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When you’re facing breast cancer, one of the most important questions is: Will I need chemotherapy before or after a mastectomy? The answer depends on several factors, including your cancer type, tumor size, and overall treatment goals.
In many cases, surgery comes first, followed by chemotherapy or radiation. But sometimes, doctors recommend chemotherapy before surgery to shrink the tumor—this is known as neoadjuvant therapy. Understanding when and why chemo is needed can help you prepare for what comes next.
What Is a Mastectomy?
A mastectomy is a surgical procedure to remove one or both breasts, typically to treat or prevent breast cancer. In a total mastectomy, all breast tissue is removed, though the nipple may be preserved depending on the situation.
The type of mastectomy your doctor recommends depends on your:
- Cancer stage and type
- Tumor size and location
- Lymph node involvement
- Overall health and preferences
When Is Chemotherapy Given Before a Mastectomy?
This approach—known as neoadjuvant chemotherapy—is often used to:
- Shrink large tumors before surgery
- Allow for breast-conserving surgery instead of a full mastectomy
- Assess how the cancer responds to treatment, which can help guide post-surgery care
Who’s a Good Candidate?
You may benefit from chemotherapy before surgery if you have:
- A large tumor
- Lymph node involvement
- Aggressive cancers like HER2-positive or triple-negative breast cancer
These fast-growing types often respond well to chemo and may even achieve pathologic complete response (no detectable cancer cells) after neoadjuvant treatment.
Patients with estrogen receptor-positive (ER+) breast cancer—the most common type—may respond better to anti-estrogen therapies, such as tamoxifen or aromatase inhibitors, to shrink the tumor before surgery.
Will I Still Need Chemotherapy After My Mastectomy?
Some patients still need adjuvant chemotherapy after surgery, depending on:
- Whether cancer remains in the breast or lymph nodes
- How the tumor responded to pre-surgery treatment
- Whether the cancer has spread to other parts of the body
Your oncologist may also recommend radiation, hormonal therapy, or targeted treatments based on your pathology results.
Diagnostic Imaging and Breast Cancer Planning
Whether you're preparing for surgery or evaluating a new diagnosis, high-quality imaging plays a key role in your treatment journey.
📍 BASS Imaging Center in Walnut Creek offers 3D mammography, breast ultrasound, and MRI services to support early detection, tumor staging, and post-surgical follow-up. Our radiologists work closely with our breast surgeons and oncologists to ensure precise, timely care.
Learn More About Your Options
Find Breast Cancer Treatment at BASS Medical Group
At BASS Medical Group, we understand that no two breast cancer cases are alike. Whether you need pre-surgery chemotherapy, a mastectomy, or help building a treatment plan, our board-certified providers are here to guide you.
Our multidisciplinary approach includes:
- Breast surgeons and medical oncologists
- Primary care providers (PCPs) and OB-GYNs
- On-site imaging and diagnostic testing
- Personalized treatment planning and support
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