I've been diagnosed with TNBC. What about treatment?

Surgery remains a cornerstone of TNBC care. The goal is to remove all cancer in the breast and check the lymph nodes in the armpit (axilla).

• Breast-conserving surgery (lumpectomy): Removes the tumor and a margin of normal tissue while preserving the breast—used when a good cosmetic result is possible.
• Mastectomy: Removes the entire breast when disease is too extensive for safe breast conservation or by patient preference (can be skin-sparing or nipple-sparing in selected cases).
• Lymph nodes: A sentinel lymph node biopsy identifies the first node(s) likely to contain cancer. Depending on how many nodes are involved and other factors, additional node surgery may—or may not—be needed.
• Chemo first may change the plan: If neoadjuvant (before surgery) chemotherapy shrinks the tumor or clears cancer from nodes, breast-conserving surgery and limited node surgery may become options. Final decisions are individualized with your surgeon.

Radiation lowers the chance of cancer returning in the breast/chest wall or nearby nodes.

• After lumpectomy: Usually recommended.
• After mastectomy: Considered based on tumor size, margins, and lymph-node findings.
• Safety today: Modern planning techniques spare the heart and lungs compared with older methods. A consult with a radiation oncologist helps integrate radiation into your plan if needed.

Most people with TNBC benefit from chemotherapy. It may be given before surgery (neoadjuvant) or after (adjuvant)—both can be curative; timing is chosen to best meet your goals.

• Why give it before surgery? To shrink tumors (sometimes turning a mastectomy plan into a lumpectomy), to gauge how well the regimen works, and to guide additional treatments if cancer remains at surgery.
• Pathologic complete response (pCR): About 30–40% of patients receiving neoadjuvant chemo have no invasive cancer found in the breast and sampled nodes at surgery; pCR is associated with a more favorable outlook.
• Common regimens: Combinations such as AC→T (Adriamycin + Cytoxan, followed by Taxol) and, at times, carboplatin. Whether to include certain drugs (e.g., Adriamycin) depends on lymph-node status, age, heart health, and overall risk—decisions made with your oncology team.

Disclaimer: Pregnancy during chemotherapy can be dangerous for both the patient and the developing baby. Chemotherapy drugs can cause birth defects, miscarriage, or other serious complications, so it’s critical to use effective contraception and speak with your care team before trying to conceive.

• Immunotherapy (checkpoint inhibitors): Medicines like pembrolizumab can help the immune system recognize cancer cells in specific TNBC settings (eligibility depends on tumor testing and stage).
• ADCs: Targeted medicines that link chemotherapy to an antibody, delivering treatment more directly to cancer cells. These are options in certain scenarios and continue to evolve through research.

If a mastectomy is performed, many patients are candidates for immediate reconstruction (implant-based or using your own tissue); others choose an external prosthesis—both are valid. For breast-conserving surgery, oncoplastic techniques can reshape the breast and improve symmetry; some patients also benefit from a reduction on the opposite side for balance.

Evidence-informed practices—such as mindfulness, meditation, and massage—may help with stress, mood, pain, or neuropathy. These approaches do not replace surgery, chemo, or radiation. Always discuss supplements or therapies with your team to avoid interactions.

• Am I a candidate for chemo before surgery? What would success look like?
• Lumpectomy vs. mastectomy: Which fits my situation and goals?
• Will I need radiation? If so, what areas and for how long?
• Which chemo regimen are you recommending and why?
• Am I eligible for immunotherapy or an ADC (antibody-drug conjugate)? What tests determine that?
• What are my reconstruction or oncoplastic options?

Remember, your plan is personal. Use these sections to prepare for a conversation with your care team and decide together what’s right for you.