Abstract

Philip Lau
Consultant Surgeon National University Hospital, Singapore

Nine large multicentre prospective randomised trials have conclusively shown that breast conservation with adequate margins, followed by postoperative radiotherapy, is just as effective as mastectomy in the treatment of breast cancer. For properly selected patients, breast conserving surgery is seen is a gold standard procedure, with the aims to achieve complete resection and good cosmetic results.

With increasing experience and longer follow – up for patients, data is emerging that help us to select whom should be offered breast conservation. Factors have emerged that predict for the increase risk of local recurrence, which is itself a poor prognostic factor that predicts systemic disease and decrease breast cancer survival. These factors have included early age of onset, extensive in – situ (EIC) disease and lobular cancer subtype.

This better understanding of the natural history of breast cancer has allowed us to modify the selection process of breast conservation, and to better define what adequately cleared margins mean. The use of special imaging techniques, such as breast MRI, will also be discussed.

A new development that can extend the use of breast conservation is the recent development of oncoplastic surgery. Extending the techniques familiar to cosmetic breast surgery into the oncological field of breast cancer treatment has allowed wider margins with better cosmetic results, often with corrective operations of the normal opposite breast to achieve symmetry. In addition the emergence of reconstruction for the partially resected breast, such as mini – latissimus dorsi flaps, is also allowing for breast conservation to obtain clear margins where only a mastectomy would have been possible before.

Underlying these developments is a fundamental change that has occurred in breast cancer treatment. From one which was primarily the purview of the general surgeon, specialist units consisting of radiology, surgery, pathology, and reconstructive surgery specialties will extend the role of breast conservation in the future.