Overview

Understanding breast cancer

Breast cancer usually is found one of two ways: by a screening mammogram image or by a change in the breast found by a woman, her partner or her healthcare provider. Once breast cancer is found it is important that you understand your breast cancer. This is the first step in your treatment journey. We will work with you and tailor your treatment to your individual needs.

Pathology

What does your breast cancer diagnosis mean?

You may have heard that a pathologist is the most important doctor you will never meet. This is especially true with a cancer diagnosis. At UW Health, your breast tissue will be reviewed by at least two breast pathologists. This important doctor will determine your diagnosis, which helps determine which treatments are recommended for you.

The importance of pathology

At the UW Health Breast Center, our pathologists specialize in breast tissue, providing our patients with the expertise they need.

Terms you may hear

You may hear a lot of different terms related to a cancer diagnosis that can be confusing. Following are common questions you might have.

  • Benign: Normal breast tissue

  • Atypical: Different from normal breast tissue but not cancerous

  • Malignant: Cancerous cells

  • In situ: Cancer cells are confined within the structures of the breast

  • Invasive: Cancer cells have moved outside the structures of the breast (ducts and lobules) and into surrounding breast tissue

  • Grade 1: Low grade, most like normal cells

  • Grade 2: Medium grade

  • Grade 3: High grade, cells are significantly different from normal cells

  • ER positive: The cancer cells grow in response to estrogen

  • PR positive: The cancer cells grow in response to progesterone

  • HER2/Neu amplified: The cancer cells grow in response to human epidermal growth factor receptor proteins

The pathologist will review lymph nodes removed during a sentinel lymph node biopsy or an axillary dissection and will report the number of nodes found to have cancer cells.

Under 40

What you need to know if you're under 40

For women diagnosed with breast cancer under age 40, the UW Health Breast Center experts offer thoughtful treatment plans that may include specialized services such as genetic counseling and fertility preservation.

For women diagnosed with breast cancer under the age of 40 it is important they find care that addresses their unique needs. At the UW Health Breast Center a team approach ensures every patient receives care tailored to them.

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Breast Center
Outstanding care for all breast conditions

Our expert team of doctors and other healthcare professionals cares for more than 850 new breast cancer patients and more than 3,000 survivors each year. We also care for many patients with non-cancerous breast conditions and those who are at high risk for getting breast cancer. This wide variety of breast care gives our Breast Center team a level of experience that is unsurpassed in Wisconsin and the region.

Treatments and research

No two breast cancers are exactly alike

Through screening, diagnosis, treatment as well as clinical trials and research, you and your family will get a personalized treatment program tailored to your needs as an individual.
Women, and men, with breast cancer have unique emotions, challenges and needs. Each person also has a unique disease, as no two breast cancers are exactly alike.

At the UW Carbone Cancer Center, our care for breast cancer is unique as well. Here, you will find treatments, knowledge and support that few can match. We are Wisconsin’s only Comprehensive Cancer Center. This title comes from the National Cancer Institute. It speaks to the strength of our patient care and reflects our commitment to research and education — for the public and cancer professionals.  

When you turn to us, you will have a large team of nationally renowned breast cancer experts ready to help. We first learn all we can about you and your specific cancer. Then, we work with you to create a personalized plan to treat it.

The UW Health breast team offers multi-disciplinary video visits so you can meet with our team virtually. We will evaluate your breast biopsy and cancer as well as review your breast imaging. Once these reviews are complete we will arrange a video visit with a surgeon, medical oncologist and radiation oncologist so you can discuss treatment options, clinical trials and options for care at UW. This approach can be used for women with a new diagnosis of breast cancer or those with metastatic disease which means breast cancer that has traveled to other parts of the body.

Breast surgery

Most individuals with breast cancer have surgery as part of their treatment plan but it may not always be the first treatment needed. The multi-disciplinary team will work with you to determine which treatment should be first in the care of your breast cancer.

There are two main types of surgery on the breast:

This is also known as lumpectomy or partial mastectomy. It involves removing your cancer and some healthy tissue around it (to ensure a negative margin) while preserving your breasts shape and contour. Survival with this surgery is the same as surgery to remove your breast (mastectomy). The UW Health breast team uses oncoplastic techniques to ensure the breast has the best appearance after your surgery.  Factors we consider when deciding if you’re a good candidate include:

  • The size of your cancer compared to the size of your breast

  • Your preferences

  • Your ability to safely receive radiation therapy after surgery if recommended after breast conservation

This is surgery to remove the whole breast. Occasionally, we can save the skin and nipple of your breast and you may choose to have breast reconstruction surgery at the time of your mastectomy.  You will be referred to one of our expert plastic surgeon to discuss the best options for reconstruction, tailored to you. 

