Extent of Primary Breast Cancer Surgery: Standards and Individualized Concepts

Abstract

Surgery is still a main therapeutic option in breast cancer treatment. Nowadays, methods of resection and reconstruction vary according to different tumors and patients. This review presents and discusses standards of care and arising questions on how radical primary breast cancer surgery should be according to different clinical situations. In most early breast cancer patients, breast conservation is the method of choice. The discussion on resection margins is still controversial as different studies show conflicting results. Modified radical mastectomy is the standard in locally advanced breast cancer patients, although there are different promising approaches to spare skin or even the nipple-areola complex. A sentinel node biopsy is the standard of care in clinically node-negative invasive breast cancer patients, whereas the significance of axillary lymphonodectomy seems to be questioned through a number of different findings. Although there are interesting findings to modify surgical approaches in very young or elderly breast cancer patients, it will always be an individualized approach if we do not adhere to current guidelines. Up to date, there are no special surgical procedures in BRCA mutation carriers or patients of high-risk families.

Surgical method of treatment and level of satisfaction with life among women diagnosed with breast cancer, according to time elapsed since performance of surgery

“…At present, breast-conserving surgery is the most frequently used method of surgical treatment of breast cancer. According to various researchers, surgeries of this type consist of more than 70% of all procedures of surgical treatment applied in breast cancer [7,18,10,19]. Considering the effectiveness of treatment, breast-conserving surgery is equally as effective as mastectomy from the oncologic aspect [20].…”

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

“…High LNR has not only been associated with unfavourable survival outcomes, its prognostic effect is found to be superior to total number of nodes [11]. Although the goal of surgery in breast cancer is to extirpate both macroscopic and microscopic tumour presence, the presence of a positive resection margin necessitates adjuvant radiotherapy with or without chemotherapy [14][15][16]. The late stage of disease in our environment makes modified radical mastectomy more favourable to a breast conserving surgery since in these cases, aggressive local therapy ensures adequate surgical margins and can determine disease-specific survival [17].…”

Surgery for BRCA, TP53 and PALB2: a literature review

“…Now, with commercial multipanel genetic testing and a better understanding of the risk of disease, surgical management of hereditary breast cancer must now take into account the additional effects of deleterious mutations, such as increased risk of contralateral breast cancer and ovarian cancer in BRCA mutations. The types of surgery are the same as sporadic breast cancer, that is, a choice between a modified radical mastectomy and breast-conserving surgery in early stage breast cancer [ 5 ]. There is still controversy over the optimal surgical choice in BRCA -associated breast cancer with regards to the extent of breast tissue removed and the effectiveness of the different surgical techniques.…”