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
Your breast cancer is every bit as unique as you are, and that is why breast cancer treatment at City of Hope is focused around you and your loved ones.
This means our physicians will personally consult with you about your disease, treatment options and desired outcomes. Afterward, our multidisciplinary team of specialists will work together to discuss, design and deliver an individual treatment plan to best meet those goals.
“Not only do I help women take care of their breast cancer, but I also try to make it look like no one has been there.”
Laura Kruper, M.D., M.S., Chief, Breast Surgery
Surgery is a common treatment option for most breast cancer patients. Depending on the tumor’s size, location and spread, the procedure may be performed as a lumpectomy or mastectomy.
- Lumpectomy (removal of the tumor, surrounding breast tissue and possibly nearby lymph nodes). Often an option for women with small, early-stage tumors, lumpectomy seeks to conserve as much of the breast as possible. The part of the breast containing the cancer is removed, as well as some surrounding normal tissue and sometimes the lymph nodes. Afterward, radiation therapy is recommended for most women, and some may receive other treatments as well, such as hormone therapy or chemotherapy.
- Mastectomy (removal of one or both breasts, along with nearby lymph nodes). Mastectomies may also be performed as a risk reduction procedure for women with a high risk of developing breast cancer.
City of Hope offers the latest advances in surgical approaches to treating breast cancer. Our leading-edge technology and surgical expertise mean that patients can achieve outstanding outcomes that are difficult to achieve elsewhere. By pairing our expert surgeons with advanced equipment, we have the ability to 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 be done with larger tumors as well, by shrinking the tumor with chemotherapy before the surgery.
For more extensive procedures, our breast surgeons work in conjunction with our plastic surgery team. This includes combining skin- and nipple-sparing mastectomies with breast reconstruction in one operation, preserving or restoring breast appearance without compromising health outcomes.
What Is a Nipple-Sparing Mastectomy?
In this procedure, the 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 along with 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 the surgery to reduce the risk of the cancer coming back. Breast reconstruction follows the surgery.
What Is a Skin-Sparing Mastectomy?
Seeking to preserve as much of the breast skin as possible, this technique removes the inner breast tissue and nipple, leaving an envelope of skin in place. The remaining shell is filled with the woman’s own tissue from other parts of her body or an artificial implant during breast reconstruction, which typically takes place during or soon after the mastectomy.
There are several options for breast reconstruction, which rebuilds the shape of the breast after a mastectomy. Some of these procedures are done, or started, at the same time as the mastectomy, and others are done later. Although the breast shape is restored, sensation in the breast and the nipple usually remains limited. 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.
- The uninvolved breast: When women have reconstruction on a cancerous breast following a mastectomy, sometimes plastic surgery is also performed on the healthy breast so that the shape of the two breasts will match.
- Oncoplastic and breast reconstruction: Oncoplastic surgery combines cancer surgery and plastic surgery techniques. This typically involves reshaping the breast at the time of the initial surgery, such as doing a partial breast reconstruction in conjunction with breast-conserving surgery. Others may choose a full reconstruction after mastectomy. It may mean operating on the other breast as well to make the breasts more alike.
Breast Implant Placement at the Time of Mastectomy
Patients who have sufficient breast skin remaining following mastectomy may be well suited for direct-to-implant breast reconstruction. With skin-sparing and nipple-sparing mastectomy techniques gaining popularity, more and more women are now good candidates for this approach.
For patients that are good candidates, direct-to-implant postmastectomy breast reconstruction allows our surgeons to place a breast implant immediately, avoiding the use of a tissue expander. This “one-step” approach can potentially allow 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. These include:
- patients who have had mastectomies in the past
- patients with larger breasts or a higher body mass index, or BMI
- patients who are dissatisfied with their previous reconstructions
For patients with a high risk of developing breast cancer, these appearance-preserving or appearance restoring techniques may also be used after risk-reduction surgeries.
To decrease the side effects of surgery and aid the return to normal activities, it’s very important that patients talk with their doctor about establishing a safe exercise routine tailored to their individual needs. The physician might suggest seeing a physical or occupational therapist, or 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.
After surgery, patients and medical professionals need to 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 sometimes in the breast, underarm, chest, trunk and/or back. A variety of treatments and lifestyle changes can be used to improve the flow of fluid. Early diagnosis and treatment of the condition is essential to preventing tissue damage and other long-term side effects.
Radiation therapy uses high-energy rays (such as X-rays) or particles that destroy cancer cells. Some women with breast cancer will need radiation in addition to other treatments, including surgery. The need depends on the type of surgery performed, whether cancer has spread to the lymph nodes or somewhere else in the body, and in some cases, age. Patients may have just one type of radiation or a combination of types.
Situations in which radiation is commonly 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 image-driven radiation planning, using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.
In addition to standard radiation therapy, which takes place daily over six or seven weeks, patients may also be eligible for hypofractionated radiotherapy — which delivers a higher dose of radiation in a shorter amount of time (four weeks), allowing patients to make fewer visits for treatment and recover faster.
What Is Intraoperative Radiation Therapy?
Select breast cancer patients may also be eligible for intraoperative radiation therapy, which delivers high dose radiation treatment at the time of their breast cancer surgery. This procedure allows patients to skip the usual six-week cycle of radiation following lumpectomy and may reduce radiation exposure to normal breast tissue.
Drug therapy may be given to patients to fight breast cancer cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:
- Chemotherapy, which targets all rapidly dividing cells, including breast cancer cells. Chemotherapy treatment consists of cancer-killing drugs that may be injected into a vein or taken by mouth. They travel through the bloodstream to reach cancer cells in most parts of the body. Chemotherapy is often recommended to treat breast cancer in situations that include:
- After surgery (called adjuvant chemotherapy), to try to kill any cancer cells that may have been left behind or spread but can't be seen
- Before surgery (called neoadjuvant chemotherapy), when it is often used to treat cancers that are too big to be removed at the time of diagnosis
- For advanced breast cancer
- Targeted therapy, which selectively attacks cancer cells based on specific characteristics
- Immunotherapy, which stimulates the patient’s own immune system to attack the cancer cells
Drugs may also be prescribed to treat conditions related to breast cancer, such as minimizing bone loss and fracture risk if the cancer has spread to the bones.
The drug or drug combination used depends on the type and stage of breast cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.
City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight breast cancer while minimizing side effects.
In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.
Endocrine (Hormone) Therapy
Approximately two-thirds of breast cancers are reliant on the hormones, such as estrogen and/or progesterone to fuel their growth and spread, so drugs that decrease endocrine production can help slow or halt the disease. It is most often used as an adjuvant therapy (given after surgery) to reduce likelihood of cancer recurrence, but may be used in other settings as well.
In addition to standard endocrine therapy treatments, City of Hope patients have access to promising endocrine therapies through our clinical trials program. These innovative therapies may be better at treating endocrine-sensitive breast cancer and/or reduce side effects associated with endocrine therapy.