Surgical considerations in early-stage breast cancer: lessons learned and future directions

Emerging evidence regarding the relationship between local failure and outcome in breast cancer has placed increased emphasis on the surgeon's role in reducing local recurrence after breast-conserving surgery. This includes both improving patient selection and optimizing the procedure. Proper patient selection, selective use of magnetic resonance imaging, and better patient-physician communication including the use of decision aids can optimize both local control and patient satisfaction without unnecessarily increasing the mastectomy rate. Neoadjuvant systemic therapy can increase both the number of patients eligible for breast-conservation surgery as well as the likelihood of success. Adequate surgical margins are crucial and can be achieved without excessive re-excision rates with detailed preoperative planning, consideration of oncoplastic resections. and intraoperative margin analysis. This article reviews several areas in which the surgeon can help ensure the success of breast-conservation therapy.