Types of breast surgery

Mastectomy

• Traditional transverse
• Skin sparing with immediate reconstruction

Breast conservation

• Wide local excision
• Image guided local excision
• Oncoplastic breast conservation including therapeutic mammoplasty
• Breast conservation and radiotherapy is at least as safe as mastectomy, and may have better cancer outcomes

Neoadjuvant treatment to achieve breast conservation

• Chemotherapy (standard FEC and taxane) +/- herceptin
• Endocrine - aromatase inhibitors more effective than tamoxigen, so usually reserved for postmenopausal women
• Both methods shown to reduce mastectomy rates
• Some overall survical advantage for younger women if chemo pre surgery, so systemic advantage

Axillary treatment options

• Pre-operative axillary staging - USS axilla +/- core biopsy
• Sentinel node biopsy
• Axillary clearance
• Axillary radiotherapy