Role of surgery in invasive breast cancer

Surgery is still the single most important treatment modality for breast cancer. Even if some patients with early stage cancer are treated, and in a clinical sense cured, by surgery alone, adjuvant local and systemic treatments are required for most patients for the best possible tumor control. Surgery must be compatible and timed with other treatment modalities. It helps provide local control, which in some cases is enough for cure but in others is limited to being a means of palliation. Surgery provides the clinical team with material for diagnosis, for prognostication and for help in clinical decision making. The choice of the surgical procedure and its performance should be handled by surgeons, knowledgeable and interested in the field in order to obtain the best possible functional and cosmetic results. An algorithm for deciding the appropriate surgical treatment of the breast is presented. Surgical treatment of the axilla is controversial. Current debate indicates that exploration of the axilla can be safely omitted in some patient groups, but more research is needed. Other important areas for clinical surgical research are use of immediate breast reconstruction, choice of management when margins are involved with tumor growth after breast-sparing operations, and surgical approach to tumors which have been treated with chemotherapy preoperatively.