Surgical Management of the Breast

Abstract

The last several decades have seen a dramatic metamorphosis in the surgical management of breast cancer. The diagnosis of this malignancy is now more often made using minimally invasive imaging-directed techniques. Cancers that were routinely managed with disfiguring radical mastectomies are now treated with breast-conserving surgery, and axillary dissection has yielded to sentinel node biopsy, which may or may not be followed with completion dissection even in the setting of node-positive disease. Increasingly, breast surgical oncology is nested within a multidisciplinary context, and advances in a number of disciplines have yielded revolutionary changes in the surgical management of the leading malignancy affecting women in the United States. This review discusses advances in the surgical management of breast cancer in this context, highlighting key clinical trials that have led to these changes. This review contains 4 figures, 6 tables and 72 references Key words: axillary dissection, breast conservation, chemotherapy, margins, mastectomy, multidisciplinary, oncoplastic, radiation therapy, reconstruction, sentinel node biopsy