In most cases of breast cancer, some kind of surgery is used to remove the cancer and surrounding tissue.
The most common is lumpectomy, or breast-conserving surgery, which removes only the cancerous mass and some surrounding tissue. The rest of the breast is left intact. It can often be performed as an outpatient surgery, meaning you’ll be able to go home and won’t need to spend the night in the hospital.
If your cancer is in more than one place in the breast, or if you are at a high risk for recurrence, a total mastectomy may be recommended. Sometimes called a simple mastectomy, this procedure removes the entire breast, and usually the skin, nipple and areola (dark area surrounding the nipple). If the cancer is touching the chest muscles, a small area of muscle may be removed.
If you choose breast reconstruction, our plastic surgeons can let you know your options before your breast cancer surgery. Reconstruction can often be done immediately after your breast cancer surgery, or even years later if you choose.
Breast reconstruction is a personal choice, and we’ll make sure you have all the information you need to make an informed decision. Today’s breast reconstruction techniques can offer natural-looking results and can often be performed immediately after your breast cancer surgery or preventive mastectomy, so that you have your new breast right away. It’s best to talk to your breast cancer surgeon and plastic surgeon about your options as soon as possible, but reconstruction can be performed even years later.
Our plastic and reconstructive surgeons are highly trained and experienced in all types of breast reconstructive surgery. Our surgeons collaborate with medical oncologists, dermatologists, radiation oncologists and others to ensure your safety, comfort and desired results.
Your options for reconstruction can depend on your age, health, body type, breast size, the location of your cancer, the stage of your cancer, your lifestyle and your personal preferences. Recovery usually takes a few weeks, and complete healing can take a few months. If only one breast is affected, you may opt to have some kind of surgery on the other breast — such as a breast lift, breast reduction, or breast augmentation — to help match both breasts as closely as possible.
Modern breast reconstruction often involves using tissue from another part of your body, such as the abdomen, hips or thighs (often called flap surgery). A skilled surgeon creates your new breast from this tissue and can even create a new nipple if needed. Your new breast will not make milk or have as much sensitivity as your original breast, but it may help you look and feel your best.
In some cases, an implant may be a better choice. Today’s saline and silicone implants are safe and last for decades. Implant surgery is usually a two-step process. First, a tissue expander (an empty balloon-like plastic sac) is inserted under the chest (pectoral) muscles. Over several weeks, using a syringe, the bag is gradually inflated with saline to stretch the muscles and breast skin to the desired size. During a second, shorter surgery, the expander is removed and replaced with the saline or silicone gel breast implant. In some cases, the final implant can be placed immediately after a mastectomy, skipping the expander step.
Fat injection, also known as fat grafting, is another way to improve the appearance of the breast after cancer surgery. Using liposuction, fat is collected from another area of your body, then injected into any dimpled areas where the breast tissue has been removed.
If you decide against breast reconstruction, you may want to consider a breast prosthesis. Many shapes, sizes and materials are available, and some are weighted to help you maintain proper posture. Some slip into a pocket in a specially designed bra, camisole or even a bathing suit. Others use adhesives or magnets to hold the prosthesis in place. You can choose from a variety of ready-made prostheses or have one custom-made just for you.
Systemic therapy is medicine that spreads throughout your body to fight cancer wherever it may be. You may need systemic therapy after surgery (adjuvant therapy) to help keep the cancer from recurring or spreading (metastasizing). Systemic therapy before surgery (neoadjuvant therapy) is sometimes used to help shrink the tumor to make it easier to remove and to help prevent spreading.
Certain genomic profiling tests can identify genetic alterations in breast tumors and help determine the need for systemic therapy. Some systemic therapy can have serious side effects, but modern methods and medications can help manage them. If you need systemic therapy, we’ll work with you to make it as safe, convenient and comfortable as possible.
Systemic therapy can include:
- Chemotherapy - many different drugs have been developed to help you fight breast cancer by interrupting the growth and spread of cancer cells. Each of them works in a different way, and requires different dosing, scheduling and methods of administration.
- Hormone therapy. Some breast cancers rely on estrogen and other hormones to fuel their growth. These medicines block or decrease these hormones to help keep these tumors from growing. Tamoxifen and aromatase inhibitors are examples.
- Targeted therapy. Some medicines can identify and attack specific types of cancer cells, blocking genes or proteins involved in tumor growth while avoiding damage to healthy cells. Some of these drugs are only available within formal clinical trials. Their use and effectiveness are still being studied.
Radiation therapy uses high-energy beams to destroy cancer cells. Miami Cancer Institute’s experienced team of radiation oncologists offer the most advanced methods available for breast cancer. Because we offer the latest radiation therapies in one location, we can work with you to choose the best technology for your cancer. Some examples:
- External beam radiation therapy - this is the most common form of radiation treatment for breast cancer. A machine called a linear accelerator, or LINAC, produces radiation as precisely targeted X-ray beams. These beams are tailored to the size and location of the cancer to help avoid damage to healthy tissue and other side effects.
- Brachytherapy - in this approach, the radiation oncologist uses a catheter or needle to place an implant in or near the tumor while you are sedated. The implant then delivers a strong dose of radiation internally. If the tumor has already been removed through surgery, the implant is placed where the tumor used to be.
- Proton therapy - If breast cancer is in the left breast, proton therapy — using charged particles called protons rather than the X-rays — may be used to reduce the risk of heart-related side effects. Miami Cancer Institute is the first center in South Florida to offer proton therapy, and we’re the only one to offer the most advanced pencil-beam Imaging techniques, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, can help ensure the precise dose is delivered to the precise location.
South Florida's First Proton Therapy Center
Proton therapy is a highly specialized treatment that directs proton particles toward tumors to destroy cancer cells while largely sparing healthy tissue and decreasing the risk of side effects. This sophisticated treatment is used only for certain types of cancers and in a limited number of individuals.
After breast cancer treatment, follow-up care is critical to monitor for recurrence, help you stay as healthy as possible and to treat or manage any side effects of breast cancer or its treatment. We’ll work with you to create a detailed follow-up care plan, and to make sure you have access to all the services and care you need. Our patient navigators will continue to work with you to help you manage your follow-up care. If we find you need further treatment, we’ll make sure you know all your options and what to expect.
Breast Cancer Treatment
Breast cancer patients have an increased risk for heart disease following treatment with common chemotherapy drugs that tend to be cardio toxic. Miami Cardiac & Vascular Institute’s cardio-oncology team cares for patients who have cardiovascular conditions or who are at risk for heart disease from this treatment.
"I feel proton therapy is one of the reasons that I’m going to be alive for many years. I had no idea it was so rare, so finding out that I could get this treatment near my home made me feel like all the worlds were coming together for me."
A multidisciplinary team of cancer experts including surgeons, medical oncologists, radiation oncologists, plastic reconstructive surgeons, pathologists, radiologists, genetic counselors, medical geneticists, social workers, patient navigators and clinical trials staff meet weekly to discuss select complex cases and determine the best course of care.
Miami Cancer Institute can provide access to clinical trials not widely available elsewhere. Clinical trials find new ways to treat and diagnose cancer and are ongoing. If an appropriate trial is available, we will talk to you about the benefits and risks.