Surgical treatment of primary breast cancer according to disease extent.

Radical mastectomy should be replaced by a number of different types of operation, either more conservative or more extended according to the extent of the disease. For cases T1NO a new procedure consisting of the removal of a quadrant of the breast, with axillary dissection plus radio-therapy on the residual breast tissue, is under evaluation. In cases T2NO modified radical mastectomy is suggested as a procedure of choice, whilst T3 cases and all N1 cases should still be submitted to radical mastectomy. Cases with tumor of inner quadrants with positive axillary nodes will benefit from the removal of the internal mammary nodes. Superradical mastectomy is limited to special selected cases with extensive lymph-node invasion. All N+ cases are submitted to adjuvant chemotherapy (CMF). In locally advanced cases "reductive" surgery may be part of an aggressive chemotherapy program.