The field of breast surgery has undergone significant transformation over recent decades. Historically, breast surgery was predominantly aggressive, with modified radical mastectomies being the standard. However, advancements in understanding breast cancer's biology have led to earlier detection and less extensive surgeries.
Currently, breast conservation therapy, characterized by lumpectomies coupled with radiotherapy, offers equivalent survival rates to mastectomy. Oncoplastic surgery, incorporating various reconstructive techniques, further increases the possibility of breast conservation while limiting deformity. Partial breast reconstruction with locoregional flaps allows more patients to benefit from breast conservation. In patients who inevitably require a mastectomy, skin-sparing, and nipple-sparing options are safe in selective conditions, and immediate reconstruction further improves cosmetic outcomes.
In axillary management, sentinel lymph node biopsy has replaced routine axillary lymph node dissection. The Z0011 study further decreases the number of patients requiring axillary dissection. With significant advances and tight collaboration with oncologists and radiologists, targeted axillary dissection (TAD) is a feasible and safe alternative in locally advanced patients with good clinical response after receiving neoadjuvant therapy before their surgery, minimizing surgical extent while ensuring thorough cancer management.
In benign cases, alternative treatments to surgical excision, such as High-Intensity Focused Ultrasound (HIFU) and vacuum-assisted breast biopsy (VABB), offer scarless solutions to our patients.
Collaborations with the university have also led to the adoption of advanced techniques. Through clinical trials and overseas training exposure, innovative treatments like cryotherapy for early breast cancers, immediate lipo-filling for breast conservations, and robotic surgery for mastectomies. These methods not only effectively manage the disease but also significantly enhance patients' quality of life.
In conclusion, the evolution towards less aggressive management for breast diseases reflects a balance between oncological safety and aesthetic outcomes, profoundly impacting patient care in both the short term and long term, physically and mentally.
