The treatment options for breast cancer depend on several factors, including the stage, molecular subtype of breast cancer, overall health, and personal preferences. A patient will likely be recommended an individualised tailored package of treatment based on their above factors. Here are some of the most common treatment options for breast cancer:
- Lumpectomy (breast-conserving surgery): This procedure may also be called wide local excision and removes the breast cancer with surrounding normal breast tissue for a clear margin. The rest of the breast is conserved.
- Mastectomy/bilateral mastectomy: This is a surgical procedure that removes one or both of the entire breast and sometimes the nipple (though a nipple-sparing surgery may be an option for nipple preservation). Nipple preserving mastectomy can be performed depending on the location and extent of the breast cancer, or the need for surgery. This often needs discussion with the treating surgeon.
- Removal of lymph nodes: This procedure helps check for the spread of cancer from the breast to lymph nodes in the armpit and/or around the central sternum (breastbone). The axillary lymph nodes, which are located in and around the armpit, are the first place that breast cancer cells often spread to and may require one or both of the below procedures:
- Sentinel lymph node biopsy (SLNB) - during a sentinel lymph node biopsy, lymph nodes that drain that part of the breast with the cancer are removed to be tested for cancer cells. This may be one or more lymph nodes. The rest of the lymph nodes are left in place if no cancer cells are present. More information on this procedure is outlined here.
- Axillary lymph node dissection (ALND) - Also known as axillary clearance, this procedure is done if there is lymph node disease at presentation or time of diagnosis of breast cancer, or a positive node on sentinel node biopsy was identified at breast surgery. The majority of the lymph nodes (10-25) are removed to reduce the risk of recurrence and help determine the appropriate treatment plan.
- Radiation therapy: This uses high-energy external beams of radiation to destroy cancer cells. It breaks up abnormal cells, stopping them from growing and dividing.
- Endocrine or hormonal therapy: This type of systemic therapy works by blocking hormones that can activate the growth of certain types of breast cancer (ER-positive). This often involves taking one tablet daily for about 5-10 years. It may produce some menopausal side effects.
- Chemotherapy: This systemic treatment uses cytotoxic drugs with the aim to destroy cancer cells throughout the body. It is often given as an intravenous infusion every 3 weeks or weekly. It can be cytotoxic to healthy cells as well as cancer cells. Some of the common side effects include temporary hair loss, nail changes, mouth ulcers, nausea, and fatigue.
- Targeted therapy: Drugs that target specific cancer cell features to stop growth. This intravenous form of therapy is generally used for HER2-positive breast cancers and is delivered once every 3 weeks. It includes drugs known as Herceptin.
- Bone-directed therapy: To help prevent or treat bone fractures and other complications.
- Palliative care: To manage symptoms and improve quality of life during treatment for Stage 4 or metastatic breast cancer.
- Immunotherapy: Immunotherapy is a type of cancer treatment that assists the body's immune system to fight cancers. Not everyone requires this treatment. It is tailored for certain subtypes and/or stages of breast cancer.
Breast reconstruction
Breast reconstruction surgery rebuilds the shape of the breast after a mastectomy (breast removal), and the goal is to restore the appearance of the breast, helping patients feel more confident and comfortable with their bodies.
Reconstruction can be immediate or delayed, and may involve more than one surgery:
- Immediate breast reconstruction: This type of reconstruction is performed at the same time as the mastectomy, during the same surgical procedure. This can minimise the number of surgeries needed and provide a smoother transition. Not all women are suitable for this type of reconstruction. This needs to be discussed further with the treating surgeon.
- Delayed breast reconstruction: This type of reconstruction is performed after the patient has recovered from their mastectomy and completed any additional treatments, such as radiation therapy.
There are several types of breast reconstruction, including:
- Reconstruction using implants: This type of reconstruction generally uses silicone or breast implants to rebuild the shape of the breast. The implants can be inserted either above or below the chest muscle. A mesh may also be used with the implants to prevent them from moving around.
- Reconstruction using tissue from the patient's body: Also known as ‘flap’ reconstruction, this type of reconstruction uses tissue from the abdomen, back, thigh or buttocks to rebuild the shape of the breast. Abdominal wall fat is the preferred form of autologous (‘free flap’) reconstruction. This operation is often performed by plastic surgeons in conjunction with the treating breast surgeon.
Breast reconstruction is not for everyone. Some patients may choose not to have their breast/s reconstructed if they want to avoid implants, for example, or a longer surgery needed for a 'flap' reconstruction.
Patients can have a ‘flat’ closure during their mastectomy when no breast mound is reconstructed but excess skin and pockets of fat or tissue are removed from the chest wall, and it is tightened to create a smooth and flat chest without folds of skin. This procedure is sometimes referred to as a flat closure. More than one surgery may be needed to achieve the optimal ‘flat’ result for the patient.
It’s important to note that the type of reconstruction suitable for a particular patient will depend on several factors, including their overall health, treatment pathway and personal preferences. The patient's healthcare team, which often includes a breast surgeon and a plastic surgeon, will work together to develop a personalised treatment plan that considers the patient's specific needs and goals.
The decision to have breast reconstruction is a personal one and should be made in consultation with a healthcare professional, including a FRACS-qualified surgeon.
