The future of breast cancer care is moving beyond one-size-fits-all treatments, says Dr. Mediget Teshome, chief of breast surgery and director of breast health at UCLA Health. Increasingly, care is tailored to each patient’s unique needs.
“Breast cancer was once viewed primarily as a surgical disease confined to the breast and lymph nodes,” Dr. Teshome explains. “Now we recognize it as a systemic disease that can affect the whole body.”
Advances in technology and collaboration across medical specialties are enabling more personalized treatment plans. “By combining surgery, radiation, medical therapies, and insights from genetics and tumor biology, we can maximize outcomes while minimizing risks,” she adds.
Breast-Conserving Surgery
Historically, breast cancer treatment relied on mastectomy or other invasive procedures. Today, many patients can choose breast-conserving surgeries that preserve natural tissue without compromising outcomes.
“Some women value preserving the breast not only for appearance but also for sensation and quality of life,” Dr. Teshome says. Collaboration with plastic surgeons further expands reconstructive options, including skin- or nipple-sparing mastectomies. For those who opt out of reconstruction, surgeons can create a natural, flat chest contour and offer custom prostheses.
Non-Surgical Interventions
In certain cases, surgery is not the initial step. Chemotherapy, hormone therapy, or targeted systemic treatments may shrink tumors before surgery, improving the likelihood of breast conservation.
This approach also applies to ductal carcinoma in situ (DCIS), a non-invasive form of breast cancer confined to milk ducts. Some patients may pursue more conservative or non-surgical options, as ongoing clinical trials investigate the effectiveness of medical therapies prior to surgery.
“Our understanding that breast cancer is not a single disease has led to targeted therapies for different subtypes,” Dr. Teshome notes. “This is a true game-changer in treatment planning.”
De-escalating Axillary Surgery
For early-stage breast cancer, doctors are increasingly reducing the extent of axillary lymph node removal. Full dissections can cause lymphedema, restricted arm movement, and numbness.
“Medications that treat the whole body can clear cancer in many patients, allowing us to start with less extensive procedures and tailor further treatment based on response,” she explains. This approach also informs the use of radiation and systemic therapies, reducing unnecessary treatment and improving patient tolerance.
Balancing Traditional and Personalized Care
Some cases still require standard treatments. Inflammatory breast cancer, for example, typically necessitates a mastectomy with full lymph node removal and no reconstruction.
“Our goal is always to optimize survival and reduce recurrence while minimizing side effects and improving quality of life,” Dr. Teshome says.
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