Current controversies in the surgical management of breast cancer

Great advances have occurred in the surgical management of breast cancer during the past 2 decades, though areas of controversy still remain. The surgical treatment of breast cancer relates to management of the breast and of the axillary nodes. Areas of controversy relate to methods of breast conservation after preoperative chemotherapy for locally advanced disease. The ideals of such treatment are described and the various methods by which such results may be obtained are discussed. The importance of conservation of the nipple-areolar complex is stressed, and the various methods of reconstruction by which this can be achieved are discussed. The role of surgery to the axilla is also discussed, with particular reference to axillary sampling. Data relating to the control of axillary disease treated by irradiation and that obtained after surgery are compared. Current controversies: Breast conservation, partial and subcutaneous mastectomy, reconstruction (using implants, prostheses and myocutaneous flaps), the management of axillary disease and the role of adjuvant therapy are discussed.