Breast Cancer, part 3

The most common side effects of immunotherapy are rash, diarrhea, and fatigue, which is feeling exhausted or extremely tired. Learn more about the side effects of immunotherapy and steps you can take to manage or prevent them.

Sources: diarrhea · fatigue · side effects of immunotherapy

Different types of treatments are available for inflammatory breast cancer. You and your cancer care team will work together to decide on your treatment plan, which likely will include more than one type of treatment. Learn more about inflammatory breast cancer symptoms, diagnosis, and prognosis at Inflammatory Breast Cancer.

Sources: Inflammatory Breast Cancer

Inflammatory breast cancer is always diagnosed as either stage III or stage IV disease. Learn more about how breast cancer is staged at Breast Cancer Stages.

Sources: Breast Cancer Stages

Treating stage III (also called stage 3) inflammatory breast cancer

Stage III inflammatory breast cancer is generally treated with a combination of chemotherapy, surgery to remove the tumor, and radiation therapy. Immunotherapy, targeted therapy, and hormone therapy may also be given, depending on whether the cancer has certain biomarkers.

Sources: chemotherapy · radiation therapy · Immunotherapy · targeted therapy · hormone therapy · biomarkers

Treating metastatic or stage IV (also called stage 4) inflammatory breast cancer

In metastatic (stage IV or stage 4) inflammatory breast cancer, the cancer has spread beyond the breast and nearby lymph nodes to distant parts of the body. Treatment for stage IV inflammatory breast cancer is the same as treatment for other types of metastatic breast cancer.

Learn more about treatment options at Metastatic Breast Cancer in the section, “How is metastatic breast cancer treated?”

Sources: Metastatic Breast Cancer

Treatment for recurrent inflammatory breast cancer

If cancer returns to the place where it began or nearby, it is called a locoregional recurrence. Treatment for locoregional recurrence of inflammatory breast cancer may include chemotherapy, surgery, and radiation. Other drugs may be added, depending on whether your cancer has certain biomarkers. Treatment for inflammatory breast cancer that has come back in distant parts of the body may be similar to treatment for stage IV breast cancer.

Sources: recurrence

Learn more about Breast Cancer Recurrence.

Sources: Breast Cancer Recurrence

Clinical trials

Connect with a cancer information specialist at 1-800-4-CANCER, through live chat, or by email.

Joining a clinical trial may be an option. There are different types of clinical trials for people with breast cancer. For example, a treatment trial tests new treatments or new ways of using existing treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.

You can use the clinical trial search to find NCI-supported cancer clinical trials that are accepting participants. This search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. You can also review a list of NCI-supported Breast Cancer Clinical Trials. Clinical trials supported by other organizations can be found at ClinicalTrials.gov.

Sources: clinical trial search · Breast Cancer Clinical Trials · ClinicalTrials.gov

Learn more about clinical trials at Cancer Clinical Trial Information for Patients and Caregivers.

Sources: Cancer Clinical Trial Information for Patients and Caregivers

Coping with inflammatory breast cancer treatment

Treatment for inflammatory breast cancer can be mentally and physically challenging. It is important that you bring up any questions and concerns you have with your health care team throughout your care and treatment to get the support you need.

In addition to support from your health care team and family, one-on-one counseling or in-person and online support groups can help you cope and improve your mental wellbeing. Learn more about how to manage the physical and emotional effects of breast cancer at Living with Breast Cancer and Survivorship.

Sources: Living with Breast Cancer and Survivorship

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation is given in a series of treatments to allow healthy cells to recover and to make radiation more effective. The number of treatments is based on details about the cancer, such as the size and location of the tumor. Most of the time, radiation is given as an outpatient treatment. This means that you will have treatment at a clinic or radiation therapy center and will not stay overnight in the hospital.

Sources: x-rays · radiation · outpatient

Types of radiation therapy for breast cancer

External beam radiation therapy and brachytherapy (internal radiation therapy) are the main types of radiation therapy used for breast cancer. External beam radiation therapy comes from a machine that aims radiation at the cancer. For internal radiation therapy, the radiation source is placed inside the body near the cancer.

External beam radiation therapy is a local treatment, which means it treats a specific part of your body. It may be given to the whole breast or chest, or to the part of the breast where the cancer is or where it was located before it was removed by surgery. Most of the time, you will get external beam radiation therapy as an outpatient.

