Surgical management of the breast: breast conservation therapy and mastectomy.

The twentieth century has witnessed dramatic changes in the surgical management of breast cancer. Herein we focus on the evolution of breast conservation surgery and current surgical trends of lumpectomy, mastectomy and contralateral prophylactic mastectomy. Margin analysis, specimen localization and processing, and the benefits of magnetic resonance imaging remain controversial. Neoadjuvant chemotherapy can offer prognostic information and aid in surgical planning while radiation therapy continues to reduce the risk of local recurrence after breast conserving surgery. Despite these advances, mastectomy remains a popular choice for many women and the use of nipple sparing procedures is increasing. Overall the low rates of local recurrence are attributed to the combination of surgery and targeted adjuvant and radiation therapies.