Innovations in Breast Cancer Surgery: Precision Medicine at the Forefront

Breast cancer treatment is undergoing a transformative evolution, as advanced surgical methods and genetic testing bring us closer to realizing the full potential of precision medicine, in line with contemporary NCCN and ASCO guidance. These advancements are continually reshaping patient care by harmonizing surgical techniques with genomic insights to deliver increasingly personalized interventions while balancing oncologic control with quality of life and cosmetic outcomes.

The surgical precision afforded by oncoplastic techniques not only improves outcomes but synchronizes with genetic insights, uniting treatment modalities. Oncoplastic surgery can facilitate wider excisions with clear margins and favorable cosmesis, supporting breast conservation with oncologic control comparable to standard lumpectomy in appropriately selected patients. This innovation balances oncologic success with cosmetic outcomes, highlighting precision medicine's role in personalizing patient care.

Genomic testing increasingly informs overall treatment planning. Techniques like targeted axillary dissection have emerged to reduce morbidity while maintaining oncologic safety. Targeted axillary dissection in cN1 patients downstaged by neoadjuvant therapy improves node identification and staging accuracy versus SLNB alone, reduces the need for completion ALND and its associated morbidity, while maintaining low axillary recurrence rates.

Extending that precision beyond the operating field, genomic profiling better predicts recurrence risk to tailor systemic therapy; surgical decisions may be indirectly influenced through the overall treatment plan rather than directly dictated by the assay. The Oncotype DX recurrence score primarily guides adjuvant systemic therapy per major trials and guidelines, indirectly shaping surgical planning through overall treatment strategy.

These integrated approaches have been associated with lower re-excision rates, reduced risk of lymphedema, and improved patient-reported satisfaction in appropriately selected patients, though results vary by setting and study design.

These integrated approaches may improve recovery experiences and satisfaction, though benefits vary by tumor biology, patient preference, and access to specialized care.

Key Takeaways:

• Oncoplastic techniques enable breast conservation without compromising oncologic control in appropriately selected patients.
• In the neoadjuvant setting, targeted axillary dissection supports axillary de-escalation with low regional recurrence rates.
• Genomic assays primarily steer adjuvant systemic therapy and only indirectly inform the extent and timing of surgery.