Skip to main content
SpringerLink
Log in
Book cover

Breast Disease pp 53–76Cite as

Surgical Treatment of Early-Stage Breast Cancer

  • Chapter
  • First Online:

  • 897 Accesses

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.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Hortobagyi NG, Connolly JL, D’Orsi CJ, et al. Chapter 48, Breast. In: Amin MB, editor. AJCC cancer staging manual. 8th ed. Chicago: AJCC; 2017. p. 589–636.

    Chapter  Google Scholar 

  2. Rafferty EA, Durand MA, Conant EF, Copit DS, Friedewald SM, Plecha DM, Miller DP. Breast cancer screening using tomosynthesis and digital mammography in dense and nondense breasts. JAMA. 2016;315(16):1784–6.

    Article  PubMed  Google Scholar 

  3. Endo T, Morita T, Oiwa M, Suda N, Sato Y, Ichihara S, Shiraiwa M, Yoshikawa K, Horiba T, Ogawa H, Hayashi Y, Sendai T, Arai T. Diagnostic performance of digital breast tomosynthesis and full-field digital mammography with new reconstruction and new processing for dose reduction. Breast Cancer. 2018;25(2):159–66.

    Article  PubMed  Google Scholar 

  4. Ohuchi N, Suzuki A, Sobue T, Kawai M, Yamamoto S, Zheng YF, Shiono YN, Saito H, Kuriyama S, Tohno E, Endo T, Fukao A, Tsuji I, Yamaguchi T, Ohashi Y, Fukuda M, Ishida T, J-START investigator groups. Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial. Lancet. 2016;387(10016):341–8.

    Article  PubMed  Google Scholar 

  5. Passaperuma K, Warner E, Causer PA, Hill KA, Messner S, Wong JW, Jong RA, Wright FC, Yaffe MJ, Ramsay EA, Balasingham S, Verity L, Eisen A, Curpen B, Shumak R, Plewes DB, Narod SA. Long-term results of screening with magnetic resonance imaging in women with BRCA mutations. Br J Cancer. 2012;107(1):24–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Solin LJ. Counterview: pre-operative breast MRI (magnetic resonance imaging) is not recommended for all patients with newly diagnosed breast cancer. Breast. 2010;19(1):7–9.

    Article  PubMed  Google Scholar 

  7. Bae MS, Chang JM, Cho N, Han W, Ryu HS, Moon WK. Association of preoperative breast MRI features with locoregional recurrence after breast conservation therapy. Acta Radiol. 2018;59(4):409–17.

    Article  PubMed  Google Scholar 

  8. Jobsen JJ, van der Palen J, Ong F, Riemersma S, Struikmans H. Bilateral breast cancer, synchronous and metachronous; differences and outcome. Breast Cancer Res Treat. 2015;153(2):277–83.

    Article  CAS  PubMed  Google Scholar 

  9. Halsted WS. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to January 1894. Ann Surg. 1894;20:497–555.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Meyer W. An improved method of the radical operation for carcinoma of the breast. Med Rec. 1894;46:746.

    Google Scholar 

  11. Halsted WS. The results of radical operations for the cure of cancer of the breast. Tr Am S A. 1907;25:61.

    Google Scholar 

  12. Özmen V. Meme cerrahisinin tarihçesi ve cerrahi tekniklerin gelişimi. In: Topuz, editor. Meme Kanseri: İstanbul Üniversitesi Onkoloji Enstitüsü yayınları 3; 1997. p. 218–28.

    Google Scholar 

  13. Özmen V. Meme koruyucu cerrahide prospektif randomize klinik çalışmalar. In: Topuz E, Aydıner A, Dinçer M, editors. Meme Kanseri. Nobel Tıp Kitabevleri; 2003. p. 297–300.

    Google Scholar 

  14. Patey DH, Dyson WH. The prognosis of carcinoma of the breast in relation to the type of mastectomy performed. Br J Cancer. 1948;2:7–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Auchincloss H. Modified radical mastectomy: why not? Am J Surg. 1970;119(5):506–9.

