Surgery can be used as a primary treatment or, it may be combined with other cancer therapies, depending on the diagnosis. Sylvester’s surgical oncologists are highly specialized in surgical options for breast cancer.
This procedure removes the tissue affected by cancer but not the breast itself. Examples of breast-conserving surgeries include lumpectomies and partial mastectomies.
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
If you have lymphedema from a previous surgery, Sylvester’s expert surgeons can prevent or provide relief from the debilitating condition caused when cancerous lymph nodes in the armpit must be removed during surgery, disrupting the normal flow of lymphatic fluid out of the arm. With nowhere to go, the fluid backs up in the tissues of the limb, causing painful swelling. In vascularized lymph node transfer, lymph nodes and their blood supply are transferred into regions where lymph nodes have been dissected to restore normal drainage.
Your radiation oncologist will discuss if radiation therapy is appropriate for your cancer and which type of radiation delivery best suits your case. Types include internal radiation therapy such as brachytherapy (radioactive “seeds” implanted in the tumor), partial breast radiation therapy (higher doses pinpointed for a shorter time to accelerate therapy), and targeted external beam radiation therapy.
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 medicine is used at the same time or one after the other to destroy different kinds of cancer cells that come from the same breast cancer.
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.
Cold Cap Therapy to Minimize Hair Loss
Sylvester offers FDA-cleared cold cap therapy to reduce hair loss during chemotherapy. The therapy works by cooling the scalp during treatment.
For breast cancers sensitive to hormones like estrogen and progesterone, taking medications that interfere with the activity of those hormones or stopping production of those hormones can prevent recurrence (returning cancer). Your oncologist may also suggest surgically removing a gland that is producing the hormones.
Targeted therapies are treatments designed to attack the molecular changes that make the cancer cells grow and spread. The FDA has approved several targeted therapies. If your biopsy showed you're positive for HER2 receptors, you will be treated with Herceptin before surgery, in addition to having chemotherapy.
Clinical trials are research studies that test testing the benefits of a new drug or therapy against the current standard of care. Talk with your Sylvester oncologist to find out if a clinical trial might be right for your particular breast cancer diagnosis.