ACS Surgery: Principles and Practice

The procedures used to diagnose, stage, and treat breast disease are rapidly becoming less invasive and more cosmetically satisfying while remaining oncologically sound. In particular, percutaneous core biopsy has largely replaced excisional breast biopsy for both palpable and nonpalpable breast lesions and has proved to be an equally accurate, less invasive, and less costly means of pathologic diagnosis.1 Moreover, in clinically appropriate patients, sentinel lymph node biopsy (SLNB) has proved to be an accurate method of staging the axilla that reduces the incidence of many of the complications associated with traditional axillary node dissection.2 Furthermore, breast conservation has largely supplanted mastectomy for definitive surgical treatment of breast cancer; randomized trials continue to demonstrate equivalent survival rates for the two therapies.3 Even in those cases where mastectomy is either required or preferred, advances in reconstructive techniques have been made that yield significantly improved outcomes after breast reconstruction.4 Finally, in an effort to eliminate the need for open surgical treatment of breast cancer, various percutaneous extirpative and ablative local therapies have been developed and are being evaluated for potential use in managing breast cancer in carefully selected patients.5 A more minimally invasive approach to breast disease will depend to a substantial extent on the availability of accurate and efficient imaging modalities. Adeptness with such modalities is rapidly becoming an essential part of the general surgeon’s skill set. In this chapter, we describe selected standard, novel, and investigational procedures employed in the diagnosis and management of breast disease.The application of these procedures is a dynamic process that is shaped both by technological advances and by physicians’ evolving understanding of the biology of breast diseases.