Surgical considerations for breast cancer patients receiving neoadjuvant systemic therapy

In appropriately selected patients whose tumors respond to neoadjuvant chemotherapy, breast-conserving therapy can be performed with excellent rates of locoregional control. Not all patients become breast-conserving therapy candidates, and in those who require mastectomy, recommendations regarding reconstruction may be influenced by whether a patient will be advised to consider postmastectomy radiation therapy. For patients with clinically node-negative disease, sentinel lymph node dissection performed after neoadjuvant chemotherapy is technically feasible and accurate and results in fewer patients with a positive sentinel lymph node, and therefore fewer patients requiring axillary lymph node dissection. For patients presenting with node-positive disease, a significant percentage will become node-negative with neoadjuvant chemotherapy, and recent trials have been designed to assess the use of sentinel lymph node dissection in select patients.