Breast cancer, treatment, and surgery, explained.

Understanding a breast cancer diagnosis

Breast cancer is not one disease. The pathology report from your biopsy describes which kind you have, and that description drives most of the decisions that follow.

Non-invasive: ductal carcinoma in situ (DCIS)

DCIS means abnormal cells are confined to the milk ducts and have not spread into the surrounding breast tissue. It is highly treatable. The main decisions are about the extent of surgery and whether radiation adds benefit. DCIS has been a particular research interest of Dr. Mabry's since her fellowship, including work on how surgical margins affect the risk of recurrence.

Invasive breast cancer

Invasive ductal and invasive lobular carcinoma have grown beyond the duct or lobule into breast tissue, which means they can reach the lymph nodes and beyond. Treatment usually combines surgery with some mix of radiation, hormonal therapy, chemotherapy, or targeted therapy, depending on the tumor's features.

What the report tells us

• Size and grade. How large the tumor is and how abnormal the cells look under the microscope.
• Receptor status. Whether the cancer responds to estrogen or progesterone (ER, PR) and whether it makes too much of the HER2 protein. These results decide which medicines will work.
• Lymph node status. Whether cancer has reached the nodes under the arm, which helps determine stage.
• Stage. A summary of size, node involvement, and spread that guides the overall plan and the expected outcome.

How treatment is planned

Modern breast cancer care is a team effort. At Mercy Health, Dr. Mabry works with medical oncologists, radiation oncologists, breast radiologists, pathologists, genetic counselors, and plastic and reconstructive surgeons. Cases are reviewed together so the sequence of treatment fits the biology of the cancer, not just the calendar.

• Surgery first is common for early-stage cancers and DCIS.
• Medicine first (neoadjuvant therapy) is often used for larger, HER2-positive, or triple-negative cancers to shrink the tumor and learn how it responds before surgery.
• Radiation usually follows breast-conserving surgery and is sometimes recommended after mastectomy.
• Genetic testing may be recommended based on age, family history, or tumor type, and can change the surgical recommendation.

Surgery as an option

Nearly every breast cancer is treated with an operation at some point. The two broad choices are removing the tumor with a margin of normal tissue (lumpectomy, also called breast conservation) or removing the breast (mastectomy). For most early-stage cancers, long-term survival is the same with either approach when lumpectomy is combined with radiation. The right choice depends on the size and location of the cancer relative to the breast, whether there is more than one area of disease, genetic risk, your ability to have radiation, and your own preferences.

Breast conservation and oncoplastic lumpectomy

A lumpectomy removes the cancer with a rim of healthy tissue. Oncoplastic techniques borrow from plastic surgery to rearrange the remaining tissue so the breast keeps a natural shape, even when a larger area must be removed. In selected patients, reducing or lifting both breasts at the same time can improve symmetry and make radiation easier to deliver. Dr. Mabry trained in these techniques during her fellowship and has used them throughout her career.

Skin- and nipple-sparing mastectomy

When mastectomy is recommended or chosen, the breast tissue is removed while preserving as much skin as is safe. In appropriate patients the nipple and areola can be preserved as well. Dr. Mabry coordinates with reconstructive surgeons before the operation so that immediate reconstruction, with implants or your own tissue, can begin at the same surgery when it is clinically appropriate. Some women choose no reconstruction, and that is fully supported too.

Sentinel lymph node biopsy

The sentinel nodes are the first lymph nodes that drain the breast. Identifying and removing only those nodes tells us whether cancer has spread while sparing most patients a full axillary dissection and its risk of lymphedema, numbness, and stiffness. Dr. Mabry has published on sentinel node mapping and its evolving indications, including in DCIS.

High-risk assessment and prevention

Some women face a higher lifetime risk of breast cancer because of a family history, an inherited mutation such as BRCA1 or BRCA2, prior chest radiation, or high-risk lesions like atypical hyperplasia or lobular carcinoma in situ found on biopsy. Care may include:

• A formal risk assessment and referral for genetic counseling and testing
• Enhanced screening, often alternating mammography and breast MRI
• Risk-reducing medication when appropriate
• Risk-reducing surgery, discussed carefully and never rushed

Benign breast disease

Most breast lumps, most abnormal mammograms, and most biopsies are not cancer. Fibroadenomas, cysts, nipple discharge, breast pain, and infections are common and treatable. Even when the answer is reassuring, patients benefit from a careful evaluation, a clear explanation of what was found, and a plan for follow-up so nothing is left uncertain. Dr. Mabry also performs minimally invasive, ultrasound-guided procedures for selected benign lesions.

Questions worth asking at your visit

• Exactly what kind of breast cancer do I have, and what stage is it?
• Am I a candidate for breast conservation? If not, why?
• Will I need radiation, and does that change with the type of surgery?
• Should I have genetic testing before deciding on surgery?
• What will my breast look like afterward, and what reconstruction options fit my situation?
• What is the recovery like, and when can I return to normal activity?
• Who is on my team, and who do I call with questions?

Write your questions down and bring someone with you. Dr. Mabry would rather answer a long list than have you leave with something unasked.

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