Surgical treatment of early breast cancer.

This brief review defines the various surgical procedures for breast cancer, which are under dispute by laymen and some surgeons, because of lack of controlled comparative studies and differences in classification of stages of breast cancer. The simplest procedure, tylectomy or lumpectomy, consists of resection of the local lesion only. Simple mastectomy refers to removal of the involved mammary gland and pectoral fascia, perhaps with some easily accessible lymph nodes. Modified radical mastectomy consists of total mastectomy with dissection of the axillary contents. Radical mastectomy, the classical Halsted operation, is removal of breast, subcutaneous tissues, pectoral muscles, axillary contents, followed by skin graft. The extended radical mastectomy also involves resection of parasternal lymph nodes and supraclavicular tissues. For metastases, some physicians prefer irradiation, some chemotherapy and some ovariectomy with hormone therapy. 2 comparative studies cited show no difference in survival rates between radical mastectomy and radical mastectomy with irradiation or between radical mastectomy with irradiation and wide local excision with irradiation.