Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy
Disease-free survival at 5 years was 56% for the mastectomy group and 69% for the breast conservation therapy
Metastases in axillary nodes or additional distant tumors also do not necessarily preclude breast conservation therapy
The lack of agreement regarding what constitutes an adequate negative margin, the common use of re-excision to optimize negative margin widths in patients undergoing breast-conserving therapy (particularly in those patients already with no ink on tumor), the recognition of the direct impact of contemporary systemic therapies in reducing local recurrence rates, and a better understanding of tumor biology led the Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) to convene a multidisciplinary panel of experts to develop consensus guidelines regarding margins for patients with stage I and II breast carcinoma in the setting of breast conservation therapy
Besides these techniques, suturing of flaps with subcutaneous tissue,  avoiding use of axillary drains following breast conservation therapy
,  and obliterating axillary dead space by muscle approximation have all been tried for reducing seroma formation.
The many refinements in breast conservation therapy
have resulted in greatly improved treatment.
An additional challenge is the lack of frozen-section procedure for the assessment of tumour-free margins, with the result that breast conservation therapy
is hardly possible.
The following clinical scenarios, for which breast MRI is indicated, will be reviewed: preoperative evaluation of patients with newly diagnosed breast cancer, evaluation of breast cancer patients treated with neoadjuvant chemotherapy, evaluation of breast cancer patients with positive surgical margins following breast conservation therapy
, evaluation of patients with metastatic axillary lymphadenopathy and an unknown primary malignancy, determination of silicone breast implant integrity, breast cancer screening in high risk women, and the use of breast MRI as a problem-solving tool for equivocal mammographic findings.
The study specifically focused on patients with tumours that were [less than or equal to] 2 cm (n=319) who either had a mastectomy (n=55) or breast conservation therapy
In addition, the number of disease foci can determine whether or not breast conservation therapy
should be considered.
Raina et al (1) proposed that patient preference for mastectomy is an important reason for the under-utilization of breast conservation therapy