Oncologic breast surgery aims to remove cancerous growth from the breast and/or regional lymph nodes. St. Clair’s surgical team has the technical expertise to perform the most advanced surgical and minimally invasive procedures.

• Partial Mastectomy – This breast conserving surgery is commonly referred to as a “Lumpectomy.” It involves removing the cancerous tissue from the breast through a small incision while leaving the remainder of the healthy breast intact. It allows patients to maintain the overall appearance of their breast with as minimal change as possible.

• Total Mastectomy – This surgery removes all of the breast tissue. It can be done using several different techniques (see below).  Total mastectomy can be done alone or in combination with breast reconstruction (see below).  The surgeons will help each patient decide which approach is best for them. 
  • Simple mastectomy: All of the breast tissue along with the overlying skin and nipple-areolar complex are removed at the time of surgery.
  • Skin-sparing mastectomy: An incision is made around the nipple-areolar complex. This incision is used to remove the nipple-areolar complex and all of the breast tissue while leaving the skin of the breast(s) for reconstructive surgery.
  • Nipple-sparing mastectomy: The breast tissue is removed while leaving the breast skin and the nipple/areola for reconstructive surgery.
  • Radical mastectomy: A combination of simple total mastectomy, removal of all axillary lymph node tissue and removal of chest wall (pectoral) muscles. This is an extensive procedure that is rarely performed in the setting of modern breast cancer treatment options.
  • Prophylactic mastectomy: Removal of a breast that does not contain cancerous tissue. It can be done using simple, skin-sparing or nipple-sparing techniques. It is considered for patients at high risk of developing breast cancer or to achieve symmetry when one breast is already being removed for cancer.
    
    
• Lymph Node Surgery – Breast cancer cells can travel through fluid-draining channels, called lymphatics, to the axillary lymph nodes in the deep tissue of the armpit. These lymph nodes are often evaluated with surgery.
  • Sentinel lymph node biopsy: The breast surgeon may remove the first-draining or “sentinel” axillary lymph nodes in order to have them examined under the microscope and assessed for breast cancer spread.
  • Axillary lymph node dissection: If breast cancer cells are found in the sentinel axillary lymph nodes then removal of all of the axillary lymph nodes and lymphatic tissue may be required. This is called an axillary lymph node dissection.

Click here to meet the Breast Surgery team. 

Our breast reconstruction experts specialize in surgically recreating natural-looking breasts to help you maintain your body image and quality of life.  Your plastic surgeon will work with you and your breast oncologic surgeon to develop a personalized plan that helps you achieve your breast reconstruction goals.  We offer the latest techniques in breast reconstruction, including:

• Muscle-sparing TRAM or DIEP flap, which uses excess lower abdominal skin and fat to reconstruct the breast. The incision for this procedure is similar to an abdominoplasty (or “tummy tuck”). These procedures leave the abdominal muscle mostly or entirely intact and use microsurgery to connect the abdominal tissue to blood vessels in the chest.
• Breast reconstruction with implants, which can include direct-to-implant reconstruction or two-stage reconstruction with initial placement of a temporary tissue expander.
• Latissimus dorsi flap, which uses tissue from the back for reconstruction (typically in combination with an implant).
• Oncoplastic reconstruction, which involves rearranging remaining breast tissue to lift and/or reduce the breast in combination with a lumpectomy for women who choose breast-conserving surgery instead of a mastectomy.
• Fat grafting, which involves collecting fat from another area of your body using liposuction and then injecting the fat into a contour depression or hollow area where the breast tissue has been removed.

Click here to meet the Plastic/Reconstructive Surgery team. 

Systemic (medication based) treatments may be another option to help prevent the recurrence and/or spread of certain types of breast cancer. These may be a part of your breast cancer treatment plan. These medications can be given before or after breast cancer surgery to help prevent breast cancer cells from showing up in other areas of the body. This is called distant metastasis. These medications may also be used if distant metastasis has already occurred. Our Medical Oncologists are responsible for selecting a patient’s customized medical care regimen once they have been diagnosed with breast cancer.

• Anti-estrogen Therapies:
  • Estrogen can promote the growth of some breast cancers. Anti-estrogen therapies are often pills taken once a day that block production of estrogen or block estrogen molecules from stimulating breast cancer cells. The most commonly used anti-estrogen therapies are selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). Commonly used SERMs include Tamoxifen and Raloxifene (Evista). Commonly used AIs include anastrozole (Arimidex), letrozole (Femera) and exemestane (Aromasin).
• Anti-HER2 Therapies:
  • HER2 is a protein that sits on the surface of all breast cells. Breast cancer cells with higher than normal levels of HER2 are called HER2 positive. These cancers are likely to respond to drugs that target the HER2 protein. Multiple anti-Her2 drugs exist. The first to be developed was an antibody therapy called trastuzumab (Herceptin) which is given IV. Others include pertuzumab, Kadcyla and Enhertu. Some anti-HER2 drugs are available orally, such as lapatinib (Tykerb), neratinib (Nerlynx) and tucatinib (Tukysa).
• Chemotherapy:
  • Chemotherapy works by targeting rapidly dividing cells (i.e. cancer cells) and is a powerful tool in treating certain, but not all, breast cancers. It is typically delivered intravenously (IV).
• Other:
  • There are many other types of breast cancer systemic therapies that may be available to certain patients, sometimes under the direction of a clinical trial. Our medical oncologists have the latest therapies and clinical trials available and will help each patient understand their options.

Click here to meet the Medical Oncology team.

Radiation Oncology uses high-powered energy beams (i.e., X-rays) to shrink or kill cancerous tumors while preserving healthy surrounding tissue. Radiation to the breast is commonly recommended after a partial mastectomy to help prevent the cancer from returning in the breast tissue. It is occasionally used after a total mastectomy and/or for palliation of symptomatic breast tumors. The St. Clair Hospital Cancer Center Affiliated with UPMC Hillman Cancer Center has two state-of-the-art linear accelerators that deliver advanced treatments, including:

• Deep Inspiration Breath Hold (DIBH)
  • Technique used to significantly remove the heart from the path of the radiotherapy beam
• Image-Guided Radiation Therapy (IGRT)
  • Is the use of imaging during radiation therapy to improve the precision and accuracy of treatment
• Intensity-Modulated Radiation Therapy (IMRT)
  • Uses linear accelerators to safely deliver precise radiation to a tumor while minimizing the dose to surround normal tissue
• Partial breast irradiation (PBI) 
  • For selected low risk breast patients, radiotherapy is directed to the area where tumor was removed

A Radiation Oncologist is responsible for selecting the patient’s customized, radiation treatment regimen. We participate in national and institutional based breast cancer clinical trials evaluating ways to improve the use of radiotherapy for breast cancer.

Click here to meet the Radiation Oncology team.