Lymph node excision

Lymph nodes are bean-like structures that are part of your immune system. Breast cancer cells that break away from a tumor often end up in your lymph nodes that drain the breast. They may travel through vessels that carry lymphatic fluid throughout your body to fight infection. In many cases, doctors try to learn if cancer cells are present in your lymph nodes. This tells them more about how the breast cancer is behaving in your body. One of two types of lymph node removal surgery are frequently recommended with the breast surgery. 

A sentinel node surgery is done to look for cancer in the node (or nodes) where breast cancer cells that break away from a tumor are likely to travel to first. This sentinel nodal excision often takes place at the time of your breast cancer surgery. Surgeons locate your sentinel node by injecting a dye or dyes into your breast. They watch to see which nodes the dye reaches first. They then remove those node or nodes so pathologists can examine them for cancer. If they find cancerous cells, you may or may not need to have more lymph nodes removed.  Most women only need 2-3 sentinel nodes removed.

This is a procedure that involves removing many lymph nodes from under your arm (typically greater than 10 though the number can vary). This type of surgery is done less commonly than sentinel lymph node surgery but is the best option for some women who have many lymph nodes with cancer in them. 

Plastic and reconstructive surgery

Options for reconstructive surgery

Dr. Sam Poore of the UW Health Breast Center talks about reconstruction options.

Reconstructive surgery

We can rebuild your breast with implants filled with saltwater or silicone which may be placed behind or in front of your chest muscle/pectoralis muscle

Two-stage reconstruction - This involves first stretching the skin and muscles of your chest. We use an expander that’s like an implant, but it’s only temporary. Over time, we fill the expander with a saltwater solution though a tiny port beneath your skin. Once we reach your desired breast size, we remove the expander and place the implant.

One-stage reconstruction - With this procedure, we rebuild your breast without the expansion process. 

The DIEP flap procedure uses fat and skin from your lower abdomen to create a breast which is as natural looking as possible. It results in a “tummy tuck” at the same time. This reconstruction avoids using the muscle of your belly or rectus muscle to avoid damaging your core strength

We can rebuild your breast with implants filled with saltwater or silicone which may be placed behind or in front of your chest muscle/pectoralis muscle

Two-stage reconstruction — This involves first stretching the skin and muscles of your chest. We use an expander that’s like an implant, but it’s only temporary. Over time, we fill the expander with a saltwater solution though a tiny port beneath your skin. Once we reach your desired breast size, we remove the expander and place the implant.

One-stage reconstruction — With this procedure, we rebuild your breast without the expansion process. 

This procedure involves tunneling muscle, skin and fat from your back under the skin near your armpit. We move it to the site of your mastectomy. There, we use the tissue to rebuild a natural-looking breast. We may also place an implant as part of this procedure.

After reconstruction, we offer procedures to make your breast look like it has a natural nipple and areola. The areola is the colored area of skin that surrounds the nipple.

Surgical nipple reconstruction — We usually do this procedure several months after breast reconstruction. It involves raising a flap of tissue on your new breast. The surgeon then shapes it to look like a nipple. Tattooing the area around the nipple gives it a more natural appearance.

Breast tattooing — Tattooing can be done after a nipple reconstruction to color the area of the areola. We also offer 3d tattooing which can be done without a surgical nipple reconstruction

After breast cancer surgery, one breast may have a different size and shape than the other. We offer procedures to lift your unaffected breast and reduce or increase its size. The goal is to help both breasts look similar. 

If you’re considering reconstructive surgery, contact us to schedule an appointment with one of our surgeons.

This operation combines breast conservation therapy (lumpectomy and radiation) with a breast reduction. This operation is a safe method for reducing the size of the breast at the time of the lumpectomy. Advantages include obtaining symmetry prior to radiation therapy and relieving the symptoms of overly-large breasts (back pain, shoulder pain, bra strap grooving, etc.).

Medical Therapy

Medical therapy for breast cancer treatment includes medications given orally as well as by a vein (IV, intravenous). Medical treatments include targeted as well as chemotherapies. These medications are used for patients with primary breast cancer as well as those with metastatic disease and are administered to:

  • Control cancer symptoms

  • Prevent cancer from returning

  • Slow cancer growth 

Targeted therapies

Targeted therapies are medicines that kill specific types of cancer cells. Because they are focused on unique features of the cancer, these drugs often cause fewer side effects than chemotherapy. Even so, they can be powerful at controlling the breast cancer when tailored to specific targets. Types of targeted therapies include:

These medications block or decrease levels of hormones that can spur cancer growth if your cancer is estrogen or progesterone sensitive or positive.

