“Less Is More”: Toward Less Morbidity After Breast Cancer Surgery

In the setting of the major efforts made by the surgical community in the last three decades to de-escalate breast cancer surgery in order to reduce morbidity while maintaining oncological safety, of efforts made by breast surgeons to further improve aesthetic outcomes and quality of life to develop oncoplastic breast conservation techniques, and of preoperative systemic therapy allowing for surgical de-escalation, here we review the surgical complications of standard and oncoplastic breast surgery, the benefit of preoperative systemic therapy on breast and axillary surgical downstaging, and the current indications to perform axillary lymph node dissection. We find that thanks to improvements in multimodality treatment, survival outcomes for breast cancer have significantly improved over the last decades, and that major progress has been made by the surgical community to de-escalate the extent of surgery without compromising oncological safety. Multiple randomized controlled trials are ongoing and will tell us whether axillary surgery can be further de-escalated. In order for oncoplastic procedures to become standard of care in the management of early breast cancer, high-level prospective multicentric studies are needed.