The principles of breast cancer surgery

The rationale for the treatment of patients with early breast cancer has changed considerably over the last 20 years. The management of the disease must now involve an integral approach taking into consideration the many developments that have occurred and how these have affected orthodox therapy. Because of advances in radiation technology, and also because patients are now presenting with tumors of much smaller size, the trend in treatment has been towards more conservative surgery. However, techniques have had to take into account a number of developments which have materially changed our concepts of what needs to be accomplished: 1) treatment must ensure local control of disease; 2) it must supply sufficient tumor tissue for histological and biochemical analysis; 3) it must be compatible with the use of adjuvant therapy; 4) it must give full information on axillary node status. At present only the radical mastectomy or its modified version has been proved to be effective whilst fuftilling all these criteria for treatment. Nevertheless new conservation techniques are now being tested which may allow the breast to be conserved whilst at the same time safely treating the patient and providing the surgeon with all the information needed for future management.