Significant progress has been made in the treatment and outcome of breast cancer. Some of the most dramatic strides have been in the surgical management of breast cancer. Breast-conserving therapy (BCT), including wide local excision of the tumor followed by irradiation, has become a standard treatment option for women with early-stage invasive breast cancer. Large cooperative group trials have contributed to the paradigm shift from mastectomy to BCT. This review reports the landmark BCT trials that provided the data for current surgical practices. The review also describes the body of literature contributing to the increasing use of oncoplastic techniques for patients undergoing BCT.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Hermann RE, Esselstyn CB, Crile G, et al. Results of conservative operations for breast cancer. Arch Surg. 1985;120:746–51.
NIH Consensus conference. Treatment of early-stage breast cancer. JAMA. 1991;265:391–5.
Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985;312:665–73.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.
Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995;332:907–11.
Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy. Cancer. 2003;98:697–702.
Arriagada R, MG LÃª, GuinebretiÃ¨re JM,<AQ7> et al. Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients. Ann Oncol. 2003;14:1617–22.
Blichert-Toft M, Nielsen M, During M, et al. Long-term results of breast-conserving surgery vs. mastectomy for early-stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol. Acta Oncologica. 2008;47:672–81.
Van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.
Audretsch WP, Rezai M, Kolotas C, et al. Tumor-specific immediate reconstruction in breast cancer patients. Semin Plast Surg. 1998;11:71–100.
Clough KB, Nos C, Fitoussi A. Oncoplastic conservative surgery for breast cancer. Operative Techniq Plast Reconstruc Surg. 1999;6:50–60.
Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989;320:822–8.
Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl M Med. 1985;312:665–73.
Sarrazin D, Le MG, Rouesse J, et al. Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less. Cancer. 1984;53:1209–13.
Sarrazin D, Le MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol. 1989;14:177–84.
Chatterjee A, Gass J, Patel K, et al. A Consensus definition and classification system of oncoplastic surgery developed by the American Society of Breast Surgeons. Ann Surg Oncol. 2019;26:3436–44.
De Lorenzi F, Loschi P, Bagnardi V, et al. Oncoplastic breast-conserving surgery for tumors larger than 2 centimeters: is it oncologically safe? A matched-cohort analysis Ann Surg Oncol. 2016;23:1852–9.
De La Cruz L, Blankenship SA, Chatterjee A, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Ann Surg Oncol. 2016;23:3247–58.
Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72:145–9.
Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91.
Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6:145–57.
Chatterjee A, Dayicioglu D, Khakpour N, Czerniecki BJ. Oncoplastic surgery: keeping it simple with 5 essential volume displacement techniques for breast conservation in a patient with moderate- to large-sized breasts. Cancer Control. 2017;24:1073274817729043.
Losken A, Hart AM, Dutton JW, Broecker JS, Styblo TM, Carlson GW. The expanded use of autoaugmentation techniques in oncoplastic breast surgery. Plast Reconstr Surg. 2018;141:10–9.
Jonczyk MM, Jean J, Graham R, Chatterjee A. Trending towards safer breast cancer surgeries? Examining acute complication rates from a 13-year NSQIP analysis. Cancer. 2019;11:253.
Kelsall JE, McCulley SJ, Brock L, Akerlund MTE, Macmillan RD. Comparing oncoplastic breast-conserving surgery with mastectomy and immediate breast reconstruction: case-matched patient-reported outcomes. J Plast Reconstr Aesthet Surg. 2017;70:1377–85.
Chand ND, Browne V, Paramanathan N, Peiris LJ, Laws SA, Rainsbury RM. Patient-reported outcomes are better after oncoplastic breast conservation than after mastectomy and autologous reconstruction. Plast Reconstr Surg Global Open. 2017;5:e1419.
Stein MJ, Zhang J. Quality-of-life and surgical outcomes for breast cancer patients treated with therapeutic reduction mammoplasty versus mastectomy with immediate reconstruction. Ann Surg Oncol. 2020;27:4502–12.
Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124:345–53.
Hwang ES, Lichtensztajn DY, Gomez SL, et al. Survival after lumpectomy and mastectomy for early-stage invasive breast cancer: the effect of age and hormone receptor status. Cancer. 2013;119:1402–11.
De Munck L, De Bock GH, Jobsen JJ, et al. 10-Year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol. 2016;17:1158–70.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Margenthaler, J.A., Dietz, J.R. & Chatterjee, A. The Landmark Series: Breast Conservation Trials (including oncoplastic breast surgery) . Ann Surg Oncol 28, 2120–2127 (2021). https://doi.org/10.1245/s10434-020-09534-y