[The treatment of primary breast cancer, surgical approach]

The surgical management of breast cancer has changed dramatically over the past two decades towards less invasive approaches, with sentinel lymph node biopsy and breast conservation therapy now representing the standard of care for the majority of patients. Supporting this trend are: (1) earlier diagnosis through mammography screening; (2) an increasing role for diagnostic imaging such as ultrasound and magnetic resonance imaging; (3) the development of image-guided core-needle biopsy and pathological diagnosis; and (4) the development of optimal induction or preoperative chemotherapy. For women who choose or require mastectomy, immediate reconstruction of the breast with a prosthetic implant or autologous tissue is a valuable alternative. The next challenge is to treat primary tumors without surgery. For this purpose,several new approaches,including intensive preoperative chemotherapy followed by irradiation alone or non-surgical ablation such as radiofrequency ablation,focused ultrasound,cryosurgery,and other approaches are currently under development. Requirements now include a complete scheme of treatment options for patients with breast cancer,coordinated multidisciplinary system based on a team of physicians, including surgeons, pathologists, radiologists, along with medical and radiation oncologists.