About 1 in 5  breast cancers depend on human epidermal growth factor receptor 2 (HER2) to grow. HER2 targeted therapies can help stop the growth of these cancers.

This class of medications is used in combination with endocrine therapy in certain individuals. They block a part of the cell cycle that is important for resistance to endocrine therapy.

This class of medications is used for the treatment of breast cancers which arise in those with BRCA1 or 2 mutation. 

This class of medications include the PD-1/PD-L1 inhibitors. They are currently only used for some individuals with triple negative breast cancer.

UW Health providers are on the cutting edge of research and are evaluating through clinical trials new drugs for breast cancer.      

Chemotherapy

Chemotherapy is a class of medications that destroy growing cells, such as cancer. It may be given before or after surgery and is often a combination of several chemotherapy medications.

We deliver chemotherapy by vein (intravenous; IV) or mouth. The medicine travels through most parts of your body. Depending on your needs, we may use the treatment to:

  • Destroy cancer cells that may have escaped from your breast to other parts of your body

  • Shrink a tumor in the breast or lymph nodes to make it easier to remove

  • Determine how your cancer responds to treatment (when given before surgery)  

Because chemotherapy travels throughout your body, it can affect healthy cells in addition to cancerous ones. Damage to healthy cells may cause side effects. In many cases, we can limit these side effects by:

  • Selecting the minimal necessary chemotherapy

  • Recommending supportive care such as light exercise and bland diets

  • Recommending medications to help counter the side effects

Radiation therapy

Radiation therapy uses high-energy X-rays to kill cancer. Unlike chemotherapy, which treats your whole body, radiation treatment focuses on a specific location. We may use it after surgery to treat areas where breast cancer cells might remain. We may also use radiation if cancer cells have traveled from your breast and started growing in other areas of your body. At UW Health, we offer the most advanced radiation treatments available. We use the type that’s best for you.

Breast brachytherapy

This treatment gives high doses of radiation to the cancerous area of your breast over a short period of time. It involves placing small, thin tubes called catheters directly into your breast. We then pass radioactive seeds or pellets into the tubes. They stay there for about 10 minutes before we remove them. In most cases, we do this treatment twice a day for five days.

Learn more

This treatment involves delivering radiation from a machine. We aim the radiation  so that it precisely conforms to the exact place your tumor was. This limits exposure to healthy nearby tissue.

We use this for breast cancer that hasn’t spread beyond your breast or nearby lymph nodes and that was treated by removing your tumor rather than your entire breast. It involves delivering radiation to your breast five days a week over three to four weeks.

IMRT delivers radiation from several different angles. We’re able to change the size, shape and strength of the beams. This helps us match the size, shape and location of the area we’re treating. It also helps us limit how much radiation the healthy tissue receives.

IGRT uses CT scans and MRIs to identify parts of the breast needing treatment. We offer this treatment with IMRT. It allows us to deliver radiation with great precision.

We provide this treatment while you lie on a table on your stomach. We aim the rays at your breast through an opening in the table. Prone breast radiation may be helpful if you have larger breasts. It can reduce radiation exposure to your heart and lungs. 

Improving cancer prevention, detection and treatment through research

At UW Health, we have one of the top breast cancer research teams in the country. Our goal is to discover better ways to find, prevent and treat breast cancer. We also work to improve patients’ lives.

If you are a patient, we will ask you if we can do research using your medical information, or tissue removed from your body in cancer treatment. Researchers at the University of Wisconsin or collaborators will then be able to use these to understand and improve future treatment of breast cancer. We invite you to watch this video about biobanking. Please ask any member of your care team about how to participate.

Types of Clinical Trials

We have many clinical trials designed to improve treatments tailored to unique breast cancer types and clinical situations.  There are different types of trials:

On these studies, you receive standard of care, but a sample will be collected or a test done such as a PET scan, biopsy, or blood test.

All UW patients receive the best standard-of-care treatments.  These trials test if the treatments can be improved by modifying one part of the treatment—adding, subtracting, replacing.  For these studies, you and your provider will not select the treatment, but both will be scientifically and ethically reasonable, as judged by your provider, and independent review teams. 

On these studies, everybody gets the promising new surgery, medicine, or radiation type in addition to the standard-of-care treatments. 

As a major research center, we are testing the most recently discovered medications or new combinations of existing medications.  These studies are offered most commonly offered in the setting of metastatic cancer.