    Article  CAS  PubMed  Google Scholar 

  16. Cunningham M, Bunn F, Handscomb K. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev. 2006;2:CD005360.

    Google Scholar 

  17. Tejirian T, DiFronzo LA, Haigh PI. Antibiotic prophylaxis for preventing wound infection after breast surgery: a systematic review and metaanalysis. J Am Coll Surg. 2006;203:729.

    Article  PubMed  Google Scholar 

  18. Cabaluna ND, Uy GB, Galicia RM, Cortez SC, Yray MD, Buckley BS. A randomized, double-blinded placebo-controlled clinical trial of the routine use of preoperative antibiotic prophylaxis in modified radical mastectomy. World J Surg. 2013;37(1):59–66.

    Article  PubMed  Google Scholar 

  19. Gulluoglu BM, Guler SA, Ugurlu MU, Culha G. Efficacy of prophylactic antibiotic administration for breast cancer surgery in overweight or obese patients: a randomized controlled trial. Ann Surg. 2013;257(1):37–43.

    Article  PubMed  Google Scholar 

  20. Throckmorton AD, Boughey JC, Boostrom SY, Holifield AC, Stobbs MM, Hoskin T, et al. Postoperative prophylactic antibiotics and surgical site infection rates in breast surgery patients. Ann Surg Oncol. 2009;16(9):2464–9.

    Article  PubMed  Google Scholar 

  21. Farrar WB, Fanning WJ. Eliminating the dog-ear in modified radical mastectomy. Am J Surg. 1988;156:401.

    Article  CAS  PubMed  Google Scholar 

  22. Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340:77–84.

    Article  CAS  PubMed  Google Scholar 

  23. Rebbeck TR, Freibel T, Lynch HT, Neuhausen SL, van ‘t Veer L, Garber JE, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE study group. J Clin Oncol. 2004;22:1055–62.

    Article  PubMed  Google Scholar 

  24. Karanlık H, Ozmen V, Asoglu O, İgci A, Keçer M, Tuzlali S, et al. Long term results of breast cancer surgery. J Breast Health. 2006;2:89–95.

    Google Scholar 

  25. Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, et al. Effect of mechanical closure of dead space on seroma formation after breast surgery. Breast Cancer. 2006;13:260–5.

    Article  PubMed  Google Scholar 

  26. van Bastelaar J, van Roozendaal L, Granzier R, Beets G, Vissers Y. A systematic review of flap fixation techniques in reducing seroma formation and its sequelae after mastectomy. Breast Cancer Res Treat. 2018;167(2):409–16.

    Article  PubMed  Google Scholar 

  27. Tadych K, Donegan WL. Postmastectomy seromas and wound drainage. Surg Gynecol Obstet. 1987;165(6):483–7.

    CAS  PubMed  Google Scholar 

  28. Shamley DR, Barker K, Simonite V, Beardshaw A. Delayed versus immediate exercises following surgery for breast cancer: a systematic review. Breast Cancer Res Treat. 2005;90(3):263–71.

    Article  PubMed  Google Scholar 

  29. Vitug AF, Newman LA. Complications in breast surgery. Surg Clin North Am. 2007;87(2):431–51.

    Article  PubMed  Google Scholar 

  30. Carless PA, Henry DA. Systematic review and meta-analysis of the use of fibrin sealant to prevent seroma formation after breast cancer surgery. Br J Surg. 2006;93(7):810–9.

    Article  CAS  PubMed  Google Scholar 

  31. Keruakous AR, Sadek BT, Shenouda MN, Niemierko A, Abi Raad RF, Specht M, Smith BL, Taghian AG. The impact of isolated tumor cells on loco-regional recurrence in breast cancer patients treated with breast-conserving treatment or mastectomy without post-mastectomy radiation therapy. Breast Cancer Res Treat. 2014;146(2):365–70.

