Chemotherapy is cancer-fighting medicine that's administered intravenously or by a pill. Chemotherapy also might be recommended before surgery, called neoadjuvant chemotherapy, to help reduce the size of the tumor and improve surgical results. Often, more than one chemotherapy medicines are used at the same time or one after the other to destroy different kinds of cancer cells that come from the same breast cancer.
Locations: If you need intravenous (infusion) chemotherapy, you can have it at the Comprehensive Treatment Unit (CTU) at Sylvester’s main location in Miami, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables, and Deerfield Beach locations.
As a breast cancer patient at Sylvester, you have access to more novel or advanced treatments than anywhere else in South Florida. Your doctor will let you know if there's a clinical trial that’s right for you.
Triple negative breast cancer has been hard to treat in the past, but a novel clinical trial at Sylvester is changing that by targeting vitamin D and androgen receptors. When used in conjunction with chemotherapy, this treatment is showing great promise.
This procedure removes a tumor (lump) and a small amount of normal tissue around it. Sylvester cancer surgeons pioneered the technique for oncoplastic lumpectomy and now teach other surgeons around the country. During a lumpectomy, your surgeon removes the tumor and a small area of surrounding tissue. Your doctor sculpts the remaining breast tissue to give your breast a natural appearance, with touch-ups to the other breast to make them match.
Lumpectomy with breast reduction
For women with large breasts, the surgical oncologist and plastic surgeon can do breast-reduction surgery, starting with the cancerous breast to make sure the removed tissue contains the lump and a clean — or safe — margin around the lump. The plastic surgeon reduces the other breast to match.
This surgery, also called a segmental mastectomy, removes a larger part of the breast than a lumpectomy.
Skin and Nipple-Sparing Mastectomy
When appropriate and possible, this procedure preserves the skin and nipple to minimize scarring and improve your surgeon's ability to reconstruct your breasts.
A mastectomy removes the entire breast that's affected by cancer. The surgeon may remove one or more of the lymph nodes under your arm during surgery, or as a separate procedure later, to see if cancer has spread.
If you have a mastectomy or a lumpectomy, you may choose to have breast reconstruction surgery during at the same time, or you can decide to do it later. Your surgeon may perform an oncoplastic lumpectomy, or your breast cancer surgeon and a plastic surgeon can work together to do reconstructive surgery. New techniques make it possible to create a breast that's close in form and appearance to your natural breast.
Sentinel lymph node biopsy
Doctors use this minor surgery to determine if cancer has spread beyond a primary tumor into your lymphatic system. A sentinel lymph node is the first place cancer cells may move to when they begin to spread. During the biopsy, your doctor injects a special dye (tracer) to locate the nodes and remove them to look for cancer cells. If they're free of cancer, it means it's unlikely that cancer has spread and it's not necessary to remove more lymph nodes.
Sylvester offers a novel treatment that prevents taking more lymph nodes, even if the sentinel node is suspicious. Before surgery, an ultrasound scan of the armpit can highlight which lymph nodes are involved (they will appear enlarged or swollen). When chemotherapy is used before surgery (neoadjuvant chemotherapy), it can convert a previously positive lymph node to negative when biopsied, which means more lymph nodes don't need to be removed.
Venous lymph node transfer and lymphatic grafting
Sentinel node biopsy was developed to reduce the need to remove most of the lymph nodes in the armpit, avoiding the debilitating problem of lymphedema, which causes painful arm swelling from a buildup of fluid that cannot drain into the lymph system. However, even if more lymph nodes must be removed, surgeons at Sylvester have developed a technique of reverse arm mapping with a special dye to highlight the drainage from the arm, so lymph channels can be re-implanted to preserve lymph drainage and prevent lymphedema.
Sylvester’s radiation oncologists use the most advanced technology to deliver radiation externally or internally to breast tumors.
Partial breast radiation radiates only the area of the tumor for a significantly shorter period of time at a higher dose. For small tumors that haven't affected the lymph nodes, this allows qualified patients to receive an accelerated treatment — three weeks, as opposed to the full breast radiation schedule of six weeks.
Most radiation for breast cancer is delivered externally. Some advanced techniques allow for the radiation to be directed to your tumor with greater precision, with one-half to one-eighth the old treatment time and less damage to surrounding healthy tissue.
Also called brachytherapy, internal radiation is good for smaller primary tumors with clean, healthy skin around them and no evidence of cancer in the lymph nodes. Brachytherapy involves temporarily implanting a radiation applicator into the tumor site and delivering doses of radiation for five days, twice a day. This allows the radiation oncologist to keep the radiation dose away from your ribs, skin and organs, and speed up treatment.