An overview of surgical management of stage I and stage II breast cancer for the primary care provider.

Breast cancer is the most common cancer affecting women. With early detection and treatment, most patients survive cancer and lead full, active lives. Two principal treatments for stage I and stage II breast cancer are total mastectomy with axillary node dissection (modified radical mastectomy) and lumpectomy with axillary node dissection (breast conservation). Preoperative evaluation is aimed at the patient's ability to withstand the stress of anesthesia and surgery. Lumpectomy is a low-risk procedure; however, more serious complications may result from axillary node dissection, and wound infection occurs in 4-18% of mastectomy patients. Patient and family education is aimed at the operative experience as well as home care to promote physiological and psychologic adjustment postoperatively. Following mastectomy, the breast cancer patient may be fitted with a prosthesis or consider breast reconstruction with a saline implant, expander, or flap procedure. The primary care provider has the opportunity to establish a therapeutic alliance with the patient by providing coping strategies, support, and education throughout the process.