Treatment of breast cancer

Surgery is often the first line of treatment for breast cancer. When planning the surgery, we take into account factors such as the extent of the tumor, the size of the breast, and the characteristics of the tumor. We make surgical decisions on a case-by-case basis, taking your wishes into account as well.

Before breast cancer surgery

If your breast cancer treatment is initiated with preoperative medication, i.e., neoadjuvant therapy, the duration of the treatment period is 6 months. After your drug therapy, you will proceed to surgery.

Breast-conserving surgery, also known as a resection or lumpectomy

The most common procedure is breast-conserving surgery, also known as a lumpectomy (resection). In this procedure, we only remove the tumor and some of the surrounding tissue. We preserve healthy breast tissue and, if necessary, reshape it using various surgical techniques.

If the area to be removed is large and it is likely that the difference in breast size will remain significant, we may sometimes consider reduction mammaplasty, i.e., reducing the size of the other breast, either at the same time or later, after other cancer treatments have been completed.

Breast removal, or mastectomy

We perform a total mastectomy if the tumor is large relative to the size of the breast, if there are multiple tumors, or if a lumpectomy is not possible for other reasons, such as previous radiation therapy. In some cases, a patient may also have a genetic mutation, in which case a mastectomy is recommended.

In some cases, we may consider breast reconstruction in conjunction with a mastectomy, either immediately during the same surgery (immediate breast reconstruction) or at a later stage (delayed reconstruction), once you have recovered from any other cancer treatments. We can reconstruct the breast using an autologous tissue graft, such as muscle from the abdomen or back, a prosthesis, fat transfer, or a combination of these methods.

During breast cancer surgery, we often also check for possible spread of the cancer to the lymph nodes in the armpit, as this affects the choice of follow-up treatment. We do this by removing a few lymph nodes from the armpit during breast surgery – nodes that were typically identified prior to surgery using sentinel lymph node imaging – to obtain a sample (sentinel lymph node biopsy). 

Lymph node removal surgery, also known as axillary lymph node dissection

If the spread of breast cancer has already been confirmed in your axillary lymph nodes prior to surgery and no preoperative drug therapy is planned, we may decide on performing an immediate procedure to remove your axillary lymph nodes, also known as axillary lymph node dissection. In this procedure, we remove the fat and lymph nodes from the armpit. 

Postoperative care for breast cancer

We will plan your post-operative follow-up care in a multidisciplinary breast cancer meeting. If necessary, we will schedule an appointment for you with a wound care specialist or physiotherapist. Treatment recommendations from the breast cancer meeting will be immediately available in the Maisa Portal.

We will make the first post-operative appointment for you to see an oncologist in the Medical Treatment Unit or Radiation Therapy Ward at the Comprehensive Cancer Center. Your appointment is usually about 3–4 weeks after surgery.

• If an initial plan for chemotherapy has been made for you, your appointment will be in the Medical Treatment Unit. Appointments for patients for whom we are initially planning hormonal therapy without radiation therapy are also arranged in the Medical Treatment Unit.
• The patients for whom we have planned radiation therapy alone as follow-up therapy and the patients who are to receive both radiation therapy and hormonal therapy as follow-up therapy, we refer to the Radiation Therapy Ward.

If you do not require follow-up care after your surgery but your condition is being monitored at the Comprehensive Cancer Center, we will inform you of your follow-up plan by phone.

During the appointment, we will review your treatment plan

During the appointment, a physician and a nurse will review your treatment plan, its implementation, and the side effects of the treatment with you. The oncologist will tell you what adjuvant therapies are recommended for you. We may perform laboratory testing or imaging examinations, such as a computed tomography scan of the body, beforehand. It is recommended that you fill in the patient history form sent to you with the invitation already before your appointment either electronically or on paper.

Your treatment usually starts about a month after the surgery, depending on the healing of your wounds.

During your appointment, we will also discuss your rehabilitation needs, such as mental health support, physical therapy, and counseling provided by a social worker. You will also receive the necessary forms for sick leave, medications eligible for special reimbursement, and a commitment to cover the cost of a wig.