding outcomes that are difficult to achieve elsewhere. We can meet each patient’s individual needs at any of our City of Hope locations. This includes taking a minimally invasive approach to breast cancer surgeries, with fewer and smaller incisions whenever possible, reducing discomfort, hastening recovery time and allowing our patients to proceed with their postsurgical treatments more quickly.

Our team is also experienced in breast-conserving surgery, which can remove early-stage tumors while achieving excellent cosmetic outcomes. This procedure can also be done with larger tumors by shrinking the tumor with chemotherapy before the surgery. For more extensive procedures, our breast surgeons work in conjunction with our plastic surgery team to preserve or restore breast appearance without compromising health outcomes.

City of Hope also offers a wide range of support services for patients and their families. The breast cancer Partners Clinic is a unique program offering partners and families the support they need to grow closer as they work with a loved one who is going through a cancer journey.

What Breast Cancer Doctors Will I See At My Appointment?

At City of Hope, your cancer care team takes a multidisciplinary approach to your health. This means that our staff works closely with you to determine the best, most targeted treatment options that offer the best health outcomes. Your care may be coordinated by a variety of specialists, from oncologists to pathologists, nurses, radiologists, researchers and support staff.

Surgery for Breast Cancer

Illustration of two common incisions used in the excision of the tumors in the breast and axillary lymph nodes.

Surgery is a common treatment option for most breast cancer patients. Depending on the tumor’s size, location and spread, doctors may recommend a lumpectomy or a mastectomy.

Lumpectomy is the surgical removal of a tumor, the surrounding breast tissue and, sometimes, the nearby lymph nodes. This option is often used for small, early-stage tumors and seeks to conserve as much of the breast as possible. A lumpectomy is usually followed by radiation therapy, and sometimes by hormone therapy or chemotherapy.
Mastectomy is the surgical removal of one or both breasts, along with nearby lymph nodes. Mastectomies are sometimes performed as a risk reduction procedure for women with a high risk of breast cancer.

Our surgical team also offers advanced surgical options like a nipple-sparing mastectomy and skin-sparing mastectomy.

What Is a Nipple-Sparing Mastectomy?

In this procedure, cancerous breast tissue is removed but the breast skin and nipple are left in place. Often, the surgeon also removes the breast tissue beneath the nipple and the areola — the pigmented skin surrounding the nipple — to check for any remaining cancer cells. Sometimes, the nipple tissue is given a dose of radiation during or after surgery to reduce the risk of the cancer coming back. Breast reconstruction follows the surgery.

What Is a Skin-Sparing Mastectomy?

This technique removes the inner breast tissue and nipple, leaving an envelope of skin in place. This skin is filled with tissue from other parts of the patient’s body or with an artificial implant during breast reconstruction.

Breast Reconstruction

At City of Hope, we offer several breast reconstruction options to rebuild the shape of the breast after a mastectomy. Some of these procedures are performed at the same time as the mastectomy, while others are done later. Although the breast shape is restored, sensation in the breast and the nipple usually remains limited.

When cancer surgery is combined with plastic surgery, it is called oncoplastic surgery. This typically involves reshaping the breast at the same time as the initial surgery. In some cases, surgery is performed on a healthy breast so that the shape of both breasts matches.

In place of reconstruction, some women prefer to wear breast forms inside their bra or attached to their body, while others choose to have a flat chest.

Breast Implant Placement at The Time of Mastectomy

Patients who have enough breast skin remaining after a mastectomy may be suited for direct-to-implant breast reconstruction. With skin-sparing and nipple-sparing mastectomy techniques gaining popularity, more and more women are good candidates for this approach. This procedure allows our surgeons to place a breast implant immediately, avoiding the use of a tissue expander, allowing patients to awaken from their mastectomy with a well-defined breast shape.

Our plastic surgery team offers reconstruction options with either implants or natural tissue to a wide range of breast cancer patients, including:

Patients who have had mastectomies in the past
Patients with larger breasts or a higher body mass index (BMI)
Patients who are dissatisfied with their previous reconstructions

These techniques can also be used for high-risk patients who undergo risk reduction surgeries.

