After you have chemotherapy and possibly targeted therapy, such as Herceptin (chemical name: trastuzumab), your doctor will try to determine how well the cancer has responded. Your doctor will want to see that any areas of cancer have shrunk or disappeared and that the breast and its skin look normal or close to normal. Breast MRI is typically used to gather more information about whether any areas of disease remain.
If the breast cancer has responded, you will then have modified radical mastectomy, which is surgery to remove the entire breast and some lymph nodes under the arm (a procedure called axillary lymph node dissection).
You might be wondering if it’s possible to have less extensive surgery that preserves some of your breast tissue — especially if the cancer has shrunk a great deal in response to chemotherapy. But because inflammatory breast cancer tends to grow and advance quickly, breast-conserving surgery is not recommended.
As you plan your surgery, you may want to talk with your doctor about the possibility of breast reconstruction later on. Because radiation therapy to the chest after surgery is a standard part of treatment for IBC, doctors often recommend waiting until the skin has healed after radiation to determine whether reconstruction is possible.
If the cancer does not respond to pre-surgical treatment
If pre-surgical chemotherapy has not helped to shrink the cancer and reduce the swelling and inflammation, your doctor may recommend additional chemotherapy or proceed to the next step: radiation therapy. If the cancer eventually responds to these treatments and the skin returns to normal, then you can proceed with surgery. Even if the cancer does not respond to additional treatment, you still can have mastectomy to remove the affected breast tissue and lymph nodes.