Surgical Treatment of Breast Cancer

The Role of Surgical Treatment

Surgery is the primary pillar in the management of early breast cancer and, in most cases, the first therapeutic step. Its goal is not only to remove the malignancy, but to achieve oncologically safe excision with clear surgical margins, accurate staging of the disease, and, where feasible, preservation of aesthetics and quality of life.

The choice of the appropriate procedure is not the same for all women. It is based on individualized evaluation, taking into account imaging and histological data from the breast biopsy, the molecular characteristics of the tumor, the stage of the disease, the patient’s general health, and personal preferences. The modern approach is multidisciplinary, and decisions are made within the framework of a tumor board, aiming for the optimal oncological and functional outcome.

Breast-Conserving Surgery (Lumpectomy)

Breast-conserving surgery, also known as lumpectomy, involves the removal of the tumor along with a margin of healthy surrounding tissue, while preserving the remaining breast parenchyma.

It is indicated when the size and location of the tumor allow oncologically safe excision, when there are no multiple foci in different quadrants, and when the patient can undergo postoperative radiation therapy. In early stages, breast-conserving surgery combined with radiation therapy offers equivalent survival rates to mastectomy.

This approach allows, in most cases, preservation of the natural appearance of the breast without compromising oncological safety.

Mastectomy

Mastectomy involves the removal of the breast gland and is indicated when the tumor is extensive relative to the breast size, when there is multifocal or multicentric disease, when there are contraindications to radiation therapy, or when the patient herself chooses it after thorough informed consent.

Modern techniques have evolved significantly and include skin-sparing mastectomy or, in selected cases, nipple-sparing mastectomy. The choice of technique is determined by strict oncological and anatomical criteria.

Sentinel Lymph Node Biopsy

Assessment of the axilla is a key element of staging. Sentinel lymph node biopsy allows identification and removal of the first lymph node draining the tumor region.

When the sentinel lymph node is negative, extensive axillary lymph node dissection is avoided, significantly reducing the risk of complications such as lymphedema. In the case of a positive result, further management is individualized according to current oncological data.

This technique has substantially contributed to reducing postoperative morbidity.

Oncoplastic Surgery

Modern breast surgery is not limited to oncological safety alone. The oncoplastic approach combines principles of oncological and plastic surgery, allowing wider excisions with improved aesthetic outcomes.

Using appropriate breast reshaping techniques, symmetry and morphology are maintained even when removal of a significant volume of tissue is required. The choice of technique depends on the location and size of the tumor, the size of the breast, and the patient’s wishes.

Breast Reconstruction

Breast reconstruction can be performed immediately, during the same surgical session as the mastectomy, or in a delayed fashion at a later time. Available methods include the use of silicone implants, autologous tissue flaps, or a combination of techniques.

The decision is made after a detailed discussion with the patient and in collaboration with the plastic surgery team, with oncological safety and personal priorities as guiding principles.

Postoperative Course

Most procedures are performed under general anesthesia, require a short hospital stay, and allow relatively rapid return to daily life. Proper preoperative information, a clear understanding of the treatment plan, and organized follow-up reduce anxiety and facilitate recovery.

Modern Advances in Breast Surgery

Breast surgery has evolved substantially in recent years, with the primary goal of achieving not only oncological safety but also preservation of quality of life and aesthetic outcome. The modern approach is personalized and is based on the biological characteristics of the disease, imaging data, and the needs of each woman.

Today, in a large proportion of cases, breast conservation through lumpectomy — that is, removal of the tumor only with safe surgical margins, combined with radiation therapy — is achievable. Current scientific evidence shows that, in appropriately selected patients, this approach is oncologically equivalent to mastectomy. At the same time, the surgical technique is planned with the aesthetic outcome in mind, so as to preserve the natural morphology of the breast as much as possible.

Oncoplastic surgery represents an important advancement, as it combines principles of oncological and plastic surgery. It allows wider and safer tumor removal, with simultaneous breast reshaping and, when needed, symmetrization of the contralateral breast. In this way, oncological adequacy is achieved without compromising the aesthetic result.

In axillary management, sentinel lymph node biopsy has largely replaced extensive axillary dissections. Targeted removal of the first draining lymph node of the tumor significantly reduces the risk of complications such as lymphedema, while providing reliable staging of the disease. Furthermore, current protocols allow, in selected cases, avoidance of complete axillary lymph node dissection even when limited lymph node disease is present, further reducing the surgical burden.

In cases where mastectomy is required, immediate breast reconstruction is often feasible, using either implants, autologous tissue, or combined techniques. The choice is made in collaboration with the woman and the multidisciplinary team, taking into account both oncological data and her personal wishes.

The modern surgical decision is not based solely on tumor size. The biological subtype, hormone receptor expression, the presence or absence of HER2 overexpression, and, in certain cases, the results of genomic assays determine the treatment plan. Surgical management is integrated into an overall framework of oncological care, in close collaboration with medical oncologists, radiologists, pathologists, and radiation oncologists, and is often complemented by adjuvant therapies. The guiding principles of modern oncological surgery are also summarized by the National Cancer Institute.

This evolution has transformed breast surgery into a more targeted, less invasive, and more personalized process. The ultimate goal remains constant: complete oncological safety, with the least possible physical and psychological burden for the woman.