    Article  PubMed  Google Scholar 

  32. Abi-Raad R, Boutrus R, Wang R, Niemierko A, Macdonald S, Smith B, Taghian AG. Patterns and risk factors of locoregional recurrence in T1-T2 node negative breast cancer patients treated with mastectomy: implications for postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2011;81(3):e151–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rowell NP. Are mastectomy resection margins of clinical relevance? A systematic review. Breast. 2010;19(1):14–22.

    Article  CAS  PubMed  Google Scholar 

  34. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

    Article  CAS  PubMed  Google Scholar 

  35. Gruber G, Cole BF, Castiglione-Gertsch M, Holmberg SB, Lindtner J, Golouh R, et al. International Breast Cancer Study Group. Extracapsular tumor spread and the risk of local, axillary and supraclavicular recurrence in node-positive, premenopausal patients with breast cancer. Ann Oncol. 2008;19(8):1393–401.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Elkhuizen PH, van Slooten HJ, Clahsen PC, Hermans J, van de Velde CJ, van den Broek LC, et al. High local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: a European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group Study. J Clin Oncol. 2000;18(5):1075–83.

    Article  CAS  PubMed  Google Scholar 

  37. http://ec.europa.eu/health/ph_projects/2002/cancer/fp.pdf. European guidelines for quality assurance of breast cancer screening, diagnosis, and treatment 4th edition, 2006.

  38. Ozmen V. Meme hastalıklarının cerrahi tedavisinin kalitesi nasıl yükseltilebilir? Meme Sağlığı Dergisi. 2009;3:119–21.

    Google Scholar 

  39. Fisher B. The present status of tumor immunology. Adv Surg. 1971;5:189–254. Review.

    CAS  PubMed  Google Scholar 

  40. Fisher B, Wolmark N, Fisher ER, Deutsch M. Lumpectomy and axillary dissection for breast cancer: surgical, pathological, and radiation considerations. World J Surg. 1985;9:692–8.

    Article  CAS  PubMed  Google Scholar 

  41. Atkins HJ, Hayward JL, Klugman DJ, Wayte AB. Treatment of early breast cancer. A report after ten years of clinical trial. BMJ. 1972;2:423–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.

    Article  PubMed  Google Scholar 

  43. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.

    Article  PubMed  Google Scholar 

  44. Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995;332(14):907–11.

    Article  CAS  PubMed  Google Scholar 

  45. van Dongen JA, Bartelink H, Fentiman IS, Lerut T, Mignolet F, Olthuis G, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial. J Natl Cancer Inst Monogr. 1992;11:15–8.

    Google Scholar 

  46. Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr. 1992;11:19–25.

    Google Scholar 

  47. Arriagada R, Lê MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol. 1996;14(5):1558–64.

    Article  CAS  PubMed  Google Scholar 

  48. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials. N Engl J Med. 1995;333:1444.

    Article  Google Scholar 

  49. Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881–10882 trial. J Clin Oncol. 2007;25(22):3259–65.

    Article  PubMed  Google Scholar 

  50. Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg. 2012;99(10):1389–95.

    Article  CAS  PubMed  Google Scholar 

  51. Mcculley SJ, Macmillan RD. Planning and use of therapeutic mammoplasty-Nottingham approach. Br J Plast Surg. 2005;58(7):889–901.

    Article  CAS  PubMed  Google Scholar 

  52. Doğru V, Yaprak M, Durmaz E, Özkan Ö, Mesci A, Özkan Ö, Özmen V, Arıcı C. Oncoplastic approach to excisional breast biopsies: a randomized controlled, phase 2a trial. Breast Cancer. 2018; https://doi.org/10.1007/s12282-018-0892-2. [Epub ahead of print] PMID:30019283.

    Article  PubMed  Google Scholar 

  53. Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356(23):2399–405.

    Article  CAS  PubMed  Google Scholar 

  54. Mamtani A, Patil S, Stempel MM, Morrow M. Are there patients with T1 to T2, lymph node-negative breast cancer who are “high-risk” for locoregional disease recurrence? Cancer. 2017;123(14):2626–33.