To learn how to prepare for radiation therapy, visit the booklet Radiation Therapy and You: Support for People with Cancer.

Sources: Radiation Therapy and You: Support for People with Cancer

Radiation therapy for breast cancer usually begins about a month or two after surgery. That is because radiation therapy can slow wound healing. If you are also receiving chemotherapy, radiation therapy usually starts about a month after you have finished chemotherapy. You can have radiation at the same time as you are receiving some other treatments, such as hormone therapy or targeted therapy.

Sources: chemotherapy · hormone therapy · targeted therapy

With this type of radiation therapy, an x-ray machine delivers radiation to either the whole breast, or, if done after mastectomy, to the entire chest wall. Sometimes, radiation will also target the lymph nodes in the armpit or neck area or under the breastbone. Most people have treatment once a day, Monday through Friday, for about 5 to 6 weeks. In some cases, it may be done in 4 weeks or less. Your doctor will recommend the treatment regimen that is right for you.

Sources: mastectomy · chest wall · lymph nodes

This type of cancer treatment comes from a machine that aims radiation at a specifc part of your body.

Two techniques are commonly used to give external beam radiation treatment to the area where the cancer is or where it was located before it was removed by surgery:

Most people have treatment once a day, Monday through Friday, for 2 to 4 weeks.

Researchers are looking at other ways to adjust the radiation dose or schedule to reach the total dose of radiation more quickly or to limit damage to healthy cells.

Intraoperative radiation therapy is a type of external beam radiation therapy in which a single dose of radiation therapy is delivered to the tumor site during surgery.

Brachytherapy (also called internal radiation therapy) is sometimes used after breast-conserving surgery. It involves placing radioactive material using seeds, pellets, or needles in the area where the cancer was removed. The radiation only reaches a small area around the surgical site, where the risk of recurrence is highest.

Sources: breast-conserving surgery

Intracavitary brachytherapy is the most common type of brachytherapy for breast cancer. In this form of brachytherapy, a balloon, applicator, or similar device is inserted into the space where the cancer was, either during or a few days after breast-conserving surgery. A radioactive pellet is placed into the device during each treatment session and then removed after each treatment.

Treatments usually last about 5 to 10 minutes and are given 2 times a day for 5 days. After about 2 weeks, the device is removed. You may need stitches to close the hole when treatment is complete.

In interstitial brachytherapy, several small tubes, called catheters, are inserted into the tissue where the breast cancer was and stitched in place. This is most often done 1 to 2 weeks after surgery. A radiation source, such as radioactive pellets or seeds, is temporarily placed into the catheters during each treatment session. Treatments usually last about 20 minutes. Two kinds of sources, high-dose implants and low-dose implants, can be used:

PBSI involves placing permanent radioactive seeds into the breast tissue around the area where the cancer was removed. The seeds emit radiation at a low dose. Although the seeds remain in the body, they lose their radioactivity over time and do not need to be removed. This is a one-time procedure that usually does not require a hospital stay.

Intravenous radiation with strontium-89 (a radionuclide) is given as palliative therapy to relieve bone pain caused by breast cancer that has spread to the bones. Strontium-89 is injected into a vein and travels to the surface of the bones. Radiation is released and kills cancer cells in the bones.

Sources: radionuclide

Learn more about Brachytherapy to Treat Cancer.

Sources: Brachytherapy to Treat Cancer

Side effects of radiation therapy for breast cancer

Radiation kills or slows the growth of cancer cells and can also affect nearby healthy cells. Damage to healthy cells can cause side effects. Your experience may be different from someone else who is getting the same amount of radiation therapy to the same part of the body. Sometimes, people may have side effects that do not improve.

Possible early side effects of radiation therapy for breast cancer include:

Problems from cancer treatment that begin 6 months or later after treatment and continue for months or years are called late effects.

Possible late effects of radiation therapy for breast cancer include:

Learn more about Late Effects of Cancer Treatment.

Sources: Late Effects of Cancer Treatment

Discuss potential side effects with your doctor or nurse so you know what to expect during and after treatment. Regular follow-up care and supportive care can help manage side effects that do occur.

Learn more about Living with Breast Cancer and Survivorship.

Sources: Living with Breast Cancer and Survivorship

Most people with breast cancer or ductal carcinoma in situ (DCIS) will have surgery to remove the tumor and nearby breast tissue. The two main types of surgery are lumpectomy (breast-conserving surgery) and mastectomy, with or without breast reconstruction.

