Treatment varies according to the type and stage of cancer, but surgery remains the first choice for most tumors. The majority of operations now are less disfiguring than the radical mastectomy that was standard until the 1970s. Operations for breast cancer are Extended radical mastectomy involves removal of the breast, underarm lymph nodes, and underlying chest muscles. This procedure, rarely performed today, is reserved for women with large tumors that are attached to or have invaded the chest muscle and its connective tissues. If the mammary lymph nodes deep in the chest are involved, they will also be removed. Modified radical mastectomy is the removal of the breast, underarm lymph nodes, and sometimes part of the chest muscle. The amount of tissue removed from the underarm depends on the spread of the tumor. This remains the most common operation for women with invasive breast cancer. Total, or simple, mastectomy is the removal of the entire breast, including its extensions to the armpit and some times near the collarbone. Because the lymph nodes are left intact, radiation therapy usually follows the operation.

Subcutaneous mastectomy involves removing the breast tissue but leaving the skin and nipple intact. A prosthesis is then slipped under the skin to restore normal appearance. This procedure is rarely performed, because it may miss cancer cells and the cosmetic results are often poor. Lumpectomy or partial mastectomy involves removal of the cancerous lump and a surrounding margin of normal tissue. Some of the armpit lymph nodes are also taken out and examined for spread, and the operation is followed by radiation therapy. Preventative, or prophylactic, mastectomy is the removal of a breast to prevent the development of cancer. This operation is done only if a woman has a very high risk of breast cancer and is so worried by the prospect that she cannot live a normal life. Breast reconstruction by a plastic surgeon can sometimes be performed immediately following a mastectomy, but more often it is done after the original incision has healed. If the opposite breast is larger, it may be reduced in size to match the reconstructed one, either at the same time as the reconstruction or in a later operation. In the past, a prosthetic implant filled with silicone gel was the first choice for reconstruction. Because questions have arisen about the long term safety of silicone, many women are now opting for implants filled with a saline solution, or a more extensive procedure in which fatty tissue from the woman's own buttocks or elsewhere is used to reconstruct a breast.

Radiation Therapy . The purpose of this treatment is to destroy any cancer cells that may have escaped surgical removal. Radiation is routinely administered after a simple mastectomy and a lumpectomy, or if numerous lymph nodes have been affected. It is also prescribed for recurring or inoperable cancer, and to alleviate the pain of advanced cancer. Typically, radiation treatments are begun two or three weeks after the surgery, or after the scar has healed and the woman has regained the use of her arm. Immediate side effects include blistering of the skin and fatigue. Later, the skin exposed to the radiation may darken, thicken, and lack sensitivity if any nerve endings have been damaged. Long term complications may include impaired lung function due to scar tissue, an increased risk of heart disease, and easy fracturing of the ribs. Chemotherapy. Studies indicate that adjuvant chemotherapy greatly increases long term survival, even for women with localized stage I cancer.

Chemotherapy may begin before surgery; however, it is usually started a few weeks afterwards. This treatment is also prescribed for recurrent or inoperable cancers. Chemotherapy appears to be most effective in preventing a recurrence among younger women who have not gone through menopause. The side effects loss of hair, nausea, reduced immunity to infections, mouth sores, fatigue, and bleeding problems are temporary, but still very trying. For this reason, chemotherapy may not be recommended for an older woman, especially if her cancer is localized. Hormone Therapy. Cancer specialists now believe that almost all breast cancer patients can benefit from hormone therapy, even if their tumors are not the type stimulated by estrogen or proges terone. Thmoxifen (Nolvadex), a drug that blocks estrogen, is the treatment of choice. It has fewer side effects than anticancer drugs, although it may cause hot flashes and other menopausal symptoms in younger women. Other, more radical approaches to hormone manipulation include ovarian ablation, a procedure in which the ovaries are either surgically removed or destroyed by chemicals or radiation, and perhaps the removal of other hormone producing glands.

Experimental Treatments

Women with advanced breast cancer may be candidates for experimental therapies such as hyperthermia, in which very high fevers are induced to kill cancer cells,photodynamic therapy, which uses a light sensitive anticancer drug; and bone marrow transplantation, in which the woman's bone marrow is destroyed by drugs and then replaced with healthy marrow to bolster the body's ability to fight the cancer.