Surgery is the basis for most breast cancer treatments. Once a diagnosis of breast cancer has been made, a consultation with your surgeon should include a discussion of the different options for breast cancer treatment. Not all breast cancers are the same and therefore not all of these treatments may be appropriate for your type of cancer. Please discuss with your surgeon about the treatments that are appropriate for your clinical situation and type of cancer.

Modified Radical Mastectomy

This is historically one of the most common breast cancer procedures performed. This involves removing the entire breast and a portion of the axillary (armpit) lymph nodes. This procedure is also referred to as a total mastectomy with axillary node dissection. The advantage of this procedure is that since the entire breast is removed, radiation therapy is not routinely needed. Although arm and hand swelling can occur, strength in the arm is not affected. The biggest disadvantage to this operation is the need for the removal of the entire breast and the large incision.

Simple Mastectomy

This is similar to the modified radical mastectomy with the exception that the axillary lymph nodes are not removed. The advantage to this procedure is that there is minimal arm swelling and a quicker recovery. The disadvantage is that the entire breast is still removed and lymph nodes are not evaluated.

Partial Mastectomy (Lumpectomy)

In this procedure the tumor is removed with a surrounding rim of normal breast tissue. Removal of some of the axillary lymph nodes is done, usually through a second incision. The advantage of this procedure is that the majority of the breast is left in place. The biggest disadvantage is that radiation therapy is often required afterwards. Also, if multicentric disease (disease located in another portion of the breast) is present, it may not be identified.

Breast Reconstruction

After removal of the breast, a plastic surgeon may be used to create a new breast in the area where the previous one was removed. This is a non-functional breast and is for cosmetic purposes only. It can be done at the time the breast is removed or months later. There are many options for breast reconstruction including placement of tissue expander for the placement of a breast prosthesis, using one of the abdominal muscles as a new breast (TRAM flap) and using one of the back muscles as a new breast (latissimus dorsi flap). The plastic surgeon will discuss the different options with you as well as the best timing for your reconstruction.

Sentinel Lymph Node Biopsy

The axillary lymph nodes are the most likely place where breast cancer will spread first. The sentinel lymph node biopsy is a procedure where the surgeon can identify the lymph node(s) that are most likely to contain the spread of cancer. The procedure involves some radioactive dye being injected into the breast. A special x-ray (lymphoscintigraphy) is then done to show the surgeon where this lymph node(s) are. The patient is then taken to the operating room where a blue dye (Lymphazurin) may also be injected. Using a special probe (Gamma probe), these lymph nodes are identified and then removed. They are immediately tested by the pathologist to see if cancer is present. If no cancer is seen, a larger operation in the axilla may be avoided. The advantage of this procedure is that it potentially can avoid the larger operation on the axillary lymph nodes. The disadvantage is the added time and cost to the procedure.

Radiation Therapy

This procedure uses x-rays to try to kill the breast cancer cells. The x-rays kill both normal and cancer cells, but since the cancer cells are dividing more quickly than normal cells, they are more affected by the x-rays. X-ray treatment is usually given five times a week for four to six weeks. A boost (additional x-ray treatment) may also be given one to two weeks later. This has the advantage of killing cancer cells in the local treatment area. It does not affect cancer cells that have already spread (metastatic disease). There are some side effects that can occur. The radiation oncologist will discuss these with you. The biggest disadvantage is the length of time and additional cost associated with this therapy.

Chemotherapy

This is the use of medications that are designed to kill cancer cells. It is directed at the cancer cells that have already spread. Multiple drugs (three or four) may be given by mouth or through the veins. This is given periodically over the course of a couple of months. Occasionally it may be given before surgery in an attempt to try to shrink the tumor. The biggest disadvantage is the numerous side effects associated with these medicines. The medical oncologist will discuss these with you.

Hormonal Therapy

It has been found that some breast cancers may be responsive to the female hormones, estrogen and progesterone. After the tumor has been removed it will be tested to see if the tumor is responsive to these hormones and the medical oncologist will determine if this form of therapy is appropriate for you.

The treatment of breast cancer can be complicated and confusing. Many doctors may be involved in your care. These may include your primary care physician, breast surgeon, plastic surgeon, medical oncologist, radiation oncologist, physical and occupational therapist and possibly a cancer care coordinator. If you have any questions in regards to your care, please do not hesitate to contact your health care providers. Our purpose is to help you understand your problem so that we can all work together to treat you.

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and is not intended as medical advice.