Specialist Services
Breast Cancer
Breast cancer statistics are staggering - women and men of all ages are at risk
But a breast cancer diagnosis is not a death sentence. In fact, our arsenal of weapons against this dreaded disease have come a long way. Let us be your partners on this journey.
We will be there every step of the way — from diagnosis to lifetime follow-up.
Every breast cancer is different and your treatment will be tailored to your specific subtype. To understand more of the different subtypes of breast cancer, please see our blogposts (Understanding your diagnosis and Types of Breast cancer)
We will facilitate your entire treatment process that entails a combination of:
Surgical options:
Breast conserving surgery (BCS/WLE) following oncoplastic principles
The purpose of this type of surgery is to remove cancer, leaving as much healthy tissue intact as possible. By using oncoplastic techniques, improved cosmetic results are achieved while ensuring oncological safety.
Mastectomy
Simple mastectomy and cosmetic flat closure:
A simple mastectomy with a cosmetic flat closure involves the removal of the entire breast tissue, including the nipple and areola, while leaving the chest wall muscles intact. After the mastectomy, the surgeon smooths and contours the remaining tissue to create a flat, symmetrical chest appearance. This procedure is often chosen by individuals who prefer a flat chest rather than undergoing breast reconstruction.
Oncoplastic mastectomy and reconstruction
Modern surgical techniques allows for a plethora of options to suit each patient’s needs and allow for optimal oncoplastic outcomes.
There are several oncoplastic and reconstruction options for skin- and nipple-sparing mastectomies, depending on the patient’s anatomy, cancer location, and personal preferences. These include:
Mastectomy Types:
- Skin-Sparing Mastectomy (SSM): Removes breast tissue while preserving most of the skin envelope, excluding the nipple-areola complex.
- Nipple-Sparing Mastectomy (NSM): Preserves the nipple-areola complex along with the skin, removing only the underlying breast tissue.
Reconstruction Options:
- Implant-Based Reconstruction:
- Direct-to-Implant (DTI): An implant is placed immediately after mastectomy.
- Two-Stage Reconstruction: A tissue expander is placed first, gradually filled over time, and later replaced with a permanent implant.
- Autologous (Flap) Reconstruction:
- DIEP Flap (Deep Inferior Epigastric Perforator): Uses skin, fat, and blood vessels from the lower abdomen.
- TRAM Flap (Transverse Rectus Abdominis Myocutaneous): Uses abdominal skin, fat, and part of the rectus muscle.
- Latissimus Dorsi Flap: Uses muscle, skin, and fat from the upper back, sometimes combined with an implant.
- SGAP/IGAP/TUG Flaps: Use tissue from the buttocks or inner thigh.
- Hybrid Reconstruction: Combines implants with autologous tissue to achieve a more natural result.
- Goldilocks mastectomy and reconstruction: A Goldilocks mastectomy is a type of skin-sparing mastectomy where the breast tissue is removed, but excess skin is used to create a small, natural-looking breast mound without implants or major flap surgery. This technique provides some volume using the patient’s own tissue while avoiding the complexity of traditional reconstruction. It is ideal for patients who want a minimal breast shape without implants or extensive procedures.
Concurrent axillary procedure – sentinel lymph node biopsy and/or nodal clearance
These procedures may be performed to ensure that the cancer has not spread into the lymph nodes. Special techniques and dyes are used to identify the relevant nodes for testing.
Oncology options offered by the oncologists on the team:
Chemotherapy
Chemotherapy may be recommended to treat your breast cancer. Regimens are tailored based on cancer subtype, stage, and patient factors to maximize effectiveness while minimizing toxicity. The purpose of this treatment is to kill cancer cells that have affected the breast and potentially spread to other parts of the body. Chemotherapy may also be used to prevent cancer from returning after surgery or to shrink a tumor before surgery, making it easier to remove.
