Surgical techniques in breast cancer: an overview

Breast cancer is the most common female cancer and its incidence continues to increase. Ongoing advances in adjuvant treatments have resulted in declining mortality rates with increasing numbers of women surviving their breast cancer diagnosis. Whilst the primary outcome of surgery remains oncological efficacy, the contemporary breast surgeon must consider the long-term aesthetic outcome of the procedure and the inevitable impact on body image and self-esteem.There has been a paradigm shift in breast surgery in the UK over the last 20 years with oncoplastic breast surgery (OPBS) techniques now representing the standard of care. As the role of breast conserving surgery (BCS) has been extended by therapeutic mammoplasty and the use of neoadjuvant treatments, mastectomy rates continue to decline. The introduction of sentinel node biopsy (SNB) has fostered an increasingly conservative approach to axillary surgery. Nationally, rates of immediate breast reconstruction (IBR) following skin-sparing Mastectomy (SSM) continue to rise. Yet the National Mastectomy and Breast Reconstruction Audit (NMBRA) highlighted the disparities in care and wide variation in practice that still exists in the UK. Whilst breast reconstruction is widely practised, the adoption of the Oncoplastic Breast Surgery Best Practice Guidelines and engagement with long-term follow-up studies focusing on patient reported outcome measures (PROMs) will hopefully result in a consistently high standard of care.