Breast Cancer Treatment

Breast cancer is primarily treated with surgery and often combined with chemotherapy, radiation therapy or both. It may also include other treatment options like targeted therapy and proton therapy Your care team will develop a comprehensive treatment plan unique to you.

Breast cancer treatment plans 

Early-stage breast cancer is usually treated with a combination of surgery, radiation therapy, and/or cancer drugs like chemotherapy, immunotherapy and targeted therapy. 

If your cancer has spread outside of the breast and lymph nodes, the disease may not be curable. In these cases, treatment focuses on controlling the disease, prolonging life and improving quality of life. Cancer drugs are the primary treatments in these cases. 

Surgery

Many patients undergo some form of surgery as part of their breast cancer treatment.

Some will receive chemotherapy or targeted therapy before surgery. The goal of these treatments is to shrink the tumor and affected lymph nodes to make the procedure and recovery easier on the patient. This also allows the treating team to assess how cancer has responded to treatment, which can be important for some breast cancer subtypes.

There are two categories of breast cancer surgery: lumpectomy and mastectomy.

Lumpectomy

In a typical lumpectomy surgery, the tumor and a small amount of surrounding normal tissue are removed, while the rest of the breast remains. This procedure may be appropriate for early breast cancer cases where the tumor is still small relative to the size of the breast. 

Lumpectomies are usually performed under general anesthesia. The procedure typically takes around 60 to 90 minutes. In some cases, a plastic surgeon performs reconstructive surgery immediately after the tumor is removed. This can add several hours to the total procedure time. Learn more about reconstructive surgery.

Lumpectomy recovery

You can begin walking the day of the procedure. In most cases, you are able to do routine tasks, like cooking and shopping, three to five days later.

If you work a desk job, you typically will be able to return to work in about a week. If the job requires physical labor, you typically can go back in about two weeks.

Full recovery from a lumpectomy takes about two weeks. There are a number or restrictions during this period including:

• No lifting anything over five pounds
• No running or strenuous exercise
• No submerging the incision in water, such in a bathtub or swimming pool.

After surgery, the skin of the breast may become either more or less sensitive. If it is less sensitive, this change may be permanent. 

A lumpectomy can also change the size and shape of the breast, as well as its sensitivity to touch. Reconstructive surgery can help restore the appearance of the breast.

Mastectomy

In a typical mastectomy surgery, the tumor and the breast are removed. There are several different types of mastectomies, including procedures that spare the breast’s skin and nipple/areola. 

If you want breast reconstruction, doctors may be able to perform that surgery immediately after the mastectomy. It can also be done at a later date.

In some cases, the patient has a tumor in one breast but chooses to have both breasts removed (double mastectomy). This can help reduce the likelihood of developing a new breast cancer in the future. It is typically discussed with patients who have a significantly elevated risk of breast cancer due to family history or their own genetic profile, such as a BRCA mutation.

Mastectomies are performed under general anesthesia. The surgery usually takes under two hours for a single mastectomy and three to four hours for a double mastectomy. Patients typically spend one night in the hospital. If the breast is reconstructed during the same surgery, the procedure will be longer.

Mastectomy recovery

You should begin walking the day of surgery. This can speed up recovery and reduce pain following surgery.

If you work a desk job, you typically will be able to return to work in about four weeks. If the job requires physical labor, you typically can go back in about six to eight weeks.

Full recovery from a mastectomy takes about eight weeks. There are a number or restrictions during this period including:

• No lifting anything over five pounds
• No running or strenuous exercise
• No submerging the incision in water, such in a bathtub or swimming pool.

If you undergo breast reconstruction at the time of the mastectomy, there may be additional restrictions on movement and exercise.

After a mastectomy, there will be permanent numbness across the chest wall. You may have a return of some sensation, but this varies from person to person.

Lymph nodes and breast cancer surgery

The lymphatic system moves disease-fighting white blood cells throughout the body. These cells are carried in lymphatic fluid. This fluid travels through the body in a network of lymph vessels, which are like tiny veins. 

Lymph nodes are tiny bean-shaped structures found in several parts of the body, including in the armpit, close to the breasts. They filter lymphatic fluid and store immune system cells.

If cancer cells spread outside of the breast, they typically go to the nearby lymph nodes first. 

There are two lymph node surgeries for breast cancer patients. These are almost always performed at the same time as the lumpectomy or mastectomy.

Sentinel lymph node biopsy

The first surgery is a sentinel lymph node biopsy. This surgery determines if the cancer has spread to the nearby lymph nodes. It is performed at the same time as your lumpectomy or mastectomy. 

During a sentinel lymph node biopsy, the surgeon identifies and removes the first lymph node or nodes that receive lymphatic fluid from the breast. 

If there are no cancer cells in the sentinel lymph node, no additional lymph node surgery is performed.

Axillary lymph node dissection

If doctors find cancer cells in the sentinel lymph nodes, they may need to remove additional lymph nodes.

This is called an axillary lymph node dissection. It can be done at the time of lumpectomy or mastectomy, but you may need a separate surgery. 

If you undergo an axillary lymph node dissection, you may develop swelling in the arm closest to the lymph nodes that were removed. This swelling, called lymphedema, occurs when fluid normally drained by the lymphatic vessels does not flow out of the arm properly.

There are several treatments for lymphedema, including physical therapy, compression sleeves and surgery to improve drainage of lymphatic fluid.

Learn more about lymphedema.

Radiation therapy

Radiation therapy uses powerful, focused beams of energy to eliminate cancer cells. For breast cancer, radiation therapy is typically given after surgery to destroy remaining cancer cells. 