Clinical Trials

The University of Wisconsin Carbone Cancer Center has many trials and the portfolio changes rapidly. The options for you will depend on the particular cancer type, clinical situation and current trial availability. You are never obligated to participate in a trial to receive treatment.  Your provider will not recommend trials that are not in your best interest. Ask your provider what trials are available for you to choose from. Learn more about clinical trials

Another research project is focused on people who live for years or decades with metastatic breast cancer. We are trying to learn from these ‘Outliers’ how they survive and thrive even when the breast cancer is not cured. We are recruiting people with metastatic breast cancer to participate in this project. For more information go to the outliers website.

PATHS Clinic

If you and your primary care provider decide you have a higher-than-normal risk of breast cancer, our PATHS Clinic can be an important resource for you. The clinic can help you learn more about screening and how to determine the best tools to manage your risk.

Learn more

Meet our team

A team that offers unmatched expertise, support and compassion

At UW Health, breast specialists provide all your care. From screening and diagnosis to treatment and reconstruction, our team focuses on your unique health and needs. You have access to the nation’s top doctors in surgery, reconstructive surgery, radiation therapy, medical oncology, radiology and pathology.

A full support team that includes nurse navigators, nutritionists, health psychologists, genetic counselors and more who will be at your side throughout your treatment. At UW Health, we care for every aspect of your physical and emotional well-being.

Breast surgical oncology
Breast advance practice providers
Breast medical oncology
General internal medicine
Plastic and reconstructive surgery
Radiation oncology
Breast imaging
Community radiology
Radiology
Breast pathology
Genetic counselors

Locations

Breast center locations

Our Breast Center has locations at the UW Hospital campus and at the 1 S. Park St. Clinic. We offer screening mammograms at eight locations throughout Dane County.

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  • UW Carbone Cancer Center - Breast Cancer Clinic
    • 600 Highland Ave. / Madison, WI
    • (608) 266-6400
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  • University Hospital - Breast Center
    • 600 Highland Ave. / Madison, WI
    • (608) 266-6400
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  • 1 S. Park Clinic - Breast Center
    • 1 S. Park St. / Madison, WI
    • (608) 287-2050
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  • UW Health Surgery at SwedishAmerican - Breast Surgery
    • 1340 Charles Street, Suite 100 / Rockford, IL
    • (779) 696-8700
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Get a second opinion

We want you to feel comfortable about your diagnosis and find the best therapy for you. Through a second opinion, you may also learn about new treatment options and find new hope.

Learn more

Patient support and services

UW Health support services and resources

We know how challenging it is to deal with breast cancer. We also know that having the right support and information can make things easier. We offer a number of resources to serve you and answer your questions.

Find answers to your questions

One of the most unpleasant side effects of cancer treatment can be hair loss. Hair loss is caused because chemotherapy targets quickly dividing cells including hair cells.

At UW Health we offer scalp cooling caps. These are silicone caps that are cooled to a very low temperature by using circulating cooling fluid. Worn during and after chemotherapy treatments, they reduce blood flow your hair follicles and can help reduce or prevent hair loss. Cooling caps can be used in cancer patients who have solid tumor cancers and are most effective for patients receiving taxane chemotherapy. Cooling caps cannot be used in patients with leukemia or for anyone who cannot tolerate extremely cold temperatures.

We work with Paxman Scalp Cooling to make cooling caps available to our patients receiving care at our Breast Centers. If you are interested in cooling caps, please speak to your oncologist to see if cooling caps is an option for you. Our staff will work with you to schedule the equipment . You will then work directly with Paxman to complete sign up and payment.

The UW Clinical Genetics Center helps people with concerns about their personal or family history of cancer. Counselors assess your risk and offer guidance on steps you and your family can take to protect yourselves.

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Many women have sexual health concerns when they're dealing with cancer. The WISH Program offers support and can direct you to resources that can help.

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After breast cancer treatment, you might wonder "What comes next? And how do I stay healthy?" The UW Health Breast Cancer Survivorship Program has answers to these and any other question you may have. Our goal is to give you suggestions for staying healthy - now and in the future.

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Additional resources

Meet our patients

Patient wearing cooling cap with Bucky Badger
Patient wearing cooling cap with Bucky Badger
DeeAnn's story

DeeAnn Schmidt's family is no stranger to cancer. She was the third sister in the family to be treated for breast cancer. But thanks to the use of cooling caps, she was able to keep her hair, which helped her feel like she could face anything.

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Cooling Caps 67897-9516.jpg
Cooling caps helped Amber during treatment

When she was undergoing breast cancer treatment, Amber used cooling caps, which helped her keep her thick, long black hair. It helped her feel a little better during treatment.