Update on the surgical management of breast cancer

The surgical management of breast cancer has undergone continuous and profound\r\nchanges over the last three decades. For patients with early stage breast cancer,\r\nbreast-conserving surgery followed by radiation therapy has been definitively\r\nvalidated as a safe alternative to radical mastectomy, with similar survival\r\nrates, better cosmetic outcomes and acceptable rates of local recurrence. Thanks \r\nto the improvements in diagnostic work-up, as well as the wider diffusion of\r\nscreening programs and efforts in patient and physician education, tumors are\r\nmore often detected at an early stage, furtherly facilitating the widespread use \r\nof breast conserving techniques. Breast-conserving surgery has been introduced\r\nalso in the treatment of patients with locally advanced tumors after tumor\r\ndownsizing with preoperative chemotherapy, with acceptable rates of ipsilateral\r\nbreast tumor recurrence. When performing breast-conserving surgery all efforts\r\nshould be made to ensure negative surgical margins in order minimize the risk of \r\nipsilateral breast tumor recurrence as they are associated with worse\r\ndistant-disease-free and breast cancer- specific survival rates. The recent\r\nintroduction of "oncoplastic techniques", that may allow more extensive excisions\r\nof the breast without compromising the cosmetic results, has furtherly increased \r\nthe use of breast-conserving procedures. Mastectomy remains a valid surgical\r\nalternative in selected cases and is usually associated with immediate\r\nreconstructive procedures. Staging of the axilla has also gradually evolved\r\ntoward less aggressive approaches with the adoption of sentinel node biopsy, but \r\nseveral controversies still remain about completion of axillary lymph node\r\ndissection in patients with a pathologic positivity in sentinel lymph node\r\nbiopsy. The present work will highlight the benefits and unresolved issues of the\r\ndifferent surgical treatment options in breast cancer and axillary treatment.KEY \r\nWORDS: Axillary treatment, Breast Cancer, Conservative surgery, Mastectomy,\r\nSentinel node.