Chemotherapy is used in early-stage, locally advanced, and metastatic breast cancer, either alone or in combination with targeted therapies. Common chemotherapy regimens include:
1. Anthracycline-Based Regimens
These are used for high-risk or aggressive breast cancer. Regimens include:
- AC (Doxorubicin + Cyclophosphamide) – Often followed by a taxane.
- EC (Epirubicin + Cyclophosphamide) – An alternative to AC with similar effectiveness.
- TAC (Docetaxel + Doxorubicin + Cyclophosphamide) – A more intense regimen effective for aggressive disease.
2. Taxane-Based Regimens
Taxane-based regimens are often used after AC or EC and are commonly used in early-stage, node-negative disease:
- TC (Docetaxel + Cyclophosphamide) – Common for early-stage, node-negative disease.
- AC-T (Doxorubicin + Cyclophosphamide, followed by Paclitaxel or Docetaxel) – A standard regimen for high-risk cases.
- EC-T (Epirubicin + Cyclophosphamide, followed by a taxane) – Similar to AC-T.
3. Platinum-Based Regimens
Platinum-based regimens are often used for triple-negative or BRCA-mutated breast cancer:
- Carboplatin + Paclitaxel – Used in neoadjuvant or metastatic settings.
- Cisplatin-based combinations – Sometimes used for BRCA-mutated tumors.
4. Capecitabine-Based Therapy
Capecitabine is used for residual disease after standard chemotherapy:
- Capecitabine (Xeloda) – An oral chemotherapy used after surgery in high-risk patients.
5. Eribulin, Vinorelbine, and Ixabepilone
These are used in metastatic breast cancer when other regimens fail:
- Eribulin, Vinorelbine, and Ixabepilone – Used in metastatic breast cancer when other regimens fail.
Please see our blog post on Chemotherapy for more details on what to expect, how to manage side effects, and optimize your experience.
Radiation
Radiation therapy may be recommended, in which case high-energy radiation is administered with considerable accuracy to cancerous cells. The radiation works by stopping cancer cells from reproducing, without damaging the surrounding healthy tissue.
External beam radiation therapy (EBRT) uses high-energy X-rays to destroy cancer cells and reduce recurrence risk. It is typically used after surgery (lumpectomy or mastectomy) or for metastatic disease affecting bones or other areas.
Key Types of EBRT in Breast Cancer:
- Whole-Breast Radiation – Standard after lumpectomy to treat remaining breast tissue and lower recurrence risk.
- Chest Wall & Regional Nodal Radiation – Used after mastectomy if lymph nodes are involved or there is a high risk of recurrence.
- Hypofractionated Radiation – Delivers higher doses per session over a shorter time (3–4 weeks instead of 5–6 weeks).
- Accelerated Partial Breast Irradiation (APBI) – Targets only the tumor bed in selected early-stage cases.
- Palliative Radiation – Used in metastatic breast cancer to relieve symptoms (e.g., bone pain, brain metastases).
EBRT is carefully planned using CT imaging to minimize damage to nearby healthy tissues, such as the heart and lungs.
Please see our blog post on radiation therapy for more detail on what to expect, how to manage side effects, and optimize your experience.
Endocrine therapy (oestrogen receptor blockers)
The team may recommend endocrine therapy for hormone-sensitive cancers, which involves the administration of drugs formulated to stop the production of oestrogen and progesterone and prevents the growth of cancerous cells.
Endocrine (hormone) therapy is used to treat hormone receptor-positive (HR+) breast cancer by blocking oestrogen or lowering oestrogen levels to slow cancer growth. It is commonly used in early-stage, advanced, and metastatic breast cancer.
1. Selective Oestrogen Receptor Modulators (SERMs):
- Tamoxifen – Blocks oestrogen receptors in breast tissue while maintaining oestrogen effects in other parts of the body (e.g., bones, uterus). Used in both pre- and postmenopausal women.
2. Aromatase Inhibitors (AIs) (for Postmenopausal Women):
- Anastrozole (Arimidex), Letrozole (Femara), Exemestane (Aromasin) – Lower oestrogen levels by inhibiting the aromatase enzyme, which converts androgens to oestrogen.