Sources: ductal carcinoma in situ · tissue · lumpectomy · mastectomy · breast reconstruction

Breast cancer surgery may also involve checking nearby lymph nodes for cancer. Usually, a sentinel lymph node biopsy is done, often during a lumpectomy or mastectomy but sometimes as a separate surgery. Learn more about sentinel lymph node biopsy at How Breast Cancer Is Diagnosed.

Sources: lymph nodes · sentinel lymph node biopsy · How Breast Cancer Is Diagnosed

What is breast reconstruction?

Many women who have a mastectomy—surgery to remove an entire breast to treat or prevent breast cancer—have the option of having the shape of the removed breast rebuilt. Some people choose not to have their breasts reconstructed after a mastectomy, instead preferring a flat closure.

Sources: flat closure

Breasts can be rebuilt using implants (saline or silicone) or autologous tissue (that is, tissue from elsewhere in the body). Sometimes both implants and autologous tissue are used to rebuild the breast.

Sources: saline · silicone · autologous

Surgery to reconstruct the breasts can be done (or started) at the time of the mastectomy, called immediate reconstruction, or it can be done after the mastectomy incisions have healed and treatment has been completed, called delayed reconstruction. Delayed reconstruction can happen months or even years after the mastectomy.

In the final stage of breast reconstruction, a nipple and areola may be re-created on the reconstructed breast, if these were not preserved during the mastectomy.

Sources: nipple · areola

Sometimes breast reconstruction surgery includes surgery on the other, or contralateral, breast so that the two breasts will match in size and shape.

Sources: contralateral

How do surgeons use implants to reconstruct a woman's breast?

Implants are inserted underneath the skin or chest muscle following the mastectomy. Implants are usually placed as part of a two-stage procedure.

In some cases, the implant can be placed in the breast during the same surgery as the mastectomy—that is, a tissue expander is not used (3).

Sources: 3

Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or “sling” to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.

How do surgeons use tissue from a woman's own body to reconstruct the breast?

In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a woman’s body and used to rebuild the breast. This piece of tissue is called a flap.

Sources: autologous

Different sites in the body can provide flaps for breast reconstruction. Flaps most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.

Sources: abdomen

Depending on their source, flaps can be pedicled or free.

Abdominal and back flaps include:

Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who don’t have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps.

The table below summarizes the different types of flaps used for breast reconstruction:

In some cases, an implant and autologous tissue are used together. For example, with flaps taken from the thigh or buttocks an implant is often used as well to provide sufficient breast volume. Also, autologous tissue may be used to cover an implant when there isn’t enough skin and muscle left after mastectomy to allow for expansion and use of an implant (1, 2).

Sources: 1 · 2

How do surgeons reconstruct the nipple and areola?

After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, the nipple and areola can be reconstructed. This can be done in two ways—surgically or with tattoos.

Sources: chest wall · nipple · areola

For surgical nipple reconstruction, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple. A few months later, the surgeon can re-create the areola. This is usually done using tattoo ink.

However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction (1).

Sources: skin grafts · 1

Alternatively, a new nipple and areola can be created by a tattoo artist who specializes in 3-D nipple tattooing. Such a nipple is flat to the touch but looks realistic.

Sources: 3-D

A mastectomy that preserves a woman's own nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts (4, 5).

Sources: 4 · 5

What factors can affect the timing of breast reconstruction?

One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy. Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed. However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy. Autologous tissue breast reconstruction is usually reserved for after radiation therapy, so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body.

Sources: radiation therapy · Autologous · chest wall

Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction. For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment. Women who delay reconstruction (or choose not to undergo the procedure at all) can use external breast prostheses, or breast forms, to give the appearance of breasts.

What factors can affect the choice of breast reconstruction method?

Several factors can influence the type of reconstructive surgery a woman chooses. These include the size and shape of the breast that is being rebuilt, the woman’s age and health, her history of past surgeries, her risk factors for complications after surgery (for example, smoking history and obesity), the availability of autologous tissue, and the location of the tumor in the breast (2, 6). Women who have had past abdominal surgery may not be candidates for an abdominally based flap reconstruction.

Sources: reconstructive surgery · risk factors · complications · autologous · 2 · 6

Each type of reconstruction has factors that a woman should think about before making a decision. Some of the more common considerations are listed below.

Reconstruction with Implants

Surgery and recovery

Possible complications

Other considerations

More information about implants can be found on FDA’s Breast Implants page.

