CURRENT CONTROVERSIES IN THE SURGICAL-MANAGEMENT OF BREAST-CANCER

Background: Great advances have occurred in the surgical management of breast cancer during the past 2 decades, though areas of controversy still remain. The surgical treatment of breast cancer relates to manag ement of the breast and of the axillary nodes. Areas of controversy re late to methods of breast conservation after preoperative chemotherapy for locally advanced disease. The ideals of such treatment are descri bed and the various methods by which such results may be obtained are discussed. The importance of conservation of the nipple-areolar comple x is stressed, and the various methods of reconstruction by which this can be achieved are discussed. The role of surgery to the axilla is a lso discussed, with particular reference to axillary sampling. Data re lating to the control of axillary disease treated by irradiation and t hat obtained after surgery are compared. Current controversies: Breast conservation, partial and subcutaneous mastectomy, reconstruction (us ing implants, prostheses and 4myocutaneous flaps), the management of a xillary disease and the role of adjuvant therapy are discussed.