New surgical trends in breast cancer treatment: conservative interventions and oncoplastic breast surgery.

AIM: From radical mastectomy by Halstedt to quadrantectomy by Veronesi, surgical treatment of breast cancer has become more and more conservative in order to preserve women quality of life. We analyzed the evolution of breast interventions through a nine-year period.

METHODS: We collected data about all breast surgery interventions performed between 2002 and 2010 in our Department Of Surgery, focusing on patients' age, tumor histology, TNM classification, hormonal status, intervention radicality on the breast and axilla, and eventual plastic surgery. Data were analyzed by R (version 2.14.2), considering significant P<0.05.

RESULTS: A total of 3320 breast surgery interventions were performed on 2300 patients. Absolute yearly number of interventions has strongly increased with the introduction of the mammography screening (291 to 430). Conservative breast surgery (55% to 62%) and skin-sparing mastectomy (1% to 8%) have been performed more frequently in premenopausal patients, and significantly increased in time, with a consequent decrease of classical radical mastectomy (38 to 15%) but an increase of margins widening after primary surgery (2% to 6%). Sentinel lymph node biopsy is mostly replacing complete axillary lymph node dissection (93% to 31%). Skin-glandular reshaping progressively increased (up to 20%) as also breast reconstruction (23% to 40%), which since 2008 has been performed also in women older than 75 years, while flaps have been used in strictly selected patients.

CONCLUSION: Conservative surgery represents the target of current breast cancer treatment where possible, and skin-sparing mastectomy an interesting alternative to classical one when radicality is required. Sentinel lymph node biopsy has replaced complete axillary lymph node dissection by clinically negative nodal status. Breast reshaping and reconstruction are increasing in every age group, including women older than 75 years.