Breast Cancer Treatment

Surgical oncologists perform a variety of breast cancer operations to surgically remove breast cancer. In some cases, reconstructive surgery is also part of the cancer treatment plan.

Breast-conserving surgery (BCS)

Breast-conserving surgery involves partial removal of the breast, depending on the size and location of the tumor. BCS surgery is typically followed by radiation treatments. A BCS procedure is technically known as a partial mastectomy, but most often BCS surgeries are described in one of two ways:

• Lumpectomy is removal of a lump.
• Segmental mastectomy is removal of the cancer and some adjacent tissue.

Mastectomy

The entire breast is removed in a total mastectomy, including all breast tissue and sometimes surrounding tissues. Types of mastectomies include:

• Mastectomy is when the entire breast is removed; no lymph nodes under the arm are involved. This surgery is also known as a total mastectomy.
• Modified radical mastectomy is when a simple mastectomy is combined with removal of most of the lymph nodes under the arms.
• Skin and nipple areola sparing mastectomy is when the breast tissue is removed, but the skin and nipple over the breast are preserved. Often the reconstructive surgeon will be present to start the breast reconstruction at the time of this type of mastectomy.

Lymph node biopsy

Typically performed at the time of surgery, a sentinel lymph node biopsy is the removal of a sentinel lymph node. These are the first lymph nodes to receive lymphatic drainage from breast tumors and are therefore removed to evaluate the spread of cancer from the breast into the lymphatic system.

If cancer cells are found in the sentinel node, another surgery to remove the axillary lymph nodes may be needed. Sentinel lymph node biopsy is the preferred first step since it removes fewer lymph nodes has fewer long-term side effects.

Reconstructive surgery

Women who have had a lumpectomy or mastectomy for breast cancer may choose to have breast reconstruction surgery to restore one or both breasts to a natural shape and size.

Often, breast reconstruction involves multiple procedures performed in stages. Some women may start reconstructive surgery at the time of mastectomy surgery, while others may wait until a later time to begin the process.

The surgeons at Scripps Clinic Division of Plastic and Reconstructive Surgery are experts in breast reconstruction after cancer treatment. Our plastic surgeons perform several types of breast reconstruction, including the newer DIEP (deep inferior epigastric perforator) flap procedure. This microsurgery uses fat from the abdomen to reconstruct breast tissue.

If you’re considering breast reconstruction, our plastic surgeons will recommend the best type of surgery for your individual needs. We recommend scheduling a consultation with one of our plastic surgeons before you have cancer surgery.

Scripps cancer experts offer state-of-the-art radiation technology that targets cancerous cells while reducing radiation exposure to healthy tissue. Radiation therapy for breast cancer can be used before surgery to shrink tumors, or more commonly after surgery to kill remaining cancer cells. It can also be used to target the whole breast or partial breast.

Radiation therapy is organized into two main categories:

• External radiation therapy may come from a machine outside the body.
• Internal radiation therapy places materials that produce radiation through thin plastic tubes into the area where the cancer cells are found.

External radiation

• 3-dimensional conformal radiotherapy uses advanced computer software that allows physicians to visualize a patient’s anatomy in three dimensions (3D), thereby more closely matching the radiation dose to the shape of the tumor while minimizing exposure to surrounding healthy tissues and organs.

Internal radiation therapy

• High-dose rate (HDR) brachytherapy administers radiation internally by placing radioactive beads or other sources directly into the body through catheters or small plastic tubes. HDR brachytherapy is given alone or with a shorter course of external radiation therapy.

All cases of invasive breast cancer are tested for estrogen receptors, progesterone receptors and HER2 receptors. Depending on the results, further testing may be indicated to help personalize additional therapies, such as endocrine therapy, HER2 directed therapy or chemotherapy. Systemic therapy may be given before or after surgery.

Chemotherapy

Chemotherapy is the use of special drugs to damage or kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by a needle in a vein. Chemotherapy drugs enter the bloodstream and travel through the body to target cancer cells outside the breast area.

Endocrine therapy

If tests show that the breast cancer cells contain estrogen or progesterone receptors, you may be given endocrine therapy. Endocrine therapy is used to block hormones in the body that might help cancers grow, or by using drugs that block the action of hormones.

Targeted therapy

Targeted therapy uses drugs to identify and attack specific markers on cancer cells. Some types of targeted therapy kill cancer cells directly by affecting how the cells grow and survive. Other targeted therapies help the body’s own immune system attack and fight the cancer. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapies used in the treatment of breast cancer.

Some breast cancer treatment plans may involve clinical trials. Talk with your physician about whether a clinical trial is right for you.

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have. 

Your breast cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your breast cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. Your team may include:

• Nurse navigators
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Pathologists
• Diagnostic radiologists
• Registered nurses
• Dietitians
• Oncology social workers

For details, refer to our section covering your cancer care team. 

The following support groups are for breast cancer patients only.

Stage 0-3 Breast Cancer Support Group (virtual or phone)

Meeting times: 2nd and 4th Wednesdays, 1 – 2 pm on Microsoft Teams

• Participants should attend either the 2nd or 4th Wednesday
• They do not need to attend both meetings

Contact info: Jeanne Vestevich, LCSW, 760-492-5899 or Vestevich.Jeanne@scrippshealth.org

Breast Cancer Support Group (Chula Vista)

• Meeting times: 1st and 3rd Monday, Chula Vista (Spanish only) (virtual or in-person)
• Meeting location: 5 – 7 pm at 237 Church Ave.
• Facilitator: Sabrina Lugo
• Contact info: 619-394-0792

For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.

In addition to the breast cancer support groups listed above, we also host a handful of free workshops and health and wellness events on a number of topics, such as:

• Nutrition
• Yoga
• Meditation

We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your breast cancer journey is about much more than your medical treatment. Specifically, Scripps offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:

• Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care
• Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge
• Home health care services when you require skilled intermittent care in the comfort of your home
• Nutrition and weight-maintenance services via registered dietitians of Scripps Center for Weight Management and Scripps Center for Integrative Medicine
• Psychological and emotional care for patients and family members seeking mental health counseling from experts in psychology and psychiatry
• Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more
• Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more
• Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor
• Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging

For the full lineup of offerings, please visit our cancer patient resources section.