We turn breast cancer patients into breast cancer survivors.

While a breast cancer diagnosis doesn’t immediately lead to breast surgery, nearly every breast cancer patient will have a surgical procedure as part of their course of treatment. The goal of breast cancer surgery is to remove the tumor and to evaluate the axillary lymph nodes to determine if the cancer has spread. The surgical procedures you may experience as part of your treatment plan include the following:

• Sentinel Lymph Node Biopsy: As cancer cells spread, they can metastasize through your lymphatic system (the nodes, tissues and organs that produce and store infection-fighting white blood cells). The first lymph nodes the cancer cells come in contact with as they move from their tumor of origin are called sentinel lymph nodes. Sentinel lymph node biopsy is surgery to identify, remove and microscopically examine the lymph nodes directly in the pathway of spreading cancer cells to assess whether breast cancer has spread to lymph nodes under your arm, which are the most likely lymph nodes to contain breast cancer. In this procedure, only those lymph nodes that may be affected by abnormal cells are removed, increasing the potential to save lives while eliminating, in most cases, the need for a more complicated breast surgery.
• Lumpectomy: A partial mastectomy (lumpectomy) is the most common form of breast surgery. It is a surgical procedure to remove a tumor from within your breast, as well as some tissue surrounding the tumor—it does not remove the entire breast, which it is why it is considered a breast-conserving or breast-preserving surgery.The size of your breast will likely be a bit smaller after a lumpectomy. If needed, our plastic surgeons will use techniques to restore symmetry and reduce the other side to match. Following surgery, most women will have radiation therapy to reduce the risk of cancer returning. Chemotherapy, if needed, is initiated before the radiation treatment.
• Mastectomy: Mastectomy is the surgical removal of your entire breast, usually to treat more advanced cases of breast cancer. Some of the more common types of mastectomy include:
  • Radical Mastectomy: The chest wall muscles (pectorals) are removed, in addition to the breast and axillary lymph nodes.
  • Modified Radical Mastectomy: The whole breast is removed, as are most of the axillary lymph nodes.
  • Skin Sparing Mastectomy: The breast, nipple and areola are removed, but the outer layer of breast skin is left intact to make a breast reconstruction as natural looking as possible. Unless you do not want a breast reconstruction, you have inflammatory or locally advanced breast cancer, or your tumors are close to your outer breast skin, a skin sparing mastectomy is often a desirable option.
  • Subcutaneous (Nipple-Sparing) Mastectomy: The entire inside of the breast is removed, but all of the breast skin, including the nipple and areola, is left intact. This procedure is recommended when tumors are small and far from the nipple and areola areas—usually it works best for women with breasts that are A and B cup size.
  • Total (Simple) Mastectomy: The whole breast, including nipple and areola, is removed, but the axillary lymph nodes are not.

Dr. Del Corral has extensive experience performing a wide variety of advanced breast reconstruction techniques following breast cancer or reconstruction after preventive mastectomy surgery, that lead to better results and fewer complications. These include various flap techniques that require transferring or transplanting tissue and blood vessels from one part of the body to another part of the body using a high-powered microscope in the operating room. Dr. Del Corral’s skills include using surgical implants; the two-stage tissue expander/implant procedure, in which saline is added to stretch the skin over the pectoral area and create a breast mound, and the one-stage direct to implant reconstruction.

Breast reconstruction is a surgical procedure that restores the appearance of a breast for women who have had their breast removed due to tumors and/or cancer. Dr. Del Corral rebuilds the size and shape of the breast using local tissue rearrangement or artificial implants. The nipple and areola can also be reconstructed. There are several types of reconstructive surgery available, and sometimes the process means more than one operation. Give yourself plenty of time to make the best decision for you. You should make your decision about breast reconstruction only after you are fully informed.

Two main types of operations can be done to reconstruct the shape of your breast or breasts:

• Using silicone or saline breast inserts known as Breast Implants
• Using your own body tissues known Flap Procedures. Dr. Del Corral is one of a few surgeons in the region trained to perform a microvascular DIEP/TUG flap technique (is there a way to call this out?).

Sometimes the implant and flap procedures are used in combination to reconstruct a breast.

In addition, nipple/areola tattooing and fat grafting can be done to help make the reconstructed breast look more like the original breast. The reconstructed nipple and areola do not have any sensation.

Breast cancer treatment often includes a radiation component to destroy cancer cells that might be left behind after surgery. We target the radiation to spare as much healthy tissue as possible.

