At the Abramson Cancer Center, our specialized breast cancer oncologists, surgeons, nurses and staff target cancer with leading-edge treatments that align with your type of cancer, your goals and lifestyle. We make it a priority to understand you before developing your treatment plan.
Who Treats Breast Cancer?
Breast cancer treatment can be complex and involves several types of specialists with varying expertise to provide well-rounded care to patients. Throughout your breast cancer treatment journey, you may encounter:
- Breast medical oncologists, who specialize in chemotherapy, immunotherapy, and other therapies
- Radiation oncologists, who specialize in administering radiation therapy
- Breast surgeons, who are surgical oncologists
- Reconstructive plastic surgeons, who specialize in all options for advanced breast reconstruction
- Nipple and areola 3D tattoo specialists, with expertise in micropigmentation
- Genetic counselors through the Basser Center for BRCA, who provide evaluation, counseling, and research studies specific to breast cancer risk and cancer genetics
- Your primary care provider (PCP)
- Imaging technicians, if further imaging is needed between treatments
- Fertility preservation specialists
- Oncology nurse navigators who offer support, guidance, and help coordinating your care
Patients who visit Penn Medicine’s Breast Cancer Program for treatment will have a multidisciplinary team by their side throughout every step of the cancer journey. We combine compassionate care and comprehensive clinical expertise to treat breast cancer, ensuring that the proper specialists are involved promptly to provide a complete and comprehensive treatment plan for your specific diagnosis.
Meet our breast cancer team
Breast Cancer Treatment Options
Our breast cancer care includes a combination of treatments and surgery tailored to meet your needs. Your breast cancer treatment plan may include one or a combination of the following treatment options and procedures:
Breast Cancer Surgery
Cancer surgery plays a key role in the treatment of breast cancer. At the Abramson Cancer Center, our surgical oncologists and plastic reconstructive surgeons collaborate to create a personalized surgical plan that considers your wishes and diagnosis. Our goal is to treat breast cancer effectively with cosmetic outcomes that leave you feeling comfortable and confident, using the latest surgical technology, and minimally invasive techniques to reduce scarring and recovery time.
Surgeries we use to treat breast cancer include:
- Lumpectomy: Our surgeons may recommend a lumpectomy for early-stage breast cancer or as a preventative measure. This procedure involves removing abnormal tissue and a small area of surrounding healthy tissue. The tissue is analyzed by a specialized breast cancer pathologist. If breast reconstruction is required to restore the appearance of your breasts, our breast surgeons and plastic surgeons work together. Learn more about lumpectomy and SAVI SCOUT® pre-operative tumor localization technology at Penn Medicine.
- Mastectomy: Patients with advanced cancer or an elevated risk of breast cancer may require or choose to have a mastectomy. During this surgery, we remove all the tissue from one or both breasts. Our surgeons perform mastectomies both with and without breast reconstruction. Whenever possible, we conserve the skin, areola and nipple to assist with reconstruction. Learn more about how we treat cancer with mastectomy.
- Sentinel Lymph Node Excision: We may conduct a sentinel lymph node excision to see whether breast cancer has spread beyond the breast. This procedure is performed during breast cancer surgery and involves the removal of one or a few specific lymph nodes. We remove the first lymph node(s) (sentinel lymph nodes) where the cancer cells are most likely to spread. To identify the sentinel lymph nodes, the surgeon injects dye and/or a radioactive tracer into the area of the tumor. These dyes and tracers travel from the tumor to the lymph nodes. We remove and biopsy lymph nodes stained by the dye and that have a high signal count from the tracer.
Breast Reconstruction after a Mastectomy
To restore the appearance of your breasts after a mastectomy, our expert plastic surgeons perform breast reconstruction. We can reconstruct your breast either during breast cancer surgery (immediate) or at a later time (delayed).
As you prepare for breast cancer surgery, we will present individualized breast reconstruction options and help you decide whether it is the right choice for you. Depending on your body type and your goals, our surgeons may use breast implants or your own tissue (free flap procedure), often taken from the lower abdomen to restore the appearance of your breasts, or a hybrid of both. Using someone's own tissue for breast reconstruction (free flap or autologous reconstruction) is a complex procedure. We perform the highest volume of free flap reconstruction in the nation and deliver superior cosmetic results.
Radiation Therapy for Breast Cancer
Radiation therapy uses high-energy radiation from X-rays and other energy sources to destroy cancer cells. Radiation can be external, delivered as beams from a machine outside the body (external-beam radiation therapy), or internal, distributed by radioactive material placed directly in or near a tumor (brachytherapy). External-beam radiation is most often used to treat breast tumors; though internal radiation may be used in some cases.
Our radiation oncologists use different techniques to deliver radiation therapy for breast cancer. This allows us to tailor treatment for your needs. The types of radiation we use to treat breast cancer at Penn Medicine include:
- Conformal Radiation: During conformal radiation, doctors shape (conform) the photon beam to match the unique shape of the breast, providing maximum radiation to the cancer while reducing damage to surrounding tissue.
- Intensity-Modulated Radiation Therapy (IMRT): During intensity-modulated radiation therapy (IMRT), doctors rely on advanced computer-assisted planning to create complex radiation patterns.
- Internal Radiation (Brachytherapy): Internal radiation (brachytherapy) treats cancer from the inside, without the use of external beams.
- Proton Therapy: Proton therapy is a targeted radiation treatment that uses protons (positively charged atoms) to destroy cancer cells with pinpoint accuracy. Proton beams emit low radiation, resulting in less exposure for healthy breast tissue and a reduced risk of side effects. Proton therapy for breast cancer is available through clinical trials and for select breast cancer patients who meet one of two criteria: challenging anatomy or re-radiation.
We typically use radiation in combination with other breast cancer treatments after a lumpectomy or mastectomy. Our wide range of advanced technology allows us to customize radiation therapy and offer radiation following breast reconstruction. We tailor the treatment to each patient’s diagnosis, anatomy and tumor location.
The breasts’ proximity to the heart can make delivering radiation a challenge. To reduce the heart’s exposure to radiation, we use precision technology and additional techniques including extensive planning using 3D imaging, deep inspiration breath hold (DIBH), and prone (face down) positioning during radiation treatment to allow the radiation beam to reach tumors while reducing exposure to the heart and lungs.
Chemotherapy for Breast Cancer
Chemotherapy uses drugs and other agents to slow or stop the growth of cancer cells. Chemotherapy for breast cancer is typically delivered intravenously (through a vein) either as an injection or as an infusion given over a longer period of time. The medication is systemic, meaning it travels through the bloodstream to every area of the body.
Depending on the type and stage of cancer, chemotherapy may be used alone or combined with other breast cancer treatments. For example, HER2 breast cancer may involve a combination of chemo with a targeted therapy drug. Chemotherapy may reduce the risk of early-stage breast cancer coming back. As a systemic treatment, chemotherapy is especially useful when treating widespread or metastatic breast cancer that has moved beyond the breast.
Penn Medicine offers the following chemotherapy techniques:
- Adjuvant therapy after surgery, to destroy remaining microscopic breast cancer cells and reduce the chance of recurring cancer.
- Neoadjuvant therapy before surgery, to shrink tumors that are too large or complex to treat.
- While not a treatment, Penn Medicine is pleased to offer PAXMAN Scalp Cooling System, which may reduce hair loss from chemo.
Chemotherapy plays a role in most breast cancer treatment plans. Breast cancer specialists rely on chemotherapy to shrink breast tumors and prevent breast cancer from spreading. We also use it to kill breast cancer found in other areas of the body. At the Abramson Cancer Center, our specialized breast cancer oncologists know the best way to include chemotherapy as part of your personalized treatment plan.
Immunotherapy for Breast Cancer
The immune system exists to protect the body from infections and other health threats. Often, cancer cells interfere with how the immune system functions or the body simply does not recognize cancer as a threat. Immunotherapy restores the body's ability to fight off cancer.
Immunotherapy for cancer uses medication to activate a patient's own immune system to recognize and destroy cancer cells. We use immunotherapy drugs called immune checkpoint inhibitors to treat breast cancer. The medication is systemic, like chemotherapy, and travels through the bloodstream to reach all areas of the body.
New research suggests that immunotherapy may improve outcomes in certain patients with breast cancer. The FDA approved the first immunotherapy drug for breast cancer in 2019. Now, researchers are rapidly developing new drugs that target specific proteins found on some breast cancer cells.
Whenever possible, our oncologists offer you the latest treatments in addition to standard approaches. At the Abramson Cancer Center, you will find that Penn Medicine is a recognized leader in immunotherapy. We are part of the Parker Institute for Cancer Immunotherapy, a collaboration of the nation’s top six academic cancer centers, with access to other groundbreaking breast cancer research through our 2-PREVENT Breast Cancer Translational Center of Excellence.
Targeted Therapy for Breast Cancer
Cancer cells contain mutated (changed) genes and proteins that make cells divide and multiply quickly. Targeted therapy for cancer blocks the growth of cancer cells by focusing on those genes and proteins. Targeted drugs are delivered through a vein or in pill form. Depending on how targeted therapy is given, the drugs can be taken at home or administered on an outpatient basis. Unlike chemotherapy, targeted drugs only pinpoint cancer cells and do not harm normal cells.
