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Surgical Treatment of Early-Stage Breast Cancer

  • Vahit OzmenEmail author
  • Volkan Dogru
Chapter

Abstract

Early-stage breast cancer is an issue of growing clinical importance due to the ever-increasing rates of small and/or non-palpable breast tumors. Wide population-based screening programs, increased awareness, and improved visualization techniques are powerful tools for the early and more precise evaluation and early diagnosis of breast cancer (BC). Optimally timed and safe surgical approaches are needed to provide local control with satisfactorily high survival. New-generation chemotherapeutics, targeted therapies, and modern radiation therapy (boost) have resulted in a decrease in locoregional recurrence (LRR) of at least 50%. These positive changes in LRR and the acceptance of clear surgical margins as no-ink on the tumor have substantially increased the rate of BCS. Long disease-free and healthy survival has resulted in questioning the cosmetic results of breast cancer surgery, and the “oncoplastic breast surgery (OBS)” concept has come into consideration among breast surgeons in the last two decades. The aim of OBS is to make no compromise from oncologic principles for a better cosmetic result. The tumor cavity is filled with the remaining breast tissue (volume displacement technique), or if the defect is relatively large, it is filled with implants or autologous tissue taken from elsewhere in the body (volume replacement technique). Commonly used displacement techniques are a local glandular flap or dermoglandular flaps within the breast, and replacement techniques are musculocutaneous, muscle, and perforator flaps. A growing body of research shedding light on new breast cancer genes other than BRCA 1 and 2 (e.g., PALB B2, CHEK2, P-TEN, p53 etc.) has revealed the concept of variants of uncertain significance (VUS). The fear of developing cancer in these patients increased the frequency of bilateral subcutaneous mastectomy. In addition, an increasing number of patients choose to undergo bilateral mastectomy and reconstruction to attain symmetry and a 95% risk reduction for local recurrence in the contralateral breast. Neoadjuvant chemotherapy (NAC) has been administered to operable breast cancer patients with clinically positive axilla to avoid axillary lymph node dissection and its complications. Since the primary tumor also partially or completely responds to NAC, the tumor should be marked by the radiologist before treatment. In this chapter, surgical management of early-stage breast cancer will be discussed. Preoperative preparation, selection of the surgical procedure, complications of surgical treatment and correction of these complications, and local and regional recurrences will be emphasized. Regional treatments for axillary involvement will be described in another section.

Keywords

Breast-conserving surgery  Wound infection  Mastectomy  Surgical complications  Oncoplastic surgery  Local recurrence  Lymphedema  Surgical margin 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryIstanbul University Istanbul Faculty of MedicineÇapa, IstanbulTurkey
  2. 2.Breast Center, Istanbul Florence Nightingale HospitalSisli, IstanbulTurkey
  3. 3.Department of General SurgeryPalandöken State HospitalErzurumTurkey

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