    Article  CAS  PubMed  Google Scholar 

  55. Olsen MA, Chu-Ongsakul S, Brandt KE, Dietz JR, Mayfield J, Fraser VJ. Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg. 2008;143(1):53–60; discussion 61.

    Article  PubMed  Google Scholar 

  56. Indelicato D, Grobmyer SR, Newlin H, Morris CG, Haigh LS, Copeland EM 3rd, et al. Association between operative closure type and acute infection, local recurrence, and disease surveillance in patients undergoing breast conserving therapy for early-stage breast cancer. Surgery. 2007;141(5):645–53.

    Article  PubMed  Google Scholar 

  57. Morrow M, Hamilton AS, Katz SJ. Why do women get mastectomy? Results from a population based study. J Clin Oncol. 2007;25(18S):28S. Abstract 605.

    Google Scholar 

  58. Taghian A, Mohiuddin M, Jagsi R, Goldberg S, Ceilley E, Powell S. Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 2005;241:629–39.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Morrow M. Margins in breast-conserving therapy: have we lost sight of the big picture? Expert Rev Anticancer Ther. 2008;8:1193–6.

    Article  PubMed  Google Scholar 

  60. Fine RE, Schwalke MA, Pellicane JV, Attai DJ. A novel ultrasound-guided electrosurgical loop device for intra-operative excision of breast lesions; an improvement in surgical technique. Am J Surg. 2009;198(2):283–6.

    Article  PubMed  Google Scholar 

  61. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 2014;21(3):704–16.

    Article  PubMed  Google Scholar 

  62. Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717–30.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, Horton J, Hwang S, Johnson PL, Marinovich ML, Schnitt SJ, Wapnir I, Moran MS. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. J Clin Oncol. 2016;34(33):4040–6.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Puckett CL, Meyer VH, Reinisch JF. Crescent mastopexy and augmentation. Plast Reconstr Surg. 1985;75:533–43.

    Article  CAS  PubMed  Google Scholar 

  65. Holmes DR, Schooler W, Smith R. Oncoplastic approaches to breast conservation. Int J Breast Cancer. 2011;2011:303879.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6(3):145–57.

    Article  PubMed  Google Scholar 

  67. Calhoun KE, Anderson BO. Chapter Oncoplastic and reconstructive breast surgery oncoplastic surgery: central quadrant techniques pp. 117–126 Date: 13 February 2013.

    Google Scholar 

  68. Galimberti V, Zurrida S, Zanini V, Callegari M, Veronesi P, Catania S, Luini A, Greco M, Grisotti A. Central small size breast cancer: how to overcome the problem of nipple and areola involvement. Eur J Cancer. 1993;29:1093–6.

    Article  Google Scholar 

  69. Della Rovere GQ, Pillarisetti RR, Bonomi R, Benson J. Oncoplastic surgery for retro areolar breast cancer - a technical modification of the Grisotti flap. Indian J Surg. 2007;69(4):160–2.

    Article  PubMed  Google Scholar 

  70. Tukenmez M, Ozden BC, Agcaoglu O, Kecer M, Ozmen V, Muslumanoglu M, Igci A. Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction. J Laparoendosc Adv Surg Tech A. 2014;24(2):77–82. https://doi.org/10.1089/lap.2013.0172. Epub 2014 Jan 8. PMID: 24401140.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Ozmen V, Sarsenov D, Ozmen T, Ilgun S, Alco G, Ordu C, Agacayak F, Elbuken F, Erdogan Z, Pilanci KN. Mini latissimus dorsi flap increases breast conserving surgery rate in early stage breast cancer patients. Cancer Res. Vol. 76 Supplement: 4 Meeting Abstract: P2-12-17. https://doi.org/10.1158/1538-7445. SABCS15-P2-12-17.

