Surgical techniques in breast cancer: an overview

With advancements in oncology and oncoplastic training, the options for treating breast cancer have expanded exponentially over the past two decades. In particular, surgical techniques have advanced to the point where oncological safety and aesthetic outcomes are now the pillars of contemporary breast surgery. Studies have demonstrated that by using oncoplastic techniques, breast conservation has become an alternative for many patients who would otherwise undergo mastectomy. Nonetheless, a considerable cohort of patients will still require, or request, a mastectomy. Surgical options range from a simple wide local excision, therapeutic mammoplasty, volume replacement techniques with a local flap or mastectomy with whole breast reconstruction using autologous tissue or a prosthetic implant. Deciding between surgical options involves careful consideration of tumour characteristics, patient comorbidities and the potential effects of neoadjuvant and adjuvant treatments. The key message for surgeons is to ensure the chosen surgery does not compromise oncological outcomes and provides an excellent aesthetic outcome with timely healing to prevent delays in commencing adjuvant oncology treatments. In this article, we discuss techniques for breast conservation surgery and reconstructive options after mastectomy. In addition, we detail the safety and influence of neoadjuvant and adjuvant treatments on surgery.