Sources: Breast Implants

Reconstruction with Autologous Tissue

Surgery and recovery

Possible complications

Other considerations

All women who undergo mastectomy for breast cancer experience varying degrees of numbness and loss of feeling in the breast because nerves that provide sensation to the breast are cut when breast tissue is removed during surgery. However, some breast sensation may be regained as the severed nerves grow and regenerate, and breast surgeons continue to make technical advances that can spare or repair damage to nerves.

Any type of breast reconstruction can fail if healing does not occur properly. In these cases, the implant or flap will have to be removed. If an implant reconstruction fails, a woman can usually have a second reconstruction using an alternative approach.

Will health insurance pay for breast reconstruction?

The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that requires group health plans and health insurance companies that offer mastectomy coverage to also pay for reconstructive surgery after mastectomy. This coverage must include all stages of reconstruction and surgery to achieve symmetry between the breasts, breast prostheses, and treatment of complications that result from the mastectomy, including lymphedema. More information about WHCRA is available from the Department of Labor and the Centers for Medicare & Medicaid Services.

Sources: reconstructive surgery · complications · lymphedema · Department of Labor · Centers for Medicare & Medicaid Services

Some health plans sponsored by religious organizations and some government health plans may be exempt from WHCRA. Also, WHCRA does not apply to Medicare or Medicaid. However, Medicare may cover breast reconstruction surgery as well as external breast prostheses (including a post-surgical bra) after a medically necessary mastectomy. Medicaid benefits vary by state; a woman should contact her state Medicaid office for information on whether, and to what extent, breast reconstruction is covered.

Sources: Medicare

A woman considering breast reconstruction may want to discuss costs and health insurance coverage with her doctor and insurance company before choosing to have the surgery. Some insurance companies require a second opinion before they will agree to pay for a surgery.

Sources: second opinion

What type of follow-up care and rehabilitation is needed after breast reconstruction?

Any type of reconstruction increases the number of side effects a woman may experience compared with those after a mastectomy alone. A woman’s medical team will watch her closely for complications, some of which can occur months or even years after surgery (1, 2, 8).

Sources: side effects · complications · 1 · 2 · 8

Women who have breast reconstruction may benefit from physical therapy to improve or maintain shoulder range of motion or help recover from weakness experienced at the site from which donor tissue was taken for an autologous reconstruction (9, 10). A physical therapist can help a woman use exercises to regain strength, adjust to new physical limitations, and figure out the safest ways to perform everyday activities.

Sources: physical therapy · 9 · 10 · physical therapist

Does breast reconstruction affect the ability to check for breast cancer?

Mammography is not typically done on a breast that is reconstructed after mastectomy; instead, physical exams are done to check for recurrence. However, women who have one breast removed by mastectomy will still have mammograms of the other breast.

Sources: Mammography · physical exams · recurrence

What is flat closure?

A flat closure (also called aesthetic flat closure) is surgery done to rebuild the shape of the chest wall after the removal of one or both breasts. It is also a surgical option for people who have had their breast implants removed.

Sources: aesthetic flat closure · chest wall

During an aesthetic flat closure, a surgeon removes extra skin, fat, and other tissue in the breast area. The remaining tissue is then tightened and smoothed out so that the chest wall appears flat and contoured. Simply forgoing additional procedures to reconstruct the breast(s) after a mastectomy will not achieve a flat closure (11).

Sources: 11

What are some new developments in breast reconstruction after mastectomy?

Are you facing a decision about lumpectomy vs. mastectomy?

Do you have ductal carcinoma in situ (DCIS) or breast cancer that can be removed with surgery? If so, you may be able to choose which type of breast surgery you have. Often, your choice is between a lumpectomy or other breast-conserving surgery (surgery that takes out the cancer and leaves most of the breast) and a mastectomy (surgery that removes the whole breast).

Sources: ductal carcinoma in situ · lumpectomy · mastectomy

Learn more about these surgeries at Breast Cancer Surgery.

Sources: Breast Cancer Surgery

Once you are diagnosed, treatment will usually not begin right away. Use the time to:

Compare lumpectomy and mastectomy

If your surgeon gives you a choice about which surgery to have, it can be hard to decide which one is best for you. This section can help you compare the different surgeries. Learn how the surgeries are alike and how they are different by clicking on each question to learn more.

No. Research shows that women who have breast-conserving surgery live as long as women who have a mastectomy. This does not change if you also have reconstruction.

Most people have some pain after surgery. Talk with your doctor or nurse before surgery about ways to control pain after surgery. Also, tell them if your pain control is not working.

Sources: tissue flap reconstruction

If lymph nodes are removed from under your arm, you may develop lymphedema. Learn more about Lymphedema.

Sources: lymph nodes · Lymphedema

Learn about local and systemic treatments and access in-depth information about each type of treatment.

If you choose to have a lumpectomy or other breast-conserving surgery, you will usually need radiation therapy. Radiation treatments are often given 5 days a week for up to 6 weeks.

Sources: radiation therapy

If you have a mastectomy, you may still need radiation therapy.

No matter which surgery you choose, you might need:

With all three surgeries, you may need more surgery to remove lymph nodes from under your arm to see how far the cancer has spread.

With all three surgeries, the scars left from where the surgeon cut the skin and stitched it back together tend to fade over time.

To get a better idea of what to expect from surgery, ask your surgeon if you can see before and after pictures of other people who have had different types of surgery.

Some surgeons are trying new techniques to preserve or restore breast feeling after a mastectomy. Find clinical trials studying this issue using our NCI-supported clinical trials search or ClinicalTrials.gov.

Sources: clinical trials search · ClinicalTrials.gov

Research suggests that women who have breast-conserving surgery have a better long-term quality of life than those who have a mastectomy.

Sources: have a better long-term quality of life than those who have a mastectomy

Think about what is important to you

After you have talked with a breast surgeon and learned the facts, you may also want to talk with your spouse or partner, family, friends, or other women who have had breast cancer surgery.

Then, think about what is important to you. Thinking about the following questions and talking them over with others might help:

Lumpectomy is a type of breast surgery in which the surgeon removes the ductal carcinoma in situ (DCIS) or breast cancer and some healthy tissue around it. If the cancer is near the chest wall, part of the chest wall lining may also be removed.

Sources: ductal carcinoma in situ · breast cancer · tissue · chest wall

Lumpectomy is an option for some people with DCIS or invasive breast cancer. It is usually followed by radiation therapy. Research shows that lumpectomy plus radiation therapy is just as effective as mastectomy (surgery to remove all breast tissue) at lowering your chance of dying from breast cancer or of the cancer coming back. Learn more about choosing between a mastectomy and lumpectomy to treat breast cancer.

Sources: radiation therapy · mastectomy · Learn more about choosing between a mastectomy and lumpectomy to treat breast cancer.

Your doctor may suggest a lumpectomy plus radiation therapy if:

If large amounts of tissue need to be removed during a lumpectomy, the surgery may be called partial mastectomy, segmental mastectomy, or quadrantectomy.

After a lumpectomy, a pathologist will check the healthy tissue that was removed to see if it contains DCIS or cancer. If it does, you may need more surgery or a mastectomy so the surgeon can remove more tissue and make sure no DCIS or cancer cells remain in the breast.

Sources: pathologist

Most people who have a lumpectomy receive radiation therapy after they heal from surgery. The goal of this treatment is to keep cancer from coming back in the same breast. Learn more about Radiation for Breast Cancer.

Sources: Radiation for Breast Cancer

You might also need chemotherapy, hormone therapy, or targeted therapy, before or after surgery. Learn more about Breast Cancer Treatment.

Sources: chemotherapy · hormone therapy · targeted therapy · Breast Cancer Treatment

The type of treatment you receive will depend on many factors, such as how different the tumor cells look from normal breast cells, how likely the tumor cells are to grow and spread, and the results of biomarker tests. Learn more at How Breast Cancer Is Diagnosed and Tests for Breast Cancer Biomarkers.

Sources: cells · biomarker · How Breast Cancer Is Diagnosed · Tests for Breast Cancer Biomarkers

Most people can go home the day of their lumpectomy and go about their daily activities with few restrictions. But you may need help with some tasks, depending on the extent of your surgery. Within two weeks, you should be able to return to your normal activities.

After a lumpectomy, your breast will usually look and feel much like it did before surgery. You will have a scar at the site of surgery. And there may be a dent where the tumor and tissue were removed.

Talk to your surgical team about how your surgery might change how your breast looks. If you think you will not be happy with the look or feel of your breast after surgery, you may think about reconstruction. Reconstruction can take place during or any time after the lumpectomy.