  72. Alço G, Igdem S, Okkan S, Dincer M, Sarsenov D, Ilgun AS, Agacayak F, Elbüken F, Ercan T, Selamoglu D, Ozmen V. Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap. Mol Clin Oncol. 2016;5(4):365–71. Epub 2016 Aug 9.PMID: 27699027.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Dixon JM, Venizelos B, Chan P. Latissimus dorsi mini-flap: a technique for extending breast conservation. Breast. 2002;11:58–65. https://doi.org/10.1054/brst.2001.0312.

    Article  CAS  PubMed  Google Scholar 

  74. Nayyar A, Gallagher KK, McGuire KP. Definition and management of positive margins for invasive breast cancer. Surg Clin North Am. 2018;98(4):761–71.

    Article  PubMed  Google Scholar 

  75. Gurdal SO, Karanlik H, Cabioglu N, Ozcinar B, Yavuz E, Tuzlali S, Ozmen V. Positive or close margins in breast conserving surgery: is re-excision always necessary? Eur J Surg Oncol. 2012;38(5):399–406. https://doi.org/10.1016/j.ejso.2012.02.182. Epub 2012 Mar 21.PMID: 22440741.

    Article  CAS  PubMed  Google Scholar 

  76. Veronesi U, Luini A, Galimberti V, Zurrida S. Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg. 1994;18(1):70–5.

    Article  CAS  PubMed  Google Scholar 

  77. Pleijhuis RG, Graafland M, de Vries J, Bart J, de Jong JS, van Dam GM. Obtaining adequate surgical margins in breast-conserving therapy for patients with early-stage breast cancer: current modalities and future directions. Ann Surg Oncol. 2009;16(10):2717–30.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y, Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.

    Article  CAS  PubMed  Google Scholar 

  79. De Lorenzi F, Loschi P, Bagnardi V, Rotmensz N, Hubner G, Mazzarol G, Orecchia R, Galimberti V, Veronesi P, Colleoni MA, Toesca A, Peradze N, Mario R. Oncoplastic breast-conserving surgery for tumors larger than 2 centimeters: is it oncologically safe? A matched-cohort analysis. Ann Surg Oncol. 2016 Jun;23(6):1852–9.

    Article  PubMed  Google Scholar 

  80. Blair SL, Thompson K, Rococco J, Malcarne V, Beitsch PD, Ollila DW. Attaining negative margins in breast-conservation operations: is there a consensus among breast surgeons? J Am Coll Surg. 2009;209(5):608–13.

    Article  PubMed  Google Scholar 

  81. Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(7):961.

    Article  CAS  PubMed  Google Scholar 

  82. Meric F, Bucholz TA, Mirza NQ, Vlastos G, Ames FC, Ross MI, et al. Long-term complications associated with breast conserving surgery and radiotherapy. Ann Surg Oncol. 2002;9:543–9.

    Article  PubMed  Google Scholar 

  83. de Glas NA, Kiderlen M, Bastiaannet E, de Craen AJ, van de Water W, van de Velde CJ, et al. Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis. Breast Cancer Res Treat. 2013;138(2):561–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Istanbul University Istanbul Faculty of Medicine, Çapa, Istanbul, Turkey

    Vahit Ozmen

  2. Breast Center, Istanbul Florence Nightingale Hospital, Sisli, Istanbul, Turkey

    Vahit Ozmen

  3. Department of General Surgery, Palandöken State Hospital, Erzurum, Turkey

    Volkan Dogru

Authors
  1. Vahit Ozmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Volkan Dogru
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vahit Ozmen .

Editor information

Editors and Affiliations

  1. Oncology Institute, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Adnan Aydiner

  2. Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Abdullah Igci

  3. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Women’s Hospital of UPMC, Pittsburgh, PA, USA

    Atilla Soran

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ozmen, V., Dogru, V. (2019). Surgical Treatment of Early-Stage Breast Cancer. In: Aydiner, A., Igci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-16792-9_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16792-9_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16791-2

  • Online ISBN: 978-3-030-16792-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation