Local therapy refers to treatments that focus on the breast cancer in a specific area without impacting the entire body. In contrast, other treatments that are systemic treat the whole body and can treat cancers that have spread throughout the body. Local therapies for breast cancer include surgery and radiation.1
Surgery for breast cancer
Surgery for breast cancer may be breast-conserving or a mastectomy, which removes the entire breast. In addition, surgery may be performed to the lymph nodes under the arm (axillary lymph nodes).
Lumpectomy is a breast-conserving surgery that removes cancerous tissue and a layer of healthy cells (called clean or clear margins) from the breast. Lumpectomy aims to preserve the appearance of the breast while removing the cancerous area. It is often followed by radiation to the area if breast cancer is discovered, to reduce the chances of the cancer recurring in that spot. Lumpectomy may not be an option for everyone. Women with two or more tumors in different areas of the breast, large tumors and/or small breasts, or other health conditions which make radiation impossible may not be a candidate for this type of surgery.2
Partial mastectomy (also called segmental mastectomy or quadrantectomy) removes a portion of the breast tissue, including the tumor and a lining of healthy tissue. It is a breast-conserving surgery because it leaves some of the breast tissue.3
A skin-sparing mastectomy removes the breast tissue underneath but leaves the skin of the breast, except for the nipple and areola (the pigmented area around the nipple). This procedure provides more options for reconstruction surgery. A skin-sparing mastectomy may not be an option in cases where the breast cancer involves the skin or where the individual will not be having immediate reconstruction.4
In a nipple-sparing mastectomy, the nipple and areola are kept intact in addition to the breast skin. This maintains the cosmetic look of the breast as much as possible while removing the cancerous tissue. As with all surgical procedures, some women may not be a candidate for nipple-sparing mastectomies, such as those with large tumors that are centrally located in the breast or those with other health conditions that may impact healing.5
Modified radical mastectomy
Modified radical mastectomy is a surgical procedure in which the entire breast, skin, nipple, areola, and many axillary lymph nodes are removed. The muscle beneath the breast, the pectoralis muscle, is left in place. Mastectomy may be recommended for women who have had prior radiation to the breast or chest, for those who cannot have radiation therapy (which typically follows breast-conserving surgeries), for those with inflammatory breast cancer, or for widespread breast cancer or a large tumor that cannot be removed with a good cosmetic outcome.6
Axillary lymph node dissection
Axillary lymph node dissection is a surgical procedure in which several lymph nodes are removed from the underarm.2
Sentinel lymph node biopsy
In sentinel lymph node biopsy, only the first one to several lymph nodes that are the primary drainage point for the breast are removed. To identify which lymph node(s) are sentinel, a radioactive substance or dye is injected into the breast near the tumor. This dye drains to the sentinel node, making it visible for the surgeon to identify.2
Surgery for metastatic breast cancer
Primary treatment for metastatic breast cancer will typically involve a systemic treatment, such as chemotherapy, targeted therapy, and/or hormone therapy. Surgery to remove the primary tumor in the breast is controversial, with some research studies finding that removing the primary tumor can potentially improve survival and other studies finding little benefit. Women with metastatic breast cancer should discuss their options with their doctor to determine the best treatment options for them.7,8
When breast cancer has spread to distant parts of the body, surgery is not usually used to remove these metastases. However, one small study found that certain women with metastases to the liver may benefit from having them surgically removed if the cancer is hormone receptor-positive (HR+), responded to chemotherapy prior to surgery, and didn’t increase in size between diagnosis of metastases and surgery. It isn’t yet known if surgery to remove liver metastases improves patient outcomes, and women should talk to their doctor about whether this is a potential option in their case.9
Treating breast cancer. American Cancer Society. Available at https://www.cancer.org/cancer/breast-cancer/treatment.html. Accessed 10/5/18.
Lumpectomy. Mayo Clinic. Available at https://www.mayoclinic.org/tests-procedures/lumpectomy/about/pac-20394650. Accessed 10/5/18.
Partial mastectomy. PubMed Health. Available at https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0030264/. Accessed 10/5/18.
Skin-sparing mastectomy. BreastCancer.org. Available at https://www.breastcancer.org/treatment/surgery/mastectomy/skinsparing. Accessed 10/5/18.
Nipple-sparing mastectomy. Stony Brook University Hospital. Available at https://www.stonybrookmedicine.edu/patientcare/surgery/patient-care/clinical/breast-surgery/patient-education/faqs-about-nipple-sparing-mastectomy. Accessed 10/5/18.
Kuwajerwala NK. Modified radical mastectomy. Medscape. Available at https://emedicine.medscape.com/article/1830105-overview. Accessed 10/5/18.
Tosello G, Torloni M, Mota BS, Neeman T, Riera R. Breast surgery for metastatic breast cancer. Cochrane. Available at https://www.cochrane.org/CD011276/BREASTCA_breast-surgery-metastatic-breast-cancer. Accessed 10/5/18.
Poggio F, Lambertini M, de Azambuja E Controversies in Oncology: Surgery of the primary tumour in patients presenting with de novo metastatic breast cancer: to do or not to do? ESMO Open 2018;3:e000324. doi: 10.1136/esmoopen-2018-000324
Surgery to treat metastatic breast cancer. BreastCancer.org. Available at https://www.breastcancer.org/symptoms/types/recur_metast/treat_metast/options/surgery. Accessed 10/5/18.