Surgical Management of Triple-Negative Breast Cancer

Early-Stage TNBC (Stage I)

For tumors <5 mm, surgical excision alone may be appropriate, though nearly half of experts recommend adjuvant chemotherapy even for these small tumors, according to the European Society for Medical Oncology 1

Neoadjuvant chemotherapy is preferred for stage II or III TNBC before definitive surgery, as recommended by the European Society for Medical Oncology 1, 2
Dose-dense anthracycline and taxane-based regimens are preferred for neoadjuvant treatment of stage II-III TNBC, according to the European Society for Medical Oncology 1

Sentinel lymph node biopsy (SLNB) is standard for clinically node-negative patients, as recommended by the European Society for Medical Oncology 1
For patients with clinically positive nodes who receive neoadjuvant chemotherapy, SLNB may be considered if nodes become clinically negative after treatment, according to the European Society for Medical Oncology 1
For residual nodal disease after neoadjuvant therapy, axillary lymph node dissection is recommended, especially for macrometastases >2mm, as suggested by the European Society for Medical Oncology 1

Post-mastectomy radiation therapy should be considered for patients with positive lymph nodes, as recommended by the European Society for Medical Oncology 2
Post-mastectomy radiation therapy should be considered for patients with positive or close margins, according to the National Comprehensive Cancer Network and supported by the British Journal of Cancer 3

There is no standard recommendation for prophylactic contralateral mastectomy based solely on TNBC status, as stated by the European Society for Medical Oncology 1, 2
Factors that may influence consideration of contralateral prophylactic mastectomy include genetic predisposition, young age at diagnosis, strong family history, and patient preference, according to the European Society for Medical Oncology 2, 3, 4, 5, 6
For patients with germline BRCA1/2 mutations and TNBC, consideration of bilateral mastectomy may be appropriate due to increased risk of contralateral breast cancer, as recommended by the European Society for Medical Oncology 6

For patients with germline BRCA1/2 mutations and HER2-negative TNBC, adjuvant olaparib for 1 year should be considered, as suggested by the European Society for Medical Oncology 6
Immediate breast reconstruction should be carefully considered in TNBC patients who may require post-mastectomy radiation, with some experts suggesting delayed reconstruction may be more appropriate, according to the British Journal of Cancer 3