The surgical perspective

Surgery is the mainstay of treatment for locoregionally confined breast cancer. Radiation and chemotherapy are both important adjuvant components of multimodal care aimed at reducing local recurrence and improving overall survival and are used in most patients, including those with early-stage disease. The goal of surgery in the treatment of the breast cancer patient is to remove all clinical detectable disease and achieve microscopically clear margins. To accomplish this objective, an accurate determination of the extent of disease is imperative, for this determination greatly influences the extent of surgery undertaken. In this article, we review considerations for determining extent of disease, the significance of this determination to the surgeon, and the ways in which different findings influence decision making at sequential junctures of patient management.