Breast Cancer Treatment
Following a breast cancer diagnosis, the care team will work with you to create a personalized treatment plan based on your cancer type and stage, as well as your overall health and treatment goals.
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, your cancer stage and what your desired outcomes are.
Your multidisciplinary breast cancer care team may include a variety of experts, all of whom work together to determine personalized, targeted treatment options that offer optimal health outcomes. You may work with oncologists, pathologists, nurses, radiologists, researchers and support staff during your treatment.
Breast Cancer Surgery

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
Lumpectomy is the surgical removal of a tumor, the surrounding breast tissue and, sometimes, 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
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.
Your surgical team may offer advanced surgical options like a nipple-sparing mastectomy or 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 and Microsurgery
Breast reconstruction procedures 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. In most cases, surgeons use a flap of tissue from elsewhere to rebuild the shape of the breast.
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.
Our world-class surgical team has expertise in some of the most innovative approaches to breast reconstruction, including:
- Rib-sparing reconstruction, which allows surgeons to access mammary blood vessels and reconnect them to the tissue being used to reconstruct the breast, helping improve surgical outcomes
- DIEP (deep inferior epigastric perforator) flap, an approach to abdominal flap-based reconstruction that preserves muscle tissue and relative innervation, reducing donor site morbidity
- Abdominal perforator exchange (APEX) flap surgery, which is an abdominal flap-based reconstruction that does not remove muscle tissue, preserving innervation and reducing donor site morbidity
- Posterior thigh-based profunda artery perforator (PAP) flap surgery, which offers an alternative to using an abdominal flap for patients who are slim or have had prior major abdominal surgery or liposuction that limits available abdominal tissue
As an alternative to reconstruction, some women prefer to wear prosthetic 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 the surgeon 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.
The plastic surgery team may offer 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.
Lymphatic Function Preservation
Lymphedema — the retention of lymph fluid and swelling after surgery or radiation — affects approximately one in five breast cancer survivors, with incidence rates as high as 30% to 60% reported in survivors with axillary lymph node dissection. Lymphedema usually occurs in the arm and hand but can also appear in the breast, underarm, chest, trunk or back. Early diagnosis and treatment can improve fluid flow and prevent long-term side effects and tissue damage. Most commonly, diagnosis occurs anytime within three years of treatment. Once lymphedema has become chronic, it is typically not curable.
However, City of Hope® has extensive experience in a variety of lymphatic reconstruction and bypass techniques. Among these are advanced microsurgery techniques such as:
- Robotic vascularized lymph node transplant, in which autologous lymph nodes are transplanted from the abdomen to replace lymph nodes removed during treatment
- Lymphaticovenous anastomosis (LVA), a bypass procedure during which lymph fluid is redirected to small veins with virtually no blood loss (typically an outpatient procedure that takes four to six hours, with patients remaining fewer than 24 hours for observation)
Skin or Nipple Reinnervation
Hypoesthesia (partial or complete loss of sensation) in the breast and nipple after total or nipple-sparing mastectomy is another common complication that can diminish a patient's psychosocial and sexual well-being.
At City of Hope, our team routinely performs breast reinnervation in conjunction with breast reconstruction surgery, following either conventional or nipple-sparing mastectomies. Reinnervation is a procedure that dissects and reconnects one of the body’s intercostal sensory nerves. This approach has been highly successful in restoring sensation both to the breast mound and nipple-areolar complex.
3-D Nipple Areolar Complex Tattoos
Mastectomy surgery for breast cancer often includes the removal of the nipple and areola. Many patients do not feel fully recovered from surgery without restoration of these critical features. Some women may consider 3D nipple areolar complex tattooing, which uses advanced tattoo techniques and multiple shades of nontoxic ink to create a more natural appearance to the nipple and areola after surgery. 3D nipple tattoos may be an appropriate option for patients who wish to restore the appearance of their breasts and without undergoing additional surgeries.
Post-Surgical Therapy and Rehabilitation
Developing a rehabilitation plan with your doctor may help you reduce post-surgery side effects and speed up your return to normal activities. Exercise supervised by a physical or occupational therapist can improve range of motion, flexibility, and immune function and decrease pain, depression, stress and anxiety while boosting body image and confidence.
Earlier cancer detection, advanced treatments, and longer life expectancies promote higher rates of cancer survivors. Now managing treatment-related complications, such as lymphedema, is vital to empowering these growing numbers so that breast cancer survivors can thrive after completing active treatment.
Radiation Therapy for Breast Cancer
- 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
Learn more about radiation therapy for breast cancer
What Is Intraoperative Radiation Therapy?
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 for Breast Cancer
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 for Breast Cancer
Targeted therapy selectively attacks cancer based on specific characteristics on the breast cancer cells.
Immunotherapy for Breast Cancer
Immunotherapy stimulates a patient’s immune system to attack the cancer cells from within.
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.