Within 48 hours of being diagnosed, most women are ready to focus on their treatment options. Before reviewing these options, it is essential that a woman has a clear understanding of her cancer diagnosis. The first question that must be answered: “Is my cancer invasive or non-invasive?” With non-invasive cancers, the initial focus of the discussion is whether or not the breast can be saved (in most cases, it can). The amount of time required to eventually make a decision is less of an issue, since these cancers are almost always curable.

With invasive cancers time is an issue; however, the process should not be rushed. It is essential that a woman take the time to fully understand the nature of her cancer, as well as all her treatment options. It is also essential that the treatment team have time to study the various clinical issues so that the most accurate treatment recommendations can be made. At the center, all newly diagnosed breast cancer patients are presented to a treatment conference in which a mammographer re-reviews the mammograms, a pathologist re-reviews the slides, and a surgeon presents the history and clinical findings. Based on these findings, the team formulates a treatment plan.

* Mastectomy (with or without immediate reconstruction)

* Chemotherapy first (to reduce the size of a larger tumor), followed by surgery.

Breast conservation :
For most women, breast conservation will be the treatment of choice since it is less traumatic, and the survival results are identical to survival rates with mastectomy. However, not all women are candidates for breast conservation, and some women prefer mastectomy. We believe women should be given the facts and encouraged to make their own choices.

Women considering breast conservation must have a clear understanding of the issue of '”margins". The goal in breast conservation is to remove the tumor, along with a surrounding rim of normal tissue. Obtaining clear margins all around the tumor edges can be a challenge. Although the surgeon attempts to take out the entire tumor at the time of the initial surgery, in some cases the tumor cells (which are not visible during the surgery) are found by the pathologist to extend to the edge (margin) of the lumpectomy specimen, and a second operation is required. Fortunately, the vast majority of women who initially choose breast conservation will ultimately achieve a good to excellent cosmetic result. Long-term survival is equal to that with mastectomy.

Mastectomy :
Some women are either not candidates for breast conservation or choose mastectomy for personal reasons. Women considering mastectomy should be given the option of immediate reconstruction. Some women, however, are not good candidates for immediate reconstruction because of an underlying medical condition, such as diabetes. For these women there is still the option of delayed reconstruction, and this option should be taken into consideration at the time the initial mastectomy

Chemotherapy first (Neoadjuvant therapy) :
Giving chemotherapy first (neoadjuvant therapy) is becoming a more common option. In the past, chemotherapy was given before surgery in situations where the tumor was too large to permit a mastectomy. The chemotherapy was given first to shrink the tumor so that a mastectomy could be successfully performed. It is now becoming common practice to give chemotherapy first to shrink the tumors so that less tissue is taken at the time of the lumpectomy, which leads to improved cosmetic results. We have had extensive experience with this approach and have now saved hundreds of breasts that in the past would have required a mastectomy