There are several different radiation therapy techniques. Doctors use these to accurately target areas that could have cancer cells while limiting damage to healthy tissue. 

Learn more about radiation therapy. 

3D-conformal radiation therapy

3-D conformal radiation therapy uses three-dimensional scans to determine the exact shape and size of the tumor. The radiation beams are shaped by tiny metal leaves that are arranged to fit the tumor dimensions. 

Volumetric modulated arc therapy

In volumetric modulated arc therapy (VMAT), the machine rotates around the patient, delivering radiation at multiple angles and intensity levels.

VMAT is frequently used in complex cases to protect healthy tissue and accurately target areas at risk after surgery. 

Proton therapy

Proton therapy is a type of radiation therapy. It is similar to standard radiation therapies like VMAT and 3D-conformal, but it uses a different type of energy.

For breast cancer, proton therapy is an option in very complex cases. In other cases, the benefits are outweighed by side effects, including increased skin reactions and a higher risk of rib fractures. 

Getting radiation therapy

Radiation treatment begins with a simulation. During this phase, the care team will find a position for your body that allows the tumor to receive radiation while protecting healthy tissue.

Most radiation treatment sessions last 30 minutes to one hour. Patients typically get daily sessions Monday through Friday. Sessions typically last one to six weeks, depending on your specific cancer type and stage.

Radiation therapy side effects

The early side effects of breast radiation include:

• Skin irritation, including dryness, redness and occasional peeling.
• Fatigue.

These side effects typically go away a few weeks after treatment ends.

Some side effects appear anywhere from six months to a year after treatment. Most are rare. They include:

• Changes in the color of the skin exposed to radiation.
• Hardening or tightening of breast tissue exposed to radiation.
• Lymphedema
• An increase or decrease in breast size. 

Chemotherapy

Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing. 

For breast cancer, chemotherapy can be part of a treatment plan to cure the disease, often in combination with surgery. It can also be used to control breast cancer that is at an advanced stage. 

Learn more about chemotherapy.

Getting chemotherapy

You can get chemotherapy through an IV infusion or orally, as pills, depending on your specific needs. If you get chemotherapy through an IV, infusions can last from just 30 minutes to several hours. The number of sessions depends on several factors, including your diagnosis and the cancer’s stage.

Chemotherapy side effects

In the short term, chemotherapy can cause:

• Hair loss
• Fatigue
• Nausea/vomiting 
• Mouth sores
• Loss of appetite
• Increased infection risk

Chemotherapy can also cause long-term side effects, including fertility problems and neuropathy, nerve damage that can cause pain, tingling and weakness.

Side effects can usually be treated or managed. Talk to your care team about any side effects you experience.

Learn more about chemotherapy side effects.

Targeted therapy 

Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. 

Targeted therapies are used to treat breast cancer at all stages. 

Learn more about targeted therapy.

Getting targeted therapy

If you are prescribed targeted therapy, it may be delivered orally, as pills. Targeted therapies can also be given through IV infusions that typically last 30 to 90 minutes. The schedule for these treatments changes depending on your needs.

Targeted therapy side effects

Different targeted therapy drugs have different side effects. Short-term side effects include:

• Fatigue
• Diarrhea
• Nausea
• Skin rashes
• Infusion reactions, such as fever and chills

Long-term side effects of targeted therapy are rare, but include liver toxicity, heart damage and lung inflammation. While these can be serious, the rewards of targeted therapy outweigh the risks. Doctors recommend it when it is the best treatment for you.

Talk to your care team about any side effects you experience. These can usually be treated or managed.

Learn more about the side effects of targeted therapy.

Immune checkpoint inhibitors

Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off during the fight against cancer. You may receive a single immunotherapy drug or multiple drugs in combination.  

Immune checkpoint inhibitors are currently approved to treat triple-negative breast cancer. They are typically used before surgery or for patients whose cancer has metastasized, or spread to distant parts of the body.

Learn more about immune checkpoint inhibitors.

Getting immune checkpoint inhibitors

Breast cancer patients typically get these drugs through IV infusions either once every three weeks or once every six weeks. The number of infusions will depend on your specific needs. Infusions typically last 30 minutes to one hour.

Immune checkpoint inhibitor side effects

Short-term side effects to immune checkpoint inhibitors include:

• Fatigue
• Diarrhea
• Nausea
• Skin rashes
• Infusion reactions, such as fever and chills

Long-term side effects include:

• Pituitary gland disorders
• Thyroid disorders
• Colitis, or inflammation of the colon that can lead to abdominal pain, urgent bowel movements and bloody stools
• Lung inflammation
• Liver inflammation

While these can be serious, doctors recommend immune checkpoint inhibitors when they are the best treatment for you. The potential benefits of treatment are greater than the risk. Talk to your care team about any side effects you experience.

Learn more about the side effects of immune checkpoint inhibitors.

Hormone blockers

Hormone blockers are a treatment for patients with hormone receptor-positive breast cancer. This cancer is fueled by estrogen and/or progesterone hormones interacting with cancer cells. Hormone blockers limit this interaction.

Getting hormone therapy

Hormone blockers are usually taken once per day as pills. In some cases, they are given as a monthly injection.

You will likely take these pills for years and only stop if the cancer spreads to distant parts of the body.

Hormone blockers side effects

Short-term side effects of hormone blockers include hot flashes, mood changes, joint pain and fatigue.

Different types of hormone blockers can cause different long-term side effects, such as bone loss. 

In rare cases certain hormone therapies can cause blood clots and uterine cancer. 

You should talk to your care team about how to manage these side effects. You may also undergo regular screening to detect breast cancer early, when it is most treatable.