Breast Cancer

Although many general surgeons perform breast surgery, dedicated breast surgeons have the experience and knowledge to handle difficult or unusual cases, and are generally more likely to understand the complexities of breast diagnosis and treatment. The surgeons at the Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center perform breast surgery exclusively, and are nationally known as leaders in their field.

Yale surgeons were among the first to perform a lumpectomy instead of a mastectomy, and were instrumental in the development of noninvasive procedures like sentinel lymph node biopsy, intraoperative guidance by ultrasound, and advanced oncoplastic procedures.

Our surgeons are experienced in cutting-edge techniques, such as skin-sparing and nipple-sparing mastectomy, and often work hand-in-hand with our plastic surgeons to offer women a variety of options for breast reconstruction.

Many patients with breast cancer also need medical therapy, such as chemotherapy and/or endocrine therapy. Our team of experts utilizes both standard chemotherapies and novel targeted therapies to attack the cancer precisely while minimizing harm to normal tissues.

Our medical oncologists are nationally recognized for their contributions to breast cancer research. For example, investigators at Yale helped to elucidate the biology of a cellular receptor called HER2. As a result, our medical oncologists have been successful in developing treatment strategies for HER2-positive breast cancer, and have extended this expertise to provide effective therapies for triple-negative/basal-like and hormone receptor-positive breast cancer. They continue to study new treatments, and patients at Smilow Cancer Hospital have the opportunity to receive such novel therapies through clinical trials, many of which are not available elsewhere in Connecticut.

New and complicated patient cases are discussed weekly by the entire team so that every patient benefits from combined our expertise. In addition, our medical oncologists are happy to see patients for a second opinion. While many patients opt to have their care at Smilow Cancer Hospital, we work closely with our colleagues at Smilow Cancer Hospital locations throughout Connecticut, to ensure that patients can receive the same high-quality care in the most convenient setting for them.

Radiation therapy is a highly effective and integral part of treatment for many breast cancer patients. Smilow has the most advanced technology in the region; the equipment is state-of-the-art, and offers a high level of care.

Reconstructions vary from placement of a simple implant to complex reconstructions using natural tissue from the abdomen, thigh, or back. Careful attention is given to achieve the best possible cosmetic result and quality of life, without compromising the chance of cure. In each case, the approach is customized to best fit each patient’s needs and goals. For breast reconstructions involving the soft tissue, we offer microsurgery, using the Symani^® Surgical System for enhanced precision and control.

Our plastic and reconstructive surgeons have adopted an Enhanced Recovery pathway (ERAS), for all DIEP and free flap breast reconstruction surgeries. The pathway encourages the use of regional anesthesia and multimodal pain management techniques to reduce the need for opioids after surgery. Studies at Yale and at other centers have seen a significant reduction in opioid use, while still adequately managing post-operative pain. Using multiple methods for managing post-op pain can reduce unwanted side effects of opioids and enables the patient to feel better faster and go home sooner.

One of the most important elements of modern breast cancer treatment is the pathologic evaluation of tumor tissue. The growing ability of pathologists to profile tumors has led to new treatments, and a nuanced understanding of the many types of breast cancer. Our pathologists play a crucial role on our team, working to identify optimal, individual treatment strategies.

The Breast Imaging Center does approximately 89,000 breast studies each year including 50,000 screenings, 10,000 diagnostic tests, 900 MRIs, and 3,000 various procedures. The newest technology, digital tomosynthesis, creates a three-dimensional picture using breast X-rays for review. This allows our radiologists to look very closely at the breast tissue, often minimizing the need for repeat mammograms. In addition, we offer ultrasound and 3-Tesla breast MRI.

The Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center places great emphasis on nurturing the medical and emotional needs of our patients to ensure they have the most tranquil treatment experience possible. Intake specialists make sure patients are prepared for their first visits, and our clinical secretaries and schedulers will coordinate appointments that best fit our patients’ schedules. Our physicians work closely with our patient care associates, nurses, advanced practice providers, and nurse coordinators to ensure that our patients feel well-informed and supported every step of the way.

Our team extends to a network of essential services, including social work, pastoral support, dietary and nutritional aid, physical therapy, integrative medicine, pain management, and psychosocial support. Smilow also hosts a state-of-the-art Survivorship Clinic that employs a multidisciplinary team designed to address patients’ needs after treatment ends.

Smilow Cancer Hospital now offers The PAXMAN Scalp Cooling System, which helps reduce hair loss for people undergoing chemotherapy.

Genetic counseling and testing are important tools in guiding management and surveillance for patients with breast cancer, as well as their families. Breast cancer patients with early-onset (<50 years) cancer, a triple-negative breast cancer before age 60, or who are of Jewish ancestry are candidates for genetic counseling and testing, as are all patients with a family history of a genetic mutation, or of breast, male breast, ovarian, gastric, or pancreatic cancer. Our experienced team of genetic counselors are here to navigate insurance pre-authorization, pre- and post-test counseling, and to ensure that the correct test is ordered and interpreted accurately.