Primary systemic treatment and oncoplastic breast surgery - influences and principles.

Primary or preoperative systemic therapy (PST) has been standard in patients with initially inoperable and inflammatory breast cancer for many years. In stage I and II breast cancer, PST leads to remission in up to 80% of the cases and up to a 10% increase in the rate of breast-conserving surgery. Most patients are highly compliant with PST because they quickly notice the efficacy of the therapy. The best surgical results after PST are obtained with oncoplastic procedures, which are done despite a lack of research in this area. After PST, the tumor localization and remission type (centrifugal, centripetal or a combination thereof) play a major role in keeping the rate of reexcisions low. The optimal extent of tissue removal after PST remains controversial, as does the reliability of sentinel node biopsies post PST. These open issues continue to highlight the need for prospective, randomized studies of the indications and techniques used in oncoplastic surgery. [ABSTRACT FROM AUTHOR]