Principles of surgical management of breast cancer

Until recently surgical ablation was the primary treatment of choice for operable breast cancers. Increasingly, this position has been challenged by concepts of lesser surgical procedures coupled with radiotherapy. The trend of recurrence rates suggests that wide local excision of the primary tumor followed by irradiation may give as good results as more extensive surgical procedures. Long-term evaluation of morbidity, treatment time, and costs, must also be included in these comparisons. One of the more attractive features of these lesser procedures is the improved cosmetic result. Good cosmetic results after modified radical mastectomy require a greater appreciation of the importance of the anterior thoracic nerves to prevent atrophy of the pectoral muscles. Adjuvant therapy after mastectomy needs to be evaluated in greater detail. Radiotherapy prevents local recurrence but does not affect the tumor-free interval or survival rates. Adjuvant chemotherapy prolongs the tumor-free interval but its effect on survival rates is not yet known.