Breast conserving surgery revisited: a narrative review

Background and Objective: Breast cancer surgery has seen a reverse evolution particularly over the last decade. There has been a universal acceptance of the fact that tumour biology and response to systemic treatment dictates risk of breast cancer recurrences and not surgical radicalism. The role of surgery has been "risk adapted" over the years to maintain function, contour and body image without compromising on the principles of surgical oncology. In this article we explore the first major transition from radical ablative mastectomies to breast conserving surgery (BCS) as we know it today comparing the different cancer specific and health related outcome measures for BCS and mastectomy. Methods: We undertook comprehensive search using Ovid Medline from 1946 till May 2021 to identify complete papers published in English, primarily comparing the clinical outcomes of BCS and mastectomy using keywords such as "mastectomy", "breast conserving surgery" to name a few. Particular emphasis was given to data from randomised controlled trials and meta-analyses looking at the safety of breast conserving treatment. The oncological characteristics and results from key studies identified are analysed and summarised in this review. Conclusions: BCS in conjunction with radiotherapy in appropriately selected cases gives results comparable to mastectomy for overall survival and relapse free survival. Current data suggest that in both node negative and node positive patients, breast conservation therapy (BCT) is a safe option with higher levels of favourable patient related outcomes.