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Breast Cancer Treatment and Surgery in Los Angeles
Reviewed by Elizabeth Arena, MD, FACS.
Every breast cancer diagnosis is different, and your treatment should be too. Dr. Elizabeth Arena provides personalized breast cancer treatment and surgery for patients in Los Angeles and Southern California, helping women understand their options and choose an approach that balances effective cancer care with their individual priorities. From breast-conserving and oncoplastic surgery to nipple and sensation preserving mastectomy, each surgical plan is thoughtfully designed around the patient, not just the diagnosis.
What is breast cancer?
Breast cancer starts when cells in the breast grow out of control and form a tumor. Most breast cancers begin in the milk ducts, the tubes that carry milk to the nipple; others begin in the lobules, the glands that make milk. A cancer is called invasive once its cells have grown through the wall of the duct or lobule into the breast tissue around it.
Invasive cancer cells can travel along the lymph vessels to the lymph nodes under your arm, which is why breast cancer surgery usually includes checking those nodes. Breast cancer is far more common in women, and it also develops in men.
What are the signs of breast cancer?
Many breast cancers are found on a screening mammogram before there is anything to feel. When there is a sign, the most common one is a new lump or mass in the breast. Other changes that can point to breast cancer:[2]
- Swelling: of all or part of your breast, even when you cannot feel a lump.
- Skin dimpling: skin that puckers or looks like the peel of an orange.
- Nipple retraction: a nipple that has recently turned inward.
- Skin changes on the nipple or breast: redness, dryness, flaking or thickening.
- Nipple discharge: fluid other than breast milk.
- Swollen lymph nodes: under the arm or near the collarbone.
Most breast lumps are not cancer. If you have found a change and have not had a biopsy yet, our page on finding a breast lump covers the next steps.
Which type of breast cancer do you have?
Your biopsy report names the type of breast cancer, based on where it started and whether it has grown beyond the duct or lobule. The type affects which imaging Dr. Arena orders before surgery and, in some cases, which operation she recommends. Ductal carcinoma in situ (DCIS) stays inside the milk duct, while invasive ductal and invasive lobular carcinoma have grown out of the duct or lobule into the surrounding breast tissue. Papillary carcinoma can be either.
Invasive ductal carcinoma
Invasive ductal carcinoma (IDC) starts in a milk duct and grows through its wall into the breast tissue. It accounts for about 8 in 10 breast cancers and usually forms a lump that shows on a mammogram or ultrasound.[3] Surgery is lumpectomy or mastectomy, together with a sentinel lymph node biopsy, which removes the first few lymph nodes under your arm to check whether the cancer has reached them.
Invasive lobular carcinoma
Invasive lobular carcinoma (ILC) starts in the lobules and makes up about 1 in 10 breast cancers. Its cells tend to grow in single-file lines rather than a round mass, so ILC may not form a lump you can feel and can be harder to see on a mammogram.[4] Before surgery, Dr. Arena may order a breast MRI to see how far the cancer extends through your breast.
Papillary carcinoma of breast
Papillary carcinoma is rare, accounting for about 0.5% of new breast cancer diagnoses, or roughly 1 in 200.[5] Its cells grow in finger-like projections inside a duct, and the first sign is often a bloody nipple discharge or a lump.[5] Papillary carcinoma generally has a more favorable outlook than invasive ductal carcinoma.[5] Dr. Arena treats it with lumpectomy or mastectomy, adding a sentinel lymph node biopsy when the cancer is invasive.
What happens in the first days after a diagnosis?
Your operation is booked only after these steps, which usually run in this order:
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Pathology review
Dr. Arena reads your biopsy report for the type of tumor and its grade, which describes how abnormal the cells look under the microscope. The report also shows whether the cells have estrogen or progesterone receptors and whether they make too much of a protein called HER2.[6] Your medical oncologist uses these results to decide whether hormone therapy or HER2-targeted drugs are part of your treatment.
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Imaging
She reviews your mammogram and ultrasound images and repeats the ultrasound in her office to measure the tumor and check the lymph nodes under your arm. A breast MRI shows her the full extent of the tumor when the mammogram cannot.
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Genetic testing
If your age or family history suggests an inherited gene change such as BRCA1 or BRCA2, she offers genetic testing in the office, so the result is back before you choose your operation.
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Choosing your operation
At your consultation she explains each operation you could have, using your own imaging, and you choose one.
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Referrals to your other doctors
She sets up your appointments with a medical oncologist, a radiation oncologist and, if you want reconstruction, a plastic surgeon. Each of them receives your pathology results, your imaging and, after surgery, her operative report.
Will you need chemotherapy, radiation or other treatment?
Not every patient does. The need depends on the stage of the cancer, meaning its size and whether it has reached the lymph nodes; on the tumor's receptors and HER2 status; and, for some hormone receptor-positive cancers, on a genomic test of the tumor tissue such as Oncotype DX or MammaPrint. Medical and radiation oncologists prescribe these treatments, and Dr. Arena schedules your operation before or after them.
Surgery is often the first treatment. For larger tumors, and for some HER2-positive or triple-negative cancers (cancers with no estrogen, progesterone or HER2 receptors), chemotherapy or targeted drugs come first to shrink the tumor, and surgery follows.
| Treatment | What it does | Who usually has it |
|---|---|---|
| Radiation therapy | Aims high-energy X-rays at your breast, and sometimes the lymph nodes, to destroy cancer cells left after surgery | Most patients after lumpectomy; some patients after mastectomy |
| Chemotherapy | Uses drugs that kill fast-dividing cells, given before or after surgery | Depends on the stage, the receptors, HER2 status and genomic test result; many patients do not need it |
| Hormone therapy | Blocks estrogen and progesterone from attaching to receptors on the cancer cells[6] | Patients with hormone receptor-positive cancer |
| HER2-targeted therapy | Uses drugs that attack cells making too much HER2 protein | Patients with HER2-positive cancer |
Alongside these standard treatments, Dr. Arena incorporates alternative strategies in select cases, and she explains what each one involves as part of the plan she discusses with you.
