Selection and technique for lumpectomy.

Abstract

The preoccupation with local recurrence in breast-conserving surgery represents the dominance of anatomic worries over biologic ones and is similar to the concerns that led our ancestors to devise the radical mastectomy which we now know to be an inappropriate solution to the cancer problem. Local recurrence in a conserved breast is not seen to be a cause of distant failure or death, but is often a reflection of metastases in those patients that have them. With the advent of adjuvant chemotherapy, even in node-negative cases, we have seen a conspicuous decline in local recurrence rates. The vast majority of patients with primary breast cancer can be safely and adequately treated by lumpectomy with radiation therapy and axillary dissection. Local recurrence rates are suppressed by the routine addition of adjuvant therapy. Careful attention to the principles of breast-conserving surgery will give the best cosmesis and the best rates of local control.