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  • Susan F. Smith Center for Women's Cancers logo spacer Dana-Farber/Brigham and Women's Cancer Care

    Breast Cancer

    How We Treat Breast Cancer

    Dr. Eric Winer, Dr. Korneilia Polyak, and Dr. Ian KropBreast cancer researcher Dr. Kornelia Polyak (center) collaborates with medical oncologists Dr. Eric Winer and Dr. Ian Krop.

    Whatever your breast cancer diagnosis, we are committed to providing you with personalized, compassionate, comprehensive care at the Susan F. Smith Center for Women's Cancers Breast Oncology Program at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC).

    Personalized, multidisciplinary approach

    Your breast cancer care team develops a personalized treatment plan based on you, your needs, and your specific type of cancer. We offer the most effective and least invasive therapies possible, while also helping you maintain your quality of life during and after treatment. We encourage you to be actively involved in the decision-making process. Your team of breast cancer specialists — medical oncologists, radiation oncologists, surgical oncologists, pathologists, radiologists, and nurses — interacts closely to provide you with a coordinated treatment plan.

    Clinical trials

    As a key element of our mission at DF/BWCC, we strongly support our patients’ participation in clinical trials. We provide an average of 50 clinical trials at any one time for all stages of breast cancer — many of which are changing the standard of care worldwide and may not be found elsewhere. Breast cancer is an area of active research, and DF/BWCC leads the way in developing new treatment approaches for breast cancer. In some cases, your clinician will offer you the option of taking part in one of our clinical trials, which may provide additional treatment possibilities.

    Treatment approaches

    Your treatment plan may include:

    Breast cancer surgery

    Amy Goldfine and  Mehra Golshan, MD, FACSAmy Goldfine and Mehra Golshan, MD, FACS

    Dana-Farber/Brigham and Women's Cancer Center offers tissue-preserving procedures and precision techniques that provide the best results possible while also minimizing the need for additional surgery and radiation. For example, using image-guided surgical techniques and radioactive seed localization approaches provide valuable information to surgeons in the operating room, helping them to achieve complete removal of the tumor and tumor margins. Our experts also are leaders in breast reconstruction.

    There are four common types of surgery for breast cancer:

    • Sentinel lymph node biopsy. Sentinel lymph node biopsy is the removal of one or a few of the first draining lymph nodes (glands under the arm) to determine whether cancer cells have spread beyond the breast.
    • Axillary lymph node dissection. Axillary lymph node dissection is the removal of the level I and II nodes below the axillary vein and close to the breast.
    • Lumpectomy. A "lumpectomy" — also known as wide excision or partial mastectomy — involves surgical removal of the cancer with a rim of normal tissue. Lumpectomy may be an option when the cancer is localized to one area of the breast. The benefits of lumpectomy include the conservation of the breast and nipple, and the surgery is as effective in treating cancer as a mastectomy in appropriate candidates. In most cases, radiation treatment is recommended following lumpectomy.
    • Mastectomy. Mastectomy (removal of the entire breast) may be medically necessary if the cancer has spread beyond a single mass. It may also be necessary when early stage cancer exists in multiple locations. In some cases, choosing mastectomy over lumpectomy may make further radiation treatment unnecessary. There are four types of mastectomies: total, modified, skin sparing, and nipple sparing. Your surgeon will help you understand the options available to you, and will work with you and your team to ensure the best possible outcomes, relative both to your health and to your appearance.

    Improving breast cancer surgery outcomes

    Breast cancer patients who opt for a lumpectomy rather than a mastectomy often experience the same long-term results; however, as many as 40 percent of these patients will need additional surgeries to remove the entire tumor.

    A phase II breast imaging study is using advanced imaging to help improve these surgical outcomes. Phase I results showed that tumor assessment is enhanced by iMRI with the patient lying facing upward rather than downward. This study is the first of its kind in the world. Learn more about this clinical trial.

    The clinical trial takes place in the Advanced Multimodality Image Guided Operating (AMIGO) suite at Brigham and Women's Hospital. The AMIGO suite uses the latest imaging tools to precisely guide removal of the tumor without the need for a repeat operation.

    Find out more about our breast cancer surgical services and breast surgery research.

    Breast reconstructive surgery

    If it seems likely that you need a mastectomy, your surgical oncologist will set up a consultation for you with one of our specialized breast reconstruction surgeons who will discuss the various options for breast reconstruction, and help you decide the best procedure, based on your particular type of breast cancer and expected treatment plan.

    We know that undergoing a mastectomy is a physically and emotionally difficult process. We will talk with you before your mastectomy to ensure that your questions are answered and that you are comfortable with your choices.

    Our surgical oncologists and reconstructive breast surgeons collaborate daily; in many cases, a breast cancer surgeon and a breast reconstructive surgeon will work together so that reconstruction begins at the same time that a mastectomy is completed.

