Accelerated partial breast irradiation, or brachytherapy, is a technique of adjuvant, or postoperative, breast irradiation that has been in limited use in a number of centers worldwide for a couple of decades. No large-scale trials have demonstrated that it is equivalent to whole-breast irradiation, but a number of small studies have had encouraging results. The main advantage is that APBI has a much shorter (5 day) time course compared to standard whole-breast irradiation (5 weeks). Currently, the Mammosite brachytherapy catheter, placed under ultrasound guidance in the office following breast conserving surgery, is FDA approved for APBI. It involves twice-daily loading of radioactive iridium seeds into the catheter for short intervals for five days, with subsequent catheter removal after the tenth treatment. Several large-scale trials are underway comparing APBI with the Mammosite catheter to standard therapy. Patients who are candidates for APBI are postmenopausal with small, favorable, node-negative tumors. Careful operative planning and technique are required to prepare the breast for a good result.

Some patients are averse to mastectomy regardless of tumor size, and certain patients motivated to pursue breast conservation can undergo neoadjuvant, or preoperative chemotherapy to decrease tumor size and improve the possibility of achieving negative surgical margins without a cosmetically prohibitive resection of breast tissue. A large body of literature exists to support this type of treatment, and no negative impact on survival has been shown. In fact, a complete pathologic response (no viable tumor remaining) has been shown to be associated with an improved survival. Patients usually receive the first half of their chemotherapy, undergo surgery, and then finish chemotherapy and, ultimately, radiation therapy. Patients must be monitored at least monthly during preoperative treatment using ultrasound measurements, and a tissue marker clip must be placed in the tumor in the event it completely disappears from view on the ultrasound images, so the geographic center of the tumor locus can be localized for surgery.

Patients undergoing chemotherapy for breast cancer often require a vascular access device, or VAD, to facilitate their chemotherapy. They are placed in the outpatient operating room under local or general anesthesia, with every attempt to place a low-profile device in a cosmetic location. If properly placed and cared for, they can last for years. Removal under local anesthesia is very easy. Dr. Ley has placed thousands of these devices, and prefers the Bardport (TM) device for his patients.