3. Selective Oestrogen Receptor Degraders (SERDs):
- Fulvestrant (Faslodex) – Binds to and degrades oestrogen receptors, used for advanced HR+ breast cancer.
4. Ovarian Suppression (for Premenopausal Women):
- LHRH Agonists (e.g., Goserelin, Leuprolide) – Suppress ovarian function, reducing oestrogen production.
- Oophorectomy (surgical removal of ovaries) – A permanent option for oestrogen suppression.
Please see our blog post on endocrine therapy for more details on what to expect, how to manage side effects, and optimize your experience.
The use of Biological & Immunotherapy Treatment Modalities for Breast Cancer
Breast cancer treatment has advanced significantly with biological therapies (targeted therapies) and immunotherapies, which specifically attack cancer cells while sparing normal cells. These treatments are often used alongside chemotherapy, surgery, or radiation, depending on the cancer subtype.
1. Biological (Targeted) Therapies:
These therapies block specific molecules involved in cancer growth and spread.
- HER2-Targeted Therapies (for HER2-positive breast cancer):
- Trastuzumab (Herceptin) – A monoclonal antibody that blocks HER2 receptors.
- Pertuzumab (Perjeta) – Often combined with trastuzumab for stronger HER2 blockade.
- Ado-trastuzumab emtansine (Kadcyla, T-DM1) – A HER2-targeted antibody-drug conjugate.
- Fam-trastuzumab deruxtecan (Enhertu) – Another antibody-drug conjugate for HER2-positive metastatic breast cancer.
- Tucatinib, Lapatinib, Neratinib – Small-molecule HER2-targeted tyrosine kinase inhibitors.
- CDK4/6 Inhibitors (for HR-positive/HER2-negative breast cancer):
- Palbociclib (Ibrance), Ribociclib (Kisqali), Abemaciclib (Verzenio) – Block cell cycle proteins to slow tumor growth.
- PI3K/AKT/mTOR Inhibitors (for advanced HR-positive breast cancer with specific mutations):
- Alpelisib (Piqray) – Targets PIK3CA-mutated cancers.
- Everolimus (Afinitor) – An mTOR inhibitor that enhances endocrine therapy.
- PARP Inhibitors (for BRCA-mutated breast cancer):
- Olaparib (Lynparza), Talazoparib (Talzenna) – Prevent DNA repair in BRCA-mutated tumors.
2. Immunotherapy:
Boosts the immune system to recognize and attack cancer cells.
- Checkpoint Inhibitors (for Triple-Negative Breast Cancer - TNBC):
- Atezolizumab (Tecentriq) – Targets PD-L1, used with chemotherapy.
- Pembrolizumab (Keytruda) – A PD-1 inhibitor, often used for high-risk early-stage or metastatic TNBC.
These treatments are often tailored based on biomarker testing to match patients with the most effective therapy.
Integrated Health Care
Integrated health care is an essential part of a holistic treatment plan. Dr. Roodt and her team offer the following elements:
- Occupational therapy and patient navigation
- Physiotherapy
- Body Talk
- Guidance on nutrition and supplements
- Patient and family counselling and education
- Psychological support and therapy
- Referral for special post-surgical adjuncts (e.g., nipple tattooing, temporary external prosthesis)
- Referral to relevant support groups in your area
Frequently Asked Questions
Dr Liana Roodt can take between one and four hours to perform breast surgery, depending on the type of surgery required. A cancer operation is more complex and takes longer than a simple lumpectomy for a benign disease.
It is crucial to visit Dr Roodt during routine visits as, just like with most breast cancers, the earlier you find a diagnosis, the better your chances of full recovery. If you have any concerns, it is always better to be safe than sorry. Early detected cancer is very treatable.
Most patients Dr Roodt deals with recover from breast cancer surgery between two to six weeks, depending on the type of surgery performed However, the scar left behind by surgery will continue to fade over time.
Please visit: Pre Operative Information Breast Surgery to find a comprehensive explanation by Dr Liana Roodt of what should be done before breast surgery.