    Find out more about our breast reconstructive surgery program.

    The latest in tissue-preserving surgery and breast reconstruction

    Our breast cancer surgical oncologists offer minimally invasive approaches, including nipple-sparing mastectomy, image-guided surgery, as well as novel pre-operative medical treatment. Our breast reconstruction surgeons offer a full range of breast reconstruction, including staged implant/expander reconstruction, TRAM (transverse rectus abdominus myocutaneous) flap, LAT (latissimus dorsi) flap, and advanced procedures such as DIEP (deep inferior epigastric perforators) flap, and SGAP (superior gluteal artery perforator) flap.

    These advanced surgical techniques shorten hospital stays and can reduce repeat procedures. We also are studying preoperative treatment, including the use of targeted therapy, chemotherapy, or a combination of drugs, to reduce tumors and allow for less aggressive surgery.

    Medical oncology

    Dr. Eric Winer with a patientBreast cancer oncologist Dr. Eric Winer visits with patient Martha Horn in Dana-Farber’s Stoneman Healing Garden.
    Expert medical oncology care across the entire spectrum of breast cancer stages and subtypes

    DF/BWCC medical oncologists lead and participate in national and international panels to set breast cancer treatment guidelines across the country and around the world. You will have access to highly experienced providers who will discuss options with you that are personalized to your type and stage of breast cancer, other medical problems, and your preferences and values.

    Breast cancers are often treated with medications, including hormonal therapy, targeted therapy, and chemotherapy. Our ability to distinguish among different subtypes of breast cancer has led to more refined treatments, reducing the use of therapies that are less likely to be effective – an important consideration for overall quality of life.

    Our medical oncologists also work with you to determine whether preventive medications are appropriate. To provide the best possible experience for each patient, we:

    • Offer consultation with reproductive medicine specialists to discuss preserving fertility during cancer treatment.
    • Address and treat symptoms, including pain and emotional distress.
    • Coordinate care with our extensive support services staff, including nutrition, social work services, and palliative care.
    Preoperative therapy

    In some cases, your treatment team, including your surgeon and medical oncologist may recommend that you receive systemic treatment (chemotherapy, hormonal therapy, and/or targeted therapy) for your breast cancer before you have your breast surgery. Studies have shown that patients who receive systemic treatment before surgery have the same cure rate as patients who undergo surgery first and then receive systemic treatment afterwards. Advantages include the potential to reduce the size of your tumor to allow for a lumpectomy. This is an active area for clinical trials testing new treatments for breast cancer.

    Radiation therapy

    Dr. Rinaa Punglia with a patientBreast cancer radiation oncologist Dr. Rinaa Punglia meets with patient Eileen Edelstein.

    Radiation therapy is a non-invasive form of cancer treatment that uses various forms of radiation to kill cancer cells. Our breast radiation oncologists specialize in precision techniques that effectively target cancer cells while sparing healthy tissue.

    Radiation is often used in addition to surgery, with chemotherapy, or to reduce the size of a tumor prior to surgery. The use of radiation therapy after mastectomy or lumpectomy not only reduces recurrence of the disease but it also improves long-term survival.

    Targeted radiation therapy that protects against heart damage

    DF/BWCC radiation oncologists were among the first to develop the "deep inspiration breath-hold" technique that involves the patient holding her breath at the deep inspiration level, allowing for the delivery of radiation beams to effectively treat tumors while eliminating direct irradiation of the heart. This technique protects the heart and other organs during radiation therapy and is now standard practice around the world.

    diagram of heart movement with deep inspiration breath-holdThis slide shows how deep inspiration breath-hold moves the heart away from the chest wall, protecting the heart when radiation therapy is directed to the chest area.

    Watch a video about the deep inspiration breath-hold technique

    Supportive resources

    At DF/BWCC, we treat the whole patient, not just your cancer. To address all your needs, we provide a comprehensive range of breast cancer support services and complementary and integrative therapies. We offer individual and family counseling, rehabilitation and physical therapy, nutrition, pain and symptom management, acupuncture, massage, Reiki, creative arts and music therapies, educational programs, and support groups.

    Next: How We Manage People at Higher Risk for Breast Cancer

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  • Susan F. Smith Center for Women's Cancers

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    • Dr. Mehra Golshan with former patient Ellen CollinsEllen Collins felt confident that her team of clinicians, that included Dr. Mehra Golshan, director of breast surgical services, developed a treatment plan that was right for her.
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    • Dr. Eric Winer from the What is DCIS videoIn this video, Eric Winer, MD, director of the Breast Oncology Center at the Susan F. Smith Center for Women’s Cancers at Dana-Farber, answers some common questions about DCIS and its treatment.
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