Post-Surgical Therapy/Rehabilitation

After breast cancer surgery, it is important to talk to your doctor about steps to recovery and rehabilitation. Having a rehabilitation plan can decrease the side effects of surgery and will help you return to normal activities. This may include visits to a physical or occupational therapist or seeing a cancer exercise specialist. In addition to improving range of motion and flexibility, exercise can also decrease pain, improve immune function, decrease depression, stress and anxiety and boost body image and confidence.

Patients and medical professionals should also stay alert for possible signs of lymphedema — retention of lymph fluid and swelling that can occur after surgery and radiation. Lymphedema usually occurs in the arm and hand, but can also appear in the breast, underarm, chest, trunk or back. A variety of treatments and lifestyle changes can be used to improve the flow of fluid. Early diagnosis and treatment is essential to preventing tissue damage and other long-term side effects.

Radiation Therapy for Breast Cancer

Radiation therapy uses high-energy rays (such as X-rays) or particles to destroy cancer cells. Your care team may recommend radiation alone, or in combination with other treatments like surgery, depending on factors such as the type of cancer, whether it has spread and your age. Radiation therapies are often used:

After breast-conserving surgery, to help lower the chance that the cancer will come back in the breast or nearby lymph nodes
After a mastectomy, especially if the cancer was larger than two inches, or if cancer is found in the lymph nodes
If cancer has spread to other parts of the body, such as the bones or brain

City of Hope is a leader in using computed tomography (CT) and magnetic resonance imaging (MRI) scans to determine tumor size and location. This ensures that we can deliver radiation as accurately as possible and minimize exposure to normal tissue.

Standard radiation therapy takes place daily over six or seven weeks. Some patients may also be eligible for hypofractionated radiotherapy, which delivers a higher dose of radiation over a shorter amount of time (four weeks), allowing patients to make fewer visits for treatment and recover faster.

What Is Intraoperative Radiation Therapy?

Some patients may also be eligible for intraoperative radiation therapy, which delivers high dose radiation treatment during breast cancer surgery. This procedure means that patients can skip the standard six weeks of radiation therapy that follows a lumpectomy and that their healthy tissues are exposed to less radiation.

Drug Therapy for Breast Cancer

There are a number of drug therapy treatments that can help the body fight breast cancer by killing the cancer cells or stopping their growth and spread.

Chemotherapy targets all rapidly dividing cells, including breast cancer cells. Chemotherapy treatment consists of cancer-killing drugs that can be injected or taken by mouth. These drugs travel through the bloodstream to reach cancer cells wherever they are in the body. Chemotherapy is often recommended:
- After surgery (called adjuvant chemotherapy), to try to kill cancer cells that may have been left behind or spread
- Before surgery (called neoadjuvant chemotherapy), often when a cancer is too big to be removed at the time of diagnosis
- For advanced breast cancer
Targeted therapy selectively attacks cancer cells based on specific characteristics
Immunotherapy stimulates a patient’s immune system to attack the cancer cells

Which drug therapies are best for you depends on a variety of factors, including the type and stage of breast cancer, previous treatments and your overall health and goals. Genetic testing can also help identify treatments that are more effective for you.

City of Hope has a wide range of cancer-fighting drugs available on-site, allowing our medical oncologists to plan and prescribe a drug regimen that can fight breast cancer while minimizing side effects. We also offer access to promising new drugs through our clinical trials program.

Endocrine (Hormone) Therapy for Breast Cancer

Approximately two-thirds of breast cancers rely on hormones like estrogen and/or progesterone to fuel their growth. Drugs that decrease endocrine (or hormone) production can help slow or halt the disease. Endocrine therapy is most often used after surgery to reduce likelihood of cancer recurrence, but may be used in other settings as well. Our clinical trials program continues to develop new endocrine therapies that are better at treating endocrine-sensitive breast cancer and reduce side effects.