Breast Cancer

Breast Cancer Treatments

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UT Southwestern Medical Center’s breast cancer specialists have extensive experience in their field, and they offer access to the latest treatments and clinical trials. In many cases, UT Southwestern physicians participated in the development of new drugs or techniques that help heal cancer patients every day.

Surgery for Breast Cancer

The first treatment for breast cancer is often surgery. Breast cancer surgery involves removing the tumor and the surrounding tissue (the margin) that might be cancerous. Sometimes women might receive chemotherapy or anti-hormone therapy before surgery to shrink the tumor.

At UT Southwestern, we offer every surgical option for women with breast cancer, performed by expert and compassionate surgical oncologists who specialize in breast cancer surgery. We work with our patients to select the surgery that is right for them, taking into account each patient’s special needs and concerns.

These surgical options include:

  • Lumpectomy: A breast-conserving procedure that removes the cancer and a small portion of the surrounding tissue. After surgery, the breast is usually still cosmetically acceptable and reconstruction of the breast is not needed.
  • Oncoplastic partial mastectomy or lumpectomy: This procedure removes a larger portion of the breast and uses plastic surgery techniques to restore the contour of the breast.
  • Mastectomy: A removal of the entire breast. Breast reconstruction is an option after a mastectomy. Skin-sparing techniques are used with reconstruction and, in some cases, nipple sparing is possible.
  • Sentinel lymph node biopsy: A minimally invasive surgical technique to check the lymph nodes for signs of cancer spread. This technique has fewer side effects than more extensive lymph node surgery.
  • Axillary lymph node dissection: A removal of lymph nodes in the armpit when the spread of cancer to the lymph nodes is confirmed.

There are nuances to each of these techniques that our surgical oncologists have not only mastered but also helped establish. Our team has participated in virtually every major clinical trial for advances in surgical care of breast cancer over the past 20 years. For example, our team played a significant role in the first trials confirming that sentinel node removal could be a less invasive, yet still effective, option over removal of all the lymph nodes.

We were the first in Dallas to use radioactive seed localization to find breast tumors during surgery. The seed is placed inside the breast to guide the surgeon to the site, allowing us to precisely remove the tissue around the seed and take out the tumor with clear edges (or margins). This technique is available at only a few facilities.

Kicking Cancer with Blue-Spiked Shoes

When Felicia Whisenhunt turned 40, she got a devastating cancer diagnosis that required a double mastectomy and a hysterectomy. “I felt like everything womanly was taken from me,” she said. But with help of UT Southwestern, and a sparkly pair of high heels, she found the strength to fight back. 

Medical Treatments

Breast cancer medical treatment involves a variety of therapies to kill cancer cells, stop them from growing, attack some of their specific characteristics, or decrease the chance of them returning. These treatments are also known as systemic therapies, meaning treatments using substances that travel through the bloodstream, reaching and affecting cells all over the body.

Medical treatments include:

  • Chemotherapy: The use of drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. We use chemotherapy to treat early-stage invasive breast cancer to get rid of any cancer cells that might be left behind after surgery and to reduce the risk of the cancer coming back. Chemotherapy is used in advanced-stage breast cancer to destroy or damage cancer cells as much as possible.
  • Hormonal therapy: Some breast cancers have receptors that feed on the hormones estrogen or progesterone, stimulating their growth. These are called hormone-receptor-positive cancers. If cancer cells have these receptors, we might recommend hormone therapy drugs, such as blockers or inhibitors. These drugs help to destroy cancer cells by cutting off their supply of hormones.
  • Targeted therapy: Therapies that target specific characteristics of cancer cells, such as an abnormal protein (HER2, for example), can attack specific breast cancer cells without harming normal cells. Medical oncologists – specialists who administer medications to treat cancer – at UT Southwestern have been involved in groundbreaking studies that have helped shape the medical treatment of breast cancer today. 

We offer access to medical treatment clinical trials to patients with all stages of breast cancer. 

Radiation Therapy

UT Southwestern radiation oncologists have pioneered techniques for delivering radiation to the breast while sparing the heart from excess radiation. We’ve also led the way in providing a noninvasive alternative to catheter-based, accelerated partial-breast radiation therapy.

Radiation to the breast is often given after breast-conserving surgery to help lower the chance of the cancer recurring in the breast or nearby lymph nodes. Two types of radiation, with different implants or catheters, are traditionally used: external beam radiation therapy and brachytherapy. 

For external beam radiation, we use the latest technology and leading-edge techniques, often with intensity-modulated radiation therapy (IMRT). This type of radiation allows us to “shape” the beam to precisely match the shape of the targeted breast tissue while moving the radiation dose away from critical organs like the heart.

We also use advanced targeting methods to track the position of the patient’s chest wall to minimize exposure to the heart. UT Southwestern physicians were the first in Texas to combine surface-image video tracking with the deep inspiratory breath-hold cardiac-sparing technique for left-sided breast cancer patients.

UT Southwestern is the first center in Texas and only the second center in the world to offer GammaPod as a treatment option. GammaPod is the first stereotactic body radiation therapy (SBRT) system optimized for treating breast cancer. By using principles of stereotactic radiotherapy to deliver higher doses in one to five treatment fractions, GammaPod can both reduce treatment time and potentially lower the toxicity of treatment.

Our Radiation Oncology Department is the first in the world to conduct a formal study of using the CyberKnife for early-stage breast cancer patients who are candidates for partial-breast irradiation. Previous studies proved that localized delivery of radiation in select cases is just as effective as delivering radiation to the whole breast to prevent the recurrence of cancer. In the past, such localized delivery was accomplished through different types of invasive implants. Now, however, using the CyberKnife, a highly precise, robotic instrument, we can offer our patients the opportunity for treatment with a noninvasive procedure in five or fewer sessions.

Breast Reconstruction After Surgery

UT Southwestern’s plastic surgeons specialize in breast reconstruction after cancer. They perform all three types of breast reconstruction:

  • Autologous tissue-based reconstruction (using tissue from another part of the body)
  • Implant reconstruction (with saline or silicone)
  • Combination autologous and implant reconstruction 

Our plastic surgeons excel in advanced techniques such as “flap” procedures in breast reconstruction, including DIEP, SIEA, double-stacked flaps, TRAM, TUG, PAP, and SGAP/IGAP. A “flap” refers to skin and soft tissue with a blood supply from a main artery and vein, which are linked to blood vessels in the chest (IMA/IMV). 

In the DIEP (deep inferior epigastric artery perforator) or SIEA (superficial inferior epigastric artery perforator) procedures, our surgeons use tissue from the abdomen to build the new breast. With the TUG (transverse upper gracilis) or PAP (profunda artery perforator) procedures, we use tissue from the inner thigh area. In the SGAP (superior gluteal artery perforator) procedure, we take tissue from the upper buttocks area.

With many options available, our plastic surgeons work closely with patients to tailor reconstructive treatments that are best for them.