Advancing Breast Conserving Surgery with Innovative Techniques

Achieving precise resection margins and integrating preventive measures have emerged as pivotal challenges for surgical oncology teams striving to optimize breast conserving surgery and reduce recurrence.

Despite advancements in breast cancer surgery techniques, standard approaches to breast-conserving surgery still report positive margin rates around 13.5%. However, complete intraoperative ultrasound (IOUS) significantly decreases positive resection margin rates, with some centers reporting rates as low as 1.4%, a finding underscored by a study on IOUS application. Incorporating ultrasound-guided surgery not only refines excision boundaries but also minimizes unnecessary tissue removal, directly impacting re-excision rates and patient satisfaction.

Building on operative precision, the integration of intraoperative radiotherapy has introduced a new dimension to postoperative management. Data indicate that optimal intraoperative radiotherapy (IORT) doses between 10 and 20 Gy, when followed by whole-breast irradiation, achieve superior disease-free survival without increasing complication rates, according to research on IORT and WBI. Earlier findings suggest this combined modality offers a tailored local control strategy, aligning radiotherapeutic intensity with individual tumor biology.

Parallel to refining surgical interventions for invasive breast cancer, expanding risk-reducing mastectomy (RRM) criteria represents a strategic shift in reducing incidence among high-risk populations. Offering risk-reducing mastectomy (RRM) to women with a lifetime breast cancer risk of 35% or greater—identified through genetic testing and family history—could prevent approximately 6,500 cases annually, as highlighted by expanding mastectomy access. Incorporating BRCA mutation screening into routine risk assessment protocols ensures that preventive mastectomy decisions are grounded in personalized oncologic risk profiles.

Consider a 42-year-old patient carrying a BRCA1 mutation who underwent a bilateral preventive mastectomy followed by immediate reconstruction. Leveraging intraoperative ultrasound, the surgical team achieved clear margins without additional tissue sacrifice, and the multidisciplinary approach—including genetic counseling and targeted IORT planning—streamlined her treatment pathway. This case exemplifies how surgical oncology can harness both advanced techniques and preventive strategies to improve long-term outcomes and quality of life.

Widespread adoption of these innovations hinges on multidisciplinary collaboration and updated clinical guidelines. Surgeons must receive training in ultrasound-guided techniques while radiotherapy departments adapt protocols to standardize IORT dosing. Genetic counselors and surgical teams should establish clear referral criteria to ensure timely identification of candidates for preventive mastectomy. As real-world data accumulate, ongoing evaluation of long-term survival, patient-reported outcomes, and cost-effectiveness will shape future iterations of breast cancer surgery standards.

Key Takeaways:

• Intraoperative ultrasound significantly reduces positive resection margin rates, enhancing surgical precision.
• Optimal IORT doses combined with whole-breast irradiation improve disease-free survival rates with minimal complications.
• Broader access to preventive mastectomy could lower breast cancer incidence for women at high risk.