[Breast saving treatment of breast cancer: 10 questionable aspects]

Conservative treatment of breast cancer includes all those techniques by which a sizable amount of the gland is left behind after tumor resection, where the axilla is partially cleared and radiotherapy follows surgery. Thus, the subcutaneous mastectomy as a means of treating breast cancer does not fall into this category. Conservative treatment of breast cancer is a well-established technique as long as some basic principles concerning indication, technical details and general therapeutic plans are respected. Among many questions that have arisen from this kind of treatment, 10 are discussed. Among those is the fact of leaving behind vital carcinoma cells within breast tissue, the question of radiation-induced malignant tumours and other radiation sequelae, advantages and drawbacks of a simultaneous combination of radio- und chemotherapy, the quality of life, questions of follow-up and especially technical aspects in relation to the more radical quadrant resection or the cosmetically more advantageous tumorectomy. Considering all these aspects and open questions, conservative treatment of breast cancer has nevertheless to be regarded as the treatment of choice, at least for T1-lesions, as long as some clearly defined conditions are fulfilled. The aim of this multimodality treatment must be to achieve a cosmetic result better than that to be expected by reconstructive surgery after amputation of the breast, as long as the same survival figures can be obtained as after amputation.