[Conservative surgery of breast cancer. Development of ideas and methods]

Conservative breast cancer surgery has been accepted by the medical profession, but the operative procedures remain to be specified. The decision to conserve the breast must take into account the tumour size/breast volume ratio. The amount of healthy breast tissue to be removed around the tumour must be determined. Quadrantectomy is more secure than wide tumorectomy for local control, at the expense of cosmetic results. It should be reserved to localized intraductal carcinomas and to small invasive tumours of less than 3 cm in diameter but with a large intraductal component. Wide tumorectomy is sufficient for early invasive tumours without intraductal component. The best surgical technique for large carcinomas with preoperative treatment remains to be determined. Defining the operative principles adapted to each clinical situation will make it possible to evaluate the oncological and cosmetic results of conservative treatments. Ideally, the future methods will combine wide excision and partial breast reconstruction using biocompatible implants.