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Weill Cornell Cancer Center

Treatment

Research has shown that there are many different types of breast cancer, and that the biology of a specific tumor dictates how that cancer may behave (for example, how aggressively it may grow). That is why pathologists at Weill Cornell examine each patient's breast cancer carefully to ensure that she receives the most effective treatment available.

Surgery

Surgery to remove the cancer is usually the first course of treatment for most women with breast cancer. Our breast surgeons have pioneered several of the techniques used to treat breast cancer today. Moreover, we take a cosmetic approach to care, considering the aesthetics of a woman's outcome as well as the effectiveness of her treatment in determining the optimal course of care for each patient. We also offer breast reconstruction approaches that preserve as much healthy tissue as possible while restoring the natural contours of a woman's physique, resulting in a higher quality of life when treatment is completed.

Weill Cornell surgeons have been pioneers in the field of oncoplastic surgery, in which a lumpectomy is combined with cosmetic surgery. Their vision has culminated in the establishment of the only academic center of oncoplastic surgery in the Tri-State area, where teams of surgeons combine the latest techniques for tumor removal with reconstructive options to remove cancerous tissue, resulting in enhanced cosmetic outcomes while reducing the risk of recurrence. Studies have demonstrated that women who undergo oncoplastic surgery for breast cancer experience psychological benefits.

  • Sentinel lymph node biopsy: Weill Cornell surgeons were among the first to use this approach for evaluating the extent of breast cancer spread. Sentinel lymph node biopsy enables the surgeon to determine if breast cancer cells have spread to the lymph nodes without removing a large area of tissue under the arm. The sentinel lymph node is the first lymph node to which cancer is likely to spread. It is identified by injecting a blue dye and/or a radioactive tracer into the area around the tumor. The surgeon then removes the sentinel node(s) where the marker collects, and it is analyzed for the presence of cancer cells. If cancer is not present, then the remaining lymph nodes do not need to be removed; additional nodes are only removed if the sentinel node contains cancer cells. This approach is widely used in breast cancer care today and spares many women from lymphedema (uncomfortable swelling that can develop in the arm when many lymph nodes are removed for analysis).
  • Skin-sparing mastectomy: In women for whom lumpectomy is not an option, skin-sparing mastectomy may be performed as a way to remove breast tissue through a tiny incision while preserving as much normal skin tissue as possible. Weill Cornell surgeons pioneered this technique and combine it with microvascular techniques and plastic and reconstructive surgery. This approach makes it possible for patients to undergo surgical removal of the breast cancer, immediately followed by reconstruction of the breast to retain its natural shape and appearance.
  • Nipple-sparing mastectomy: Weill Cornell surgeons have substantial experienced performing mastectomies to remove breast tissue while sparing the skin and nipple. This approach is especially popular among women having prophylactic mastectomy to reduce the risk of BRCA-associated breast cancers. Today, skin-sparing procedures are also applied to preserving the areola (the pigmented skin around the nipple) in some patients, allowing for reconstruction of the nipple and making it virtually impossible to detect scars or other signs of surgery. Weill Cornell surgeons were the first to use areola skin preservation mastectomy, which enables the patient to have the same skin pigmentation in the nipple area that existed prior to the surgery.
  • Breast reduction surgery: Weill Cornell surgeons have developed a surgical approach called oncoplastic reduction lumpectomy for breast cancer patients that combines removal of the cancerous tumor with breast reduction in one surgical procedure. The procedure is designed for large-breasted women who have breast cancer and who experience back and neck pain associated with large breasts. After surgery, the breasts retain both sensation and function. The rates of cancer recurrence and survival associated with this type of oncoplastic surgery are equivalent to those of traditional breast cancer surgery. In addition, this approach can reduce the risk of skin complications associated with radiation therapy in these women.
  • Reconstruction: Weill Cornell reconstructive surgeons offer all of the latest approaches to breast reconstruction, including the use of implants as well as reconstruction using a patients own tissue. Reconstructive surgeons are commonly involved right from the beginning of a patients care to ensure that the best possible cosmetic outcome is achieved.

Chemotherapy

Many different anticancer drugs are available for the treatment of breast cancer in women who need therapy beyond surgery and radiation therapy. These include cyclophosphamide, paclitaxel, doxorubicin, capecitabine, docetaxel, and trastuzumab, to name a few. The choice of drugs depends on the stage of a woman's disease and the biology of her tumor. For example, patients whose tumors contain the HER2 receptor may be candidates for trastuzumab or lapatinib.

Weill Cornell oncologists have participated in clinical trials that led to the approval of anticancer drugs used to treat breast cancer today, including bevacizumab. They are actively engaged in clinical research evaluating novel therapies for breast cancer, including those for women with a moderate to high risk of recurrence.

Learn more about our research.

Radiation Therapy

The goal of radiation therapy is to maximize the radiation dose to the site of cancer while keeping the dose to the surrounding healthy tissue as minimal as possible. In addition to standard external beam radiation therapy, Weill Cornell offers patients with breast cancer more targeted techniques such as three-dimensional conformal radiation therapy and intensity-modulated radiation therapy, which finely target and shape radiation beams to the contours of each patient's breast while sparing healthy tissue as much as possible.
  • Balloon brachytherapy: In 2002, Weill Cornell became one of the first institutions in the country to offer MammoSite Accelerated Partial Breast Radiation Treatment for certain types of breast cancer. This therapy permits the administration of radiation directly to breast tissue that has the greatest risk of recurrence in a relatively short time, typically over several days, and with minimal discomfort. A balloon catheter is inserted into the breast tissue immediately following lumpectomy. The catheter is inflated and is used to deliver a high dose of radiation to the tissue surrounding the cavity left behind after the tumor was removed. This approach is just one example of partial breast irradiation, which enables some women to complete their radiation therapy in just five days, compared with the five to six weeks of daily treatment needed for standard radiation therapy.
  • External beam therapy: In addition to standard external beam radiation therapy, we offer several different radiation therapy schedules that are tailored to each patients particular breast cancer. We discuss the schedule of treatment with each patient at the time of consultation.
  • Radiation after mastectomy: Although radiation therapy is not often employed following mastectomy, there are certain situations when it is recommended: These situations include large tumors (greater than 5 centimeters) or positive margins or positive lymph nodes after surgery. Doctors evaluate each patient and the characteristics of the patients tumor to determine if radiation treatment directed to the chest wall and/or reconstructed breast is recommended.

Learn more about radiation therapy for breast cancer.

Hormonal Therapy

Women whose breast tumors contain receptors for estrogen and/or progesterone may be treated with drugs that reduce the production of these hormones. Examples include tamoxifen, letrozole, and exemestane. These drugs are usually used for several years after other treatments are completed to reduce the risk of recurrence.

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