Most women with a diagnosis of breast cancer undergo some form of a surgical procedure. All surgical treatment is discussed in detail with your surgeon and plastic surgeon, if applicable. Surgical techniques have improved dramatically over the years, allowing most women the option of surgery that preserves the breast. There are several types of surgical procedures for breast cancer.
In addition to surgical treatment, chemotherapy is used adjuvantly (in addition) to further decrease the chance of a malignancy coming back in the breast or body generally. There are certain drugs which are considered standard of care. However, clinical trials are available should you meet certain criteria and desire participation.
Radiation therapy is usually used in conjunction with breast conservation surgery as this is known to increase local control and help prevent cancer from recurring in the same breast. The standard of care is whole-breast and limited breast irradiation. However, other options will be discussed including hypofractionated irradiation. Your radiation therapist will discuss this in detail with you.
Surgeons can remove significant portions of the breast tissue utilizing oncoplastic techniques allowing for breast preservation to minimize the indentation or depression created by removing tissue.
Breast Conservation consists of lumpectomy, partial mastectomy, and wide local excision. The terms are used interchangeably. The breast conservation surgery is usually followed by radiation therapy to the affected breast.
Our surgeons are trained in Hidden Scar Breast Cancer Surgery, an advanced approach to removing breast cancer or your risk of breast cancer. The Hidden Scar approach allows your surgeon to make the incision is placed in a location that is hard to see, so your scar is not visible when it heals.
Mastectomy with or without breast reconstruction is removal of all breast tissue including the nipple areolar complex. Some rare exceptions can be made.
Sentinel Node Excision
Sentinel node excision may be used with either breast conservation or mastectomy procedures. Lymphatic mapping is a sophisticated method of identifying the first lymph nodes (usually 1-3) that drains the tumor. This is called the sentinel node. This procedure demonstrates sentinel nodes in the axilla (arm pit) on the same side as the affected breast.
The sentinel node(s) are removed and evaluated at the time of the breast conservation surgery or mastectomy. A sentinel node which contains cancer cells indicates more complete surgical dissection of the axilla. A sentinel node without cancer cells does not require more extensive surgery.
Women who have undergone mastectomy for breast cancer have many options for breast reconstruction. The best option for you depends on your personal medical history and preferences. Our plastic surgeon works with our breast surgeons to coordinate each patient’s personalized surgical plan. Options include rearrangement of breast tissue, reduction in breast size, and implant placement.
Oncotype DX is a diagnostic tool that allows the medical oncologist to target therapy specific to your tumor and your needs. The tumor that is removed in women who are sentinal node negative and demonstrate estrogen receptors in the tumor cells can have this test performed by evaluation of 21 genes present in their cancerous tumor. Statistical methods are then used to generate a recurrence score. If your recurrence score is low, you may only require endocrine therapy (Tamoxifen or Aromatase inhibitors) as this treatment gives the greatest effect to reduce recurrence. If the recurrent score is high then chemotherapy gives the greatest benefit but adding endocrine therapy produces additional benefit.
Growth Factor Receptor / Biological Therapy
Other prognostic tests available and offered at Jordan include Growth Factor Receptor (HER2). If this indicator is present in the cancerous tumor, it will allow targeted therapy with use of a new drug, Herceptin. This is known as biological therapy.
This is discussed in detail with your medical oncologist, who is a part of the multidisciplinary team here at Beth Israel Deaconess - Plymouth.