title: Extent of primary breast cancer surgery: standards and individualized concepts.
abstract: Surgery is still a main therapeutic option in breast cancer treatment. Nowadays, methods of resection and reconstruction vary according to different tumors and patients. This review presents and discusses standards of care and arising questions on how radical primary breast cancer surgery should be according to different clinical situations. In most early breast cancer patients, breast conservation is the method of choice. The discussion on resection margins is still controversial as different studies show conflicting results. Modified radical mastectomy is the standard in locally advanced breast cancer patients, although there are different promising approaches to spare skin or even the nipple-areola complex. A sentinel node biopsy is the standard of care in clinically node-negative invasive breast cancer patients, whereas the significance of axillary lymphonodectomy seems to be questioned through a number of different findings. Although there are interesting findings to modify surgical approaches in very young or elderly breast cancer patients, it will always be an individualized approach if we do not adhere to current guidelines. Up to date, there are no special surgical procedures in BRCA mutation carriers or patients of high-risk families.
authors.affiliation: Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Heil
authors.affiliation: Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
authors.forename: Valerie
authors.initials: V
authors.lastname: Fuchs
authors.affiliation: Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Golatta
authors.affiliation: Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schott
authors.affiliation: Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wallwiener
authors.affiliation: Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Domschke
authors.affiliation: Institut für Pathologie, Universität Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Sinn
authors.affiliation: Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Germany.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
authors.affiliation: Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
authors.affiliation: Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Schütz
keywords: Axillary lymphonodectomy; Breast cancer surgery; Resection margins; Sentinel lymph node biopsy