What are the surgical options for breast cancer?
Breast cancer surgery either removes the tumor and keeps the breast (lumpectomy) or removes the breast (mastectomy), and most operations also check the lymph nodes under the arm. Dr. Arena places her incisions where they are least visible, such as along the edge of the areola or in the fold beneath the breast.
| Operation | What is removed | What stays |
|---|---|---|
| Lumpectomy (breast-conserving surgery) | The tumor and a rim of healthy tissue. A marker placed by the radiologist guides Dr. Arena to a tumor that cannot be felt. | Your breast and nipple. Radiation usually follows. |
| Oncoplastic lumpectomy | The tumor, after which Dr. Arena reshapes the remaining tissue in the same operation | Your breast and nipple, with the remaining tissue moved to fill the space where the tumor was |
| Simple (total) mastectomy | All the breast tissue, the nipple and the areola | The chest muscle and most of the underarm lymph nodes |
| Skin-sparing mastectomy | The breast tissue, nipple and areola, through a smaller incision | Most of the breast skin, which the plastic surgeon uses for reconstruction |
| Nipple-sparing mastectomy | The breast tissue from behind the skin and nipple | The skin, nipple and areola |
| Nerve-sparing mastectomy | The breast tissue, taken out around the nerves that supply the chest skin and nipple unless the tumor lies close to them | The nerves to your chest skin and nipple, so they may keep some feeling |
| Aesthetic flat closure | The breast and the excess skin | A smooth, flat chest wall, without reconstruction |
| Modified radical mastectomy | The whole breast and the lymph nodes under the arm | The chest muscle |
| Operation | What is removed | When it is used |
|---|---|---|
| Sentinel lymph node mapping and biopsy | The first few lymph nodes that fluid from the tumor flows to, found with a tracer injected before surgery | For most invasive cancers, to check for spread while keeping the other nodes and lowering the risk of arm swelling (lymphedema) |
| Axillary lymph node dissection | A larger group of lymph nodes from under the arm | When cancer is found in several lymph nodes |
Do you need breast reconstruction?
Reconstruction is optional, and you can have it during your mastectomy or later. Dr. Arena removes the cancer, and the plastic surgeon rebuilds your breast, often in the same operation as a skin-sparing or nipple-sparing mastectomy. You can also have reconstruction after radiation or chemotherapy ends. If you would rather not have reconstruction, Dr. Arena performs an aesthetic flat closure instead.
Why choose Dr. Arena for breast cancer surgery in Los Angeles?
- Double board certification: Dr. Arena is double board-certified in general surgery and complex general surgical oncology.
- Fellow of the American College of Surgeons (FACS): the College grants Fellowship after verifying a surgeon's credentials and reviewing their surgical case log, training and ethical conduct.[7]
- One surgeon from diagnosis to follow-up: at your first consultation, in the operating room and at each follow-up visit, you see Dr. Arena.
- Ultrasound and genetic testing in her office: you do not need a separate appointment at an imaging center or lab.
Choosing a breast cancer surgeon is about more than selecting a procedure, it is about finding someone who understands what matters to you beyond treating the cancer. Dr. Arena combines advanced breast surgical techniques with thoughtful, honest guidance, considering opportunities to preserve healthy breast tissue, natural appearance and sensation whenever medically appropriate.
Frequently asked questions
What is a breast cancer surgeon called?
A surgeon who specializes in operating on breast cancer is called a breast surgical oncologist. Dr. Arena is a surgical oncologist who operates on breast cancers, on the lymph nodes under the arm, and on benign breast conditions such as cysts and fibroadenomas.
How soon after a diagnosis is breast cancer surgery?
Dr. Arena schedules surgery once your imaging and any genetic test results are back and you have chosen your operation. If your treatment starts with chemotherapy or targeted drugs, surgery follows that treatment.
Can I get a second opinion before breast cancer surgery?
Yes. Dr. Arena reviews your pathology report, your imaging and the operation you have been offered, and tells you whether she would recommend the same surgery or a different one.
Sources
- American Cancer Society. Breast-Conserving Surgery (Lumpectomy). https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/breast-conserving-surgery-lumpectomy.html
- American Cancer Society. Breast Cancer Signs and Symptoms. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/breast-cancer-signs-and-symptoms.html
- Breastcancer.org. Invasive Ductal Carcinoma (IDC). https://www.breastcancer.org/types/invasive-ductal-carcinoma
- Breastcancer.org. Invasive Lobular Carcinoma (ILC). https://www.breastcancer.org/types/invasive-lobular-carcinoma
- Pal SK, Lau SK, Kruper L, et al. Papillary carcinoma of the breast: an overview. Breast Cancer Research and Treatment. 2010;122(3):637-645. https://pmc.ncbi.nlm.nih.gov/articles/PMC3244819/
- American Cancer Society. Breast Cancer Hormone Receptor Status. https://www.cancer.org/cancer/types/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-hormone-receptor-status.html
- American College of Surgeons. Surgeon Qualifications and Certifications. https://www.facs.org/for-patients/preparing-for-surgery/qualifications/
Speak with Dr Arena about your next step
Whether you have a new diagnosis, want another opinion, are weighing surgical options or need a concerning finding assessed, the first step is a consultation focused on your specific situation.
After you submit the request, the office will contact you to confirm the appropriate consultation and the records or information needed.
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