Breast Cancer Treatments
"Reconstruction — including restoration of function and sensation as feasible — is integral to the personalized surgical approach patients receive at City of Hope. Our team is highly skilled in lymphatic bypass and repair, breast reinnervation and all aspects of aesthetic reconstruction. Our goal is to restore patients who undergo surgical procedures for cancer to a feeling of normalcy.”
Alex Wong, M.D., Plastic Surgeon
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
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
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.
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.
Lymphatic Function Preservation and Skin or Nipple Reinnervation
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.
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.
City of Hope's surgical team is highly skilled in reconstruction during the mastectomy to preserve the lymphatic system and skin/nipple sensation. Function and sensory preservation during breast cancer surgery can lead to improved recovery and better quality of life for the breast cancer survivor. Learn about our lymphedema treatments.
City of Hope is an expert in performing skin and nipple reinnervation for alloplastic and autologous breast reconstruction. After mastectomy, this technique provides sensation to the breast mound and nipple-areolar complex by reconstructing the fourth or fifth intercostal sensory nerve using an extended allograph. Breast reinnervation is a new procedure not offered by many other medical centers.
Post-Surgical Therapy and Rehabilitation
Developing a rehabilitation plan with your doctor can minimize 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, decrease pain, depression, stress, and anxiety, and boost 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
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?
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
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.