[Primary surgery in the treatment of invasive cancers of the breast].

The modalities and indications for surgery in the treatment of breast cancers have changed considerably over the last 30 years with a succession of exclusive surgery, exclusive radiotherapy, then limited surgery with adjuvant radiotherapy, adjuvant chemotherapy and finally neoadjuvant chemotherapy. With the contribution of all of these treatment modalities, the authors discuss the respective roles of radical surgery and conservative surgery as first-line surgery for invasive breast cancers. After recalling its objectives, first-line surgery is then described in terms of its diagnostic role in the presence of a suspicious node, an patch of mastopathy, nipple discharge or subclinical lesions. The various radical and conservative techniques of primary curative surgery are then described in the context of combined therapy (adjuvant radiotherapy and/or chemotherapy): no longer Halsted's radical mastectomy, by modified Patey's mastectomy with limited lymph node dissection and especially partial mastectomies (quadrantectomy, lumpectomy) with axillary lymph node dissection, alone or combined with radiotherapy. The implications on the cosmetic result and the various modalities of reconstructive surgery are also discussed.