Breast Cancer Surgery Guidelines

Introduction to Breast Cancer Surgery

The European Society of Breast Cancer Specialists recommends breast-conserving surgery as the primary surgical choice for breast cancer, with 60-80% of newly diagnosed cancers in Western Europe amenable to breast conservation through wide local excision and radiotherapy 1, 2
The American Cancer Society states that patients with early-stage breast cancer who opt for breast-conserving therapy may have even better survival compared with those who have mastectomy 2

The American Society of Breast Surgeons suggests that oncoplastic approaches reduce the impact of local tumor excision on cosmesis, primarily using tissue displacement techniques 1, 2
The Society of Surgical Oncology recommends oncoplastic procedures for superior cosmetic outcomes, especially in patients with large breasts, less favorable tumor-to-breast size ratio, and cosmetically challenging tumor locations 2, 3
The American College of Surgeons states that therapeutic mammoplasty represents a newer oncoplastic technique that can achieve better cosmetic outcomes in patients with large breasts 4, 5
The European Society of Surgical Oncology recommends glanduloplasty techniques using adjacent tissue displacement flaps to reduce the local volume deficit created by tumor excision 4, 5

The College of American Pathologists states that careful histological assessment of resection margins is essential, with margins reported as positive when ink touches invasive cancer or DCIS 3
The American Society for Clinical Pathology recommends specimen orientation by the surgeon using sutures, clips, multicolored indelible ink, or other suitable techniques for accurate margin assessment 6, 7
The Society of Surgical Oncology suggests marking the tumor bed with clips to facilitate accurate planning of the radiation boost field and demarcate the tumor bed for future imaging studies 6, 7

The American Society of Plastic Surgeons recommends skin-sparing mastectomy to conserve the skin envelope for use in breast reconstruction, improving cosmetic outcomes 4, 5
The European Society of Plastic, Reconstructive and Aesthetic Surgery states that nipple-sparing procedures should be limited to carefully selected patients with early-stage, biologically favorable cancers located >2cm from the nipple 8
The American College of Surgeons recommends the Deep Inferior Epigastric Perforator (DIEP) flap as the preferred autologous option for breast reconstruction, providing optimal tissue volume from the lower abdomen while preserving the rectus abdominis muscle 9

The Society of Surgical Oncology recommends sentinel lymph node biopsy rather than full nodal clearance as the standard of care for axillary staging in early breast cancer, unless axillary node involvement is suspected clinically or on ultrasound 4, 5
The American Cancer Society states that SLNB delivers less morbidity in terms of shoulder stiffness and arm swelling, and allows for reduced hospital stay 4, 5

The European Society of Medical Oncology recommends a neoadjuvant approach for subtypes highly sensitive to chemotherapy, such as triple-negative and HER2-positive, in tumors >2 cm and/or a positive axilla 1, 2
The American Society of Clinical Oncology states that neoadjuvant therapy can downstage large tumors, converting patients who would require mastectomy into candidates for breast conservation 10

The European Society of Breast Cancer Specialists recommends that local recurrence rates after wide excision and radiotherapy should be <1% per year and should not exceed 10% overall 4, 5

The American Cancer Society states that the choice of treatment strategy must be extensively discussed with the patient and take into account the patient's preferences, based on tumor burden/location and biology, as well as age, menopausal status, general health status and preferences of the patient 1, 2
The European Society of Breast Cancer Specialists recommends that information on diagnosis and treatment choice should be given repeatedly (both verbally and in writing) in a comprehensive and easily understandable form 3