There are two types of breast reconstruction for people who have a lumpectomy:

As with any surgery, lumpectomy has risks, including:

In a mastectomy, the surgeon removes the whole breast that contains ductal carcinoma in situ (DCIS) or cancer. Your doctor may suggest a mastectomy if:

Sources: ductal carcinoma in situ

If you have a mastectomy, you may not need radiation therapy, so your doctor may also suggest a mastectomy if you are not able to have radiation therapy because you are pregnant or can’t commit to daily treatments.

People who have a mastectomy may need chemotherapy, hormone therapy, or targeted therapy. Learn more about Breast Cancer Treatment.

Sources: chemotherapy · hormone therapy · targeted therapy · Breast Cancer Treatment

After a mastectomy, you may choose to stay flat, wear a prosthesis (breast-like form) in your bra, or have breast reconstruction surgery.

Sources: breast reconstruction

Types of mastectomy

Single vs. double mastectomy

In a single (unilateral) mastectomy, only the breast with cancer is removed. A double (bilateral) mastectomy involves the removal of both breasts.

Your doctor may suggest a double mastectomy if:

If you do not have a genetic mutation or strong family history of breast cancer, you do not have an increased risk of developing a new cancer in the other breast. For you, research shows that having a double mastectomy instead of a single mastectomy does not help you live longer.

You may choose to have a double mastectomy, even if your doctor suggests a single mastectomy, if:

Discuss insurance coverage and the risks and benefits of a double mastectomy with your doctor before making a decision.

Mastectomy with breast reconstruction surgery

You can have breast reconstruction at the same time as the mastectomy, or at any time after. Some types of mastectomies (skin- and nipple-sparing) require reconstruction at the same time. Breast reconstruction is done by a plastic surgeon with experience in this type of surgery. The surgeon uses an implant or tissue from another part of your body to create the breast mound after the breast has been removed. If your nipple is removed, the surgeon may also make the form of a nipple and add a tattoo that looks like the areola.

Sources: plastic surgeon

For more information about types of breast reconstruction, recovery times, and possible complications, visit Breast Reconstruction After Mastectomy.

Sources: Breast Reconstruction After Mastectomy

Going flat after a mastectomy

You may choose to not have breast reconstruction after a mastectomy. This is called “going flat.” If you decide against reconstruction, you have the option of wearing a breast prosthesis to create the breast form under your clothes. To make the chest flat and smooth after a mastectomy, the surgeon will perform an aesthetic flat closure.

Sources: aesthetic flat closure

Recovering after a mastectomy

Recovery after a mastectomy depends on the type of mastectomy you had and whether you had breast reconstruction. Most people begin returning to normal activities 4 weeks after surgery. But recovery could take longer for people who have breast reconstruction.

Mastectomy risks

As with any surgery, a mastectomy has possible risks:

Mastectomy with reconstruction has additional risks. Learn more at Breast Reconstruction After Mastectomy.

Sources: Breast Reconstruction After Mastectomy

Targeted therapy is a type of cancer treatment that targets proteins that control how cancer cells grow, divide, and spread. To learn what to expect when receiving targeted therapy, visit Targeted Therapy to Treat Cancer.

Sources: Targeted Therapy to Treat Cancer

Who gets targeted therapy for breast cancer?

Many people with breast cancer get targeted therapy but not everyone. For example, targeted therapy may be an option for some people with:

Once breast cancer is diagnosed, breast cancer cells are routinely tested for the presence of certain biomarkers or tumor features. These tests can help determine if you are likely to benefit from targeted cancer therapy. To learn more, visit Tests for Breast Cancer Biomarkers.

Sources: biomarkers · Tests for Breast Cancer Biomarkers

When is targeted therapy for breast cancer given?

Targeted therapy for breast cancer may be given at different times in your treatment. It might be started before or after surgery. It can also be given even if surgery is not recommended for you.

Targeted therapy for HER2-positive breast cancer

HER2 is a protein that helps control breast cell growth. Some breast cancers have too much HER2, which causes the breast cells to grow and divide faster than normal. This is called HER2-positive breast cancer.

Several targeted therapy drugs may be used alone or with other kinds of drugs for HER2-positive breast cancer:

Some of these targeted therapy drugs, such as trastuzumab and trastuzumab deruxtecan, may also be used for HER-low breast cancer. HER2-low breast cancers have a small amount of HER2 protein on their surface.