For targeted drugs to work effectively, we need to understand what fuels cancer cells’ growth. Researchers have found several different "targets" (genes, proteins and other characteristics) that help breast cancer cells grow and spread. To see which targets breast cancer has, we study a tissue sample. These tests are completed as part of a breast cancer diagnosis.
We use targeted therapy to treat many types of breast cancer, including HER2-positive breast cancer, hormone receptor-positive breast cancer, triple negative breast cancer, and patients with BRCA gene mutations.
Hormone Therapy for Breast Cancer
We treat hormone receptor-positive breast cancer (also called hormone-positive or HR+ breast cancer) with hormone therapy. Breast cancer cells contain receptors that attach to hormones like estrogen (ER-positive breast cancer) and progesterone (PR-positive breast cancer) for better growth and metastasis.
Hormone therapy is typically administered after surgery through drugs that prevent hormones from helping the breast cancer cells grow, by either blocking the connection completely or lowering the hormone levels to decrease the chance of connecting. We may add targeted therapy to other treatments to improve efficacy. The types of targeted drugs we use include CDK4/6 inhibitors, mTOR inhibitors, and PI3K inhibitors, which obstruct proteins in cells to prevent them from growing or dividing.
Treating Breast Cancer with BRCA Gene Mutations
Some people with BRCA1 or BRCA2 gene mutations can be treated with targeted therapies called PARP inhibitors. PARP, which gets its name from poly-ADP ribose polymerase, is an enzyme protein found in the body’s cells. PARP inhibitors intercept PARP proteins, whose job is to repair damaged DNA in cells. Cancer cells are destroyed when they are not repaired.
Breast Cancer Clinical Trials
In addition to conventional treatments, we offer clinical trials through our breast cancer research program. Participation in a clinical trial may provide new and promising treatment options that are not available anywhere else. Learn more about breast cancer research and clinical trials at the Abramson Cancer Center.
Breast Cancer Treatment by Stage
Your breast cancer treatment type, treatment combinations, and length of treatment time heavily depend on the type of breast cancer and the stage of cancer progression. Other factors, such as hormone receptor status, personal overall health, and the existence of gene mutations, may also impact your treatment plan. All of this information helps our treatment team make an informed decision about which treatment option will be most effective for your personal diagnosis, to achieve and maintain a cancer-free status.
Breast cancer stage 0 contains no spread of cancer cells and therefore is treated using surgery, depending on the size of the tumor, followed by radiation therapy and hormone therapy (if you are hormone receptor positive).
Breast cancer stages I, II, and III are typically treated using surgery and radiation therapy, supplemented by chemotherapy or other systemic therapies at different points in the process when needed.
Breast cancer stage IV (metastatic breast cancer) is when the cancer has spread (metastasized) and requires ongoing treatment. Systemic therapies, like chemotherapy, hormone therapy, and immunotherapy, are considered the primary treatment. Surgery and radiation therapy are used to treat stage IV breast cancer under very specific conditions, like severe pain management and wounds caused by tumor growth.
Managing Side Effects of Breast Cancer Treatment
You may experience physical and emotional side effects as you go through your cancer treatment. Common side effects of cancer treatment include anxiety and depression, change in appearance (hair loss, weight loss, etc.), lower white and red blood cell count, changes in sex drive, dehydration, fatigue, fertility impacts, nausea, pain, and more.
While friends and family may try to do everything they can to help, it’s normal to feel sad, alone or out of control due to sudden side effects that you experience during your breast cancer treatment journey.
Supportive Care Services such as counseling, social workers, support groups, workshops, physical therapy, and wig services at Penn Medicine are offered to help patients manage the concerns and changes they may face as they undergo cancer treatment. The Abramson Cancer Center offers psychological and spiritual counseling. Look to your doctors and oncology nurse navigators for help through this time.
Unite for Her Virtual Wellness Days
Our Breast Cancer Program is also a proud partner of Unite for HER (UFH) and offers virtual Wellness Days, at no cost, for our breast and ovarian cancer patients four times per year. During this interactive Wellness Day, the UFH team and Penn care providers come together to share the benefits of integrative therapies with the intention to educate, empower and restore you. You’ll learn about UFH’s services which include: medical acupuncture, oncology massage, yoga, reiki, counseling, and whole food nutrition.
Ask your care team for more information or register directly at UniteforHer.org/applypenn.
*All program participants receive a HER Care Box containing educational resources, healing and healthy self-care products, and the UFH Wellness Passport. Participation is for women who have been diagnosed within the last 18 months, are living with metastatic disease, or have had a recurrence.
Request an Appointment
To make an appointment, please call 800-789-7366 or request a callback.