[Surgical strategies in treatment of breast carcinoma]

The surgical strategies in the treatment of operable breast cancer have changed basically within the last decades. Today the therapy of breast cancer is indicated by the individualization of the procedure in which the extent of the operative intervention is determined in first line in dependence of the clinical and histopathological results and the wishes of the patients. The current surgical strategies are indicated by a further reduction of radicalness in the operative procedure and a patient obtained strategy adapted to the individual risk. Goals of the reduction of the radicalness are discussed at the example of the extend of minimal tumor free margins and the technique of the "sentinel lymph node detection". The use of Van-Nuys classification is described as an example for an individual risc adapted strategy in the surgical treatment of breast cancer. Furthermore is discussed the significance of the extensive intraductal component, of lymphatic and blood vessel invasion and the patient's age for estimating the risk of of local recurrence after breast preserving therapy. Besides of all efforts there are still limits in reducing surgical radicalness of the therapy of breast cancer. That has to be taken into account in an adequate therapeutical concept.