Multiple breast cancer radiation techniques and technologies can be used, including:

3D Conformal Radiotherapy: This therapy sculpts radiation beams to the shape of a tumor and is ideal for irregularly shaped tumors or those close to healthy tissues and organs. Our specialists view a tumor in three dimensions with the help of advanced imaging and deliver radiation beams to the tumor from several directions.

Intensity Modulated Radiation Therapy (IMRT): IMRT sends tiny beams of radiation that conform to the shape of the breast and the area of risk. This technique allows for different areas to receive different highly-sculpted doses of radiation. IMRT helps protect healthy tissue and critical nearby organs from unnecessary radiation exposure and reduces skin damage around the breast.

Accelerated Partial Breast Irradiation (APBI): APBI is an advanced method of internal high-dose radiation used for select breast cancer patients after a lumpectomy. It delivers radiation to the area where the tumor was removed and eliminates the need for whole breast radiation.

External beam radiation therapy for Partial Breast Irradiation (PBI): External beam radiation uses a linear accelerator to aim high-energy radiation beams at the tumor from outside your body. Our specialists treat as small an area of your breast as possible to avoid causing unnecessary damage to your healthy tissue.

Intraoperative Radiation Therapy (IORT): IORT is a single-dose radiation alternative for women with early stage breast cancer. Standard radiation treatment can involve five to six weeks of treatment, but with IORT, a single dose is delivered in the operating room immediately following a lumpectomy.

Most breast cancer recurrences after surgery occur in the same place as the original tumor. With IORT, we are targeting the radiation and treating only the original tumor bed, sparing breast tissue that whole-breast radiation may negatively affect.

Advantages of IORT

• A single, low-energy radiation dose is delivered internally to the tumor during the surgical procedure.Healthy tissue is exposed to less radiation.
• This treatment is patient-focused, reducing travel time, physical and psychological stress, and time away from work and family.
• With IORT, you have the choice of breast-sparing treatment (lumpectomy), without the hassle of five to six weeks of daily radiation.

At MedStar Health Cancer Network, we give our patients access to the latest treatment options and clinical trials, and we have one of the largest programs in the state. When you choose us for your breast cancer treatment, you may be asked to participate in a study where you receive either treatments not yet available to the general public or available treatments used in new ways or in new combinations.

Clinical trials can offer the most up-to-date treatment for your breast cancer and can represent a significant improvement in your care, especially if your first-line therapy has not been successful. Participation means that you will receive the additional support of a research nurse who will be your advocate and will see to it that your treatment regimen follows strict clinical trial instructions. At the end of your treatment, your research nurse will continue to call you or your doctor to follow up on your condition.

Clinical trials are the most effective way to improve breast cancer survival rates. Your participation in a clinical trial will benefit future breast cancer patients.

Our chemotherapy centers offer a warm and welcoming treatment environment, along with friendly nurses who are proactive in helping you avoid complications and discomfort from symptoms. All members of our multidisciplinary team take pride in seeing that you are comfortable and well taken care of.

About Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells. These drugs can be administered in several ways including:

• Injections
• Intravenously (IV into the veins)
• Pills

Injections into the fluid that surrounds the spinal cord or brain

Unlike surgery, which targets only your breast, chemotherapy is considered a systemic treatment because the medicine travels into your entire body. Depending on your type and stage of breast cancer, chemotherapy can be used for:

• Eliminating cancer: It can be used as the primary, or even the sole, treatment for breast cancer.Supporting other treatments: Chemotherapy can shrink a tumor before radiation or surgery or after other treatments to kill any remaining cancer cells.
• Minimizing cancer: It can keep cancer from spreading to other parts of your body.
• Palliative treatment: Chemotherapy can relieve symptoms of cancer when the cancer is too advanced to be cured.

Also known as hormonal therapy, hormone treatment or endocrine therapy, hormone therapy is often used in combination with surgery to treat only hormone-receptor-positive breast cancer. Since estrogen makes hormone-receptor-positive breast cancer grow, hormone therapy reduces the amount of estrogen in your body or blocks your body’s ability to produce estrogen, slowing or stopping the growth of hormone-sensitive tumors.

The goals of hormone therapy are as follows:

• Prevent cancer recurrence after early-stage breast cancer surgery
• Shrink tumors in late-stage breast cancer patients
• Lower the chances of high-risk women developing breast cancer

A long-term treatment, hormone therapy may be prescribed for several years and requires you to take most medications at home on a daily basis. Your specialist will perform a complete pathological evaluation of your breast cancer to determine if hormone therapy is right for you.