Surgery

Surgery is often the first and most common step in treating breast cancer.
There are two main types of breast cancer surgery:
1. Breast-Conserving Surgery (Lumpectomy):
  - Removes only the tumor and a small area of surrounding tissue.
  - Dr. Kraft especially uses her plastic surgery training to hide the specific scars to access the tumor, in either the area where the bra-line hits (infra-mammary fold), in the darkened skin around the nipple (peri-areolar), or in the axilla in one of the skin folds of the armpit (axillary incision)- see below photo
  - This is usually followed by radiation therapy.
- 1. Mastectomy:
    - Removes the entire breast.
    - Radiation therapy may still be needed if the tumor is large (over 5 cm), has spread to the chest wall, or involves lymph nodes.
Survival rates and the chance of the cancer returning are the same for breast-conserving surgery and mastectomy.
For patients with BRCA1 or BRCA2 mutations, removing both breasts (bilateral mastectomy) may offer a survival benefit.
If radiation therapy also not an option, mastectomy is considered

Radiation Therapy

Radiation uses powerful X-rays to kill leftover cancer cells in the breast.
It is described as an insurance policy to kill any remaining cancer cells that could not be seen on the imaging or in the surgery.
It does not cause hair loss.
Treatments are usually short: 5 minutes a day, 5 days a week, for 1-3 weeks and it is painless.
Common side effects:
- Fatigue
- Skin changes (like a rash)
- Mild pain after treatment
Rare side effects include effects on the heart or lungs or the development of another cancer.

Chemotherapy

Chemotherapy is medication that treats cancer throughout the body.
It can be given before surgery (neoadjuvant) or after surgery (adjuvant) depending on your cancer type and how aggressive your specific tumor is (that is determined by your cancer team).
Why/When use chemo before surgery?
- Chemo is used before surgery typically in HER2 + breast cancers, triple negative breast cancers, and some ER+ tumors.
- To shrink the tumor and make surgery easier.
- To see how well the cancer responds to the medication.
- To target aggressive types like triple-negative or HER2-positive breast cancer.
If chemotherapy is needed after surgery, this is determined using tests like Oncotype or Mammaprint (for certain types of cancer).

Hormone Therapy (Hormone Blockade)

Many breast cancers grow because of hormones like estrogen or progesterone.
Hormone-blocking medications reduce the chance of cancer coming back and are thought of as insurance policies.
- Pre-menopausal: Tamoxifen
- Post-menopausal: Anastrozole (Arimidex)
Treatment length: 5-10 years.
Reduces the chance of cancer returning by 40-60%
Common side effects:
- Tamoxifen: Hot flashes, vaginal dryness, fatigue, rare blood clots, and protection against osteoporosis.
- Anastrozole: Joint pain, mild bone loss, hot flashes, and slight cholesterol increases.