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

2 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

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

Radiation therapy for breast cancer 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

Learn more about radiation therapy for breast cancer

What Is Intraoperative Radiation Therapy?

Some patients may also be eligible for intraoperative radiation therapy (IORT), 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.

Learn more about IORT for breast cancer

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.

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 may also help identify treatments that are more effective for you.

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.