Targeted therapy for hormone receptor–positive breast cancer

In hormone receptor–positive (HR positive) breast cancer, the breast cancer cells have estrogen or progesterone receptors, or both.

The following targeted therapy drugs may be used alone or with other treatments, particularly hormone therapy:

These drugs may be given with hormone therapy, such as an aromatase inhibitor (such as anastrozole, letrozole, or exemestane) or fulvestrant or letrozole, to treat hormone receptor–positive, HER2-negative breast cancer. Learn more about Hormone Therapy for Breast Cancer.

Sources: anastrozole · letrozole · exemestane · fulvestrant · letrozole · Hormone Therapy for Breast Cancer

Targeted therapy for triple-negative breast cancer

Triple-negative breast cancer is estrogen receptor (ER) negative, progesterone receptor (PR) negative, and HER2 negative.

The targeted therapy drug sacituzumab govitecan may be used to treat triple-negative breast cancer.

Sources: sacituzumab govitecan

Learn more about Triple-Negative Breast Cancer Treatment.

Sources: Triple-Negative Breast Cancer Treatment

Targeted therapy for BRCA-positive breast cancer

BRCA1 and BRCA2 are genes that produce proteins that help fix damaged DNA. Certain changes, called mutations or pathogenic variants, in these genes can disrupt DNA repair and cause cancer to develop.

The following targeted therapy drugs may be used to treat BRCA1- or BRCA2-positive breast cancer:

Side effects of targeted therapy

The most common side effects of targeted therapy are diarrhea and liver problems. Other side effects may include mouth sores and hair and nail changes. Learn more about the side effects of cancer treatment and steps you can take to manage or prevent them.

Sources: diarrhea · mouth sores · nail changes · side effects of cancer treatment

Triple-negative breast cancer (also called TNBC) does not have targets that are typically used to treat other types of breast cancer, but treatment options are available. You and your cancer care team will work together to create a personalized treatment plan, which may include more than one type of treatment. Learn more about Triple-Negative Breast Cancer.

Sources: Triple-Negative Breast Cancer

Treating stages I–III triple-negative breast cancer

If the cancer is small enough to be removed by surgery, the first treatment for stages I–III (also called stages 1 through 3) TNBC will usually be lumpectomy or mastectomy.

Sources: lumpectomy · mastectomy

Learn more about Breast Cancer Surgery.

Sources: Breast Cancer Surgery

For larger tumors, chemotherapy may be given before surgery to shrink the cancer enough to make surgery possible and lessen the amount of breast tissue that needs to be removed during surgery. Additional drugs, such as the immunotherapy drug pembrolizumab, may be given with chemotherapy. Receiving treatment before surgery, called neoadjuvant therapy, may also improve long-term outcomes.

Sources: chemotherapy · immunotherapy · pembrolizumab

Learn about local and systemic treatments and access in-depth information about each type of treatment.

After surgery for TNBC, other treatments may be given to destroy any remaining cancer cells. These include:

Treating metastatic or stage IV (also called stage 4) triple-negative breast cancer

In metastatic (stage IV or stage 4) TNBC, the cancer has spread beyond the breast and nearby lymph nodes to distant parts of the body. Treatment for stage IV TNBC is focused on managing the disease and improving quality of life. Treatment options may include:

Treatment for recurrent triple-negative breast cancer

Treatment for TNBC that has recurred (come back) in distant parts of the body may be similar to treatment for stage IV breast cancer. When the cancer recurs locally, such as in the breast or nearby lymph nodes, surgery and radiation therapy may be an option to remove or shrink the tumor.

Learn more about treatments for breast cancer and breast cancer recurrence.

Sources: treatments for breast cancer · breast cancer recurrence

Clinical trials

Connect with a cancer information specialist at 1-800-4-CANCER, through live chat, or by email.

Joining a clinical trial may be an option. There are different types of clinical trials for people with breast cancer. For example, a treatment trial tests new treatments or new ways of using existing treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.

You can use the clinical trial search to find NCI-supported cancer clinical trials that are accepting participants. This search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. You can also review a list of NCI-supported Breast Cancer Clinical Trials. Clinical trials supported by other organizations can be found at ClinicalTrials.gov.

Sources: clinical trial search · Breast Cancer Clinical Trials · ClinicalTrials.gov

Learn more about clinical trials at Cancer Clinical Trial Information for Patients and Caregivers.

Sources: Cancer Clinical Trial Information for Patients and Caregivers