At Penn Women's Specialty Center, we offer women several treatment options for their cancer -- no matter what stage of development.

Lumpectomy

A lumpectomy is a surgery to remove cancer or other abnormal tissue from your breast. Also called breast-conserving or breast-sparing surgery, only a portion of the breast is removed. During lumpectomy, a small amount of normal tissue around the lump (clean margins) also is taken to help ensure that all the cancer or other abnormal tissue is removed.

Lumpectomy helps to confirm a diagnosis of cancer or rule it out. Lumpectomy is also a first treatment option for some women with early-stage breast cancer. In cases where cancer is found, lumpectomy usually is followed by radiation therapy to reduce the chances of cancer returning.

Lumpectomies have become more common for women who have smaller tumors. Recovery time for a lumpectomy is usually just several days.

Our surgeons perform hundreds of these surgeries a year and are sensitive to how vital a woman's breasts are to her self-esteem, emotional well being and sexual identity. Your surgeon will discuss ways to minimize lumpectomy scars so you feel the impact of the surgery as little as possible. Your surgeon also take steps to reduce the appearance of loss of volume wherever possible. Women who are candidates for breast conserving surgery have one tumor in the breast that is easily removed with surrounding tissue to yield a good cosmetic result.

Mastectomy

Mastectomy is surgery to remove all breast tissue from a breast as a way to treat or prevent breast cancer. For those with early-stage breast cancer, mastectomy may be one treatment option.

There are several types of mastectomies:

  • Total simple mastectomy - This is removal of the breast, nipple and areola. No lymph nodes from the axillae are taken. Recovery from this procedure, if no reconstruction is done at the same time, is usually one to two weeks. Hospitalization varies; for some it may be an outpatient procedure and other patients may require an overnight stay.
  • Modified radical mastectomy - This procedure is removal of the breast, nipple and areola as well as axillary node dissection. Recovery, when surgery is done without reconstruction, is usually two to three weeks.
  • Skin sparing mastectomy - This is the removal of the breast, nipple and areola, keeping the outer skin of the breast intact. It is a special method of performing a mastectomy that allows for a good cosmetic outcome when combined with a reconstruction done at the same time. A tissue expander may also be placed as a space holder for later reconstruction.
  • Nipple sparing mastectomy - A newer technique, this kind of mastectomy is reserved for a smaller number of women with tumors that are not near the nipple areola area. Your surgeon will make an incision on the outer side of the breast or around the edge of the areola and hollow out the breast, removing the areola and keeping the nipple intact. This method involves simultaneous reconstruction. Sometimes the completed reconstruction is done at the same time and in other cases, a tissue expander is inserted as a space holder for later reconstruction.
  • Nipple and areola sparing mastectomy - In this newer procedure, your surgeon will make the incision on the side of your breast or in some cases, around the edge of the areola. The breast will be hollowed out and reconstruction is performed at the same time. In some cases, a tissue expander may be placed as a space holder for later reconstruction
  • Scar sparing mastectomy - This is a fairly new form of surgery. The affected breast is hollowed out. Whether done as skin sparing, nipple sparing, areola sparing or a combination, one goal of this surgery is to minimize the surgical incisions that are visible. It is not uncommon for an entire mastectomy procedure to be performed through an opening that is less than two inches in length.
  • Preventive/prophylactic mastectomy - Prophylactic mastectomy is a surgery designed to remove one or both breasts in order to dramatically reduce the risk of developing breast cancer. Women who test positive for certain genetic mutations like BRCA1 and BRCA2, or who have a strong family, may elect to do this kind of surgery. They may also elect to have their ovaries removed at the same time. Genetic counseling may help to confirm or eliminate any nagging suspicion about family history. When a preventive mastectomy is performed, no lymph nodes need to be removed, since there is no evidence of cancer. For preventive purposes, you should have a mammogram performed within 90 days of the procedure to ensure that the breast tissue being removed is healthy.

Women can undergo simultaneous reconstruction of any kind after mastectomy; there is no medical need to delay reconstruction. All forms of mastectomy listed above are options, excluding modified radical mastectomy. This is a complicated decision and requires the guidance of breast cancer specialists who can explain all the potential risks and complications of taking this extraordinary step.

Neoadjuvant Chemotherapy

What is Neoadjuvant Chemotherapy
Neoadjuvant Chemotherapy refers to medicines that are administered before surgery for the treatment of breast cancer. Your doctors may recommend neoadjuvant chemotherapy due to the size of the tumor, since the drugs may shrink the tumor and give you more surgical options.In some cases, a woman who would have needed a mastectomy due to the large size of her tumor can become a candidate for lumpectomy by shrinking the invasive tumor prior to surgery. Neoadjuvant chemotherapy is also performed for certain types of breast cancer, such as inflammatory breast cancer.

What is Adjuvant Chemotherapy?
Adjuvant (meaning "in addition to") chemotherapy refers to medicines administered after surgery for the treatment of breast cancer. Adjuvant chemotherapy is designed to prevent recurrence of the disease.

How is Chemotherapy Administered?
Chemotherapy is usually administered intravenously and given to patients in an outpatient setting. Our physicians at The Cancer Center are well trained to provide this treatment. There are some drugs that can be given orally. Some protocols call for a cycle of treatment every three weeks; others may be more frequent. Most women undergoing chemotherapy will have treatment for three to six months. The majority of women having chemotherapy are able to work while receiving treatment, only missing a few days from work at a given time.

Your medical oncologist takes measures to help reduce and prevent side effects from the drugs, most commonly gastrointestinal side effects. Each drug has different potential side effects, so patients should ask for information about their drugs. Hair loss is a common side effect, so we encourage patients to prepare for this eventuality. Red and white blood cells are also affected by chemotherapy, so exposure to people with colds or flu should be limited.

Radiation Oncology

Patients who undergo lumpectomy surgery for treatment of their breast cancer almost always receive radiation therapy afterward.

This form of adjuvant (supplemental) therapy uses high-energy rays (such as X-rays) to kill cancer cells or shrink tumors. Most commonly, radiation therapy is used to kill any cancer cells that remain in the breast, chest wall or underarm area after surgery. It is also used to treat the healthy breast tissue that remains after a lumpectomy -- not to kill cancer cells that may have remained, but to radiate the tissue to prevent it from creating breast cancer cells again.

There are two forms of radiation therapy available in our community.

  • External Beam Radiation - A physicist and the radiation oncologist carefully plan where the beams should be aimed using advanced calculations and past scans of the patient. The patient lies on a table and the beams are aimed toward the breast cancer. This type of radiation can treat part of the breast (known as partial breast radiation) or the whole breast (known as whole breast radiation). Though the standard of care is six weeks of treatment, there are now three week protocols that have proven to be very effective. We use both methods at our Breast Center.
  • Brachytherapy - This involves the use of a balloon inserted into the breast at the time of lumpectomy surgery. The radiation oncologist places tiny rods that carry radiation to the site where the cancer originally grew. Radiation can be completed in just a few days. This method is part of a clinical trial.