Present standards and future concepts of surgery in breast cancer

Abstract

Not so long ago, most breast cancer patients were treated with mastectomy (without reconstruction) and routine axillary lymph node dissection (ALND). With the increased emphasis on minimally invasive and less morbid surgical procedures, most patients today undergo breast-conserving surgery (BCS)without ALND. The surgical options for patients who require or desire mastectomy have dramatically expanded with the development of skin- and nipple-sparing mastectomies and better access to reconstructive options. Surprisingly, an increasing proportion of patients with unilateral breast cancer are undergoing bilateral mastectomy with contralateral prophylactic mastectomy. Today, surgeons are more involved in the delivery of partial breast irradiation therapy with the development of balloon-catheter brachytherapy and intraoperative radiation therapy. As a result of new technologies, improved surgical techniques and practice-changing studies, the surgeons’ role in breast cancer treatment has become increasingly more complex. The purpose of this review article is to outline the rapidly changing landscape of breast cancer management and to highlight the surgeons’ role in this multifaceted disease.