Ask the Experts

Treating Breast Cancer: From Surgery to Radioactive Seed Therapy

dr. angela j. keleher
Angela J. Keleher, MD, FACS
More about Dr. Keleher

What surgeries can be used to treat breast cancer?

Most of the time, surgery is used as first-line therapy for newly diagnosed breast cancer. The two main types of breast surgery are lumpectomies and mastectomies. For non-palpable tumors, radiology helps surgeons localize tumors on the day of the surgery to assist with surgical excision. The standard of care has been to use a wire localization procedure. The radiologist places a wire at the tumor site on the day of surgery prior to the patient going to the operating room. At the Dyson Breast Center, we offer another option called seed localization.

What is seed localization?

After the tumor is identified using mammography or ultrasound guidance, our radiology team places a radioactive seed (I 125) at the tumor site up to five days prior to the surgery. Surgeons have a probe in the operating room, called a gamma probe, which we use to sweep across the breast when the patient is asleep. The radioactivity from the seed is picked up by the probe and a high-pitched signal is heard. The surgeon can localize and make an incision directly over what we call the “hot spot.” The cancer is then excised with the seed at the same time.

Why might patients and doctors prefer seed localization?

It allows flexibility in scheduling and less discomfort for the patient. We have the option of placing the seed up to five days prior to the procedure. The wire can only be placed on the day of surgery. The seed is placed the same way as the biopsy clip was placed during the biopsy. Many surgeons find excising tumors using seed localization easier to perform.

What is breast reconstruction, and what procedures are available?

Breast reconstruction for a patient can be performed at the same time as the breast surgery (immediate) or at a later date (delayed). Our facility offers many different types of breast reconstruction. Implant reconstruction is performed using a prosthesis to form a new breast. Tissue Reconstruction is performed using the patient’s natural tissue from other parts of their own body. For example, we offer a type of tissue reconstruction called DIEP flap reconstruction. Our breast surgeons operate with New York City plastic surgeons that specialize in this advanced technique involving microsurgery.

Sometimes, a lumpectomy can leave a cosmetic defect after resection of the tumor. Oncoplastic reconstruction is correcting this defect. This technique can be performed by trained breast surgeons or qualified plastic surgeons. Plastic surgeons also assist in symmetry surgery, making both breasts the same size and shape, for optimal cosmetic outcomes from breast surgery.

What are the advantages of having a team working in collaboration?

We are really proud of our team at the Dyson Breast Center; one element that sets our facility apart is that we don’t just treat cancer — we treat the whole patient. We aim to keep patients feeling comfortable and in control throughout the process. In our center, we have genetics, a nutritionist, social workers, navigation, physical therapy, occupational therapy, massage therapy, and a boutique to meet all the needs of our patients. We also participate on clinical trials and have a robust research team. Our multidisciplinary team of radiation oncology, medical oncology, surgery, plastic surgery, gynecological oncology, and PCP/Gyn all participate in the care of our breast patients. Our providers and staff communicate and work together for the same common goal for the best care of our breast patients.


Dr. Keleher is the Director of the Dyson Breast Center and Director of Breast Surgery. Dr. Keleher is a proud member of the American Society of Breast Surgeons and the Society of Surgical Oncology.


Vassar Brothers Medical Center
Northern Dutchess Hospital
Dyson Breast Center
21 Reade Place, Second Floor
Poughkeepsie, NY 12601
845-214-1840
TTY /Accessibility: (800) 421-1220
www.healthquest.org/breastcancer


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