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Peer-reviewedCC BYJournal of Clinical Medicine

Breast Cancer Surgery: Past, Present and Future—A Narrative Review

  • Paolo Izzo1
  • Marcello Molle2
  • Pierfrancesco Di Cello3
  • Paolo Meloni4
  • Silvia Lai5
  • Luciano Izzo1
  • Simone Sibio1
  • Daniela Messineo6
  • Sara Izzo2
6 affiliations
  1. 1“Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, Sapienza University of Rome, 00161 Rome, Italy
  2. 2Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania “L.Vanvitelli”, 80138 Naples, Italy
  3. 3General Surgery Unit, ASL Frosinone, 03100 Frosinone, Italy
  4. 4Department of Radiological, Oncological, and Anatomical Pathology Sciences, Sapienza University of Rome, 00161 Rome, Italy
  5. 5Nephrology Unit, Department of Translational and Precision Medicine, Policlinico “Umberto I”, Sapienza University of Rome, 00161 Rome, Italy
  6. 6Department of Radiological Sciences, Oncology and Anatomo-Pathological Science, Sapienza University of Rome, 00161 Rome, Italy
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Abstract

Breast cancer surgery has evolved from radical procedures to increasingly individualized and less invasive approaches. This narrative review contextualizes this evolution, synthesizes current evidence supporting surgical de-escalation, and examines emerging strategies that may further reduce the need for surgery. The manuscript is based on a structured appraisal of PubMed/MEDLINE literature and major international guidelines, prioritizing randomized trials, prospective studies, and consensus statements. Contemporary practice is characterized by progressive reduction in both breast and axillary surgery, enabled by advances in tumour biology, neoadjuvant systemic therapy, sentinel node strategies, and oncoplastic techniques. Emerging approaches-including selective omission of axillary surgery, targeted axillary dissection, and investigational strategies aiming at omission of breast surgery in exceptional responders-highlight a shift toward response-adapted and biology-driven care. While technological innovations such as robotic surgery and intraoperative radiotherapy may influence surgical practice, their role in true de-escalation remains limited or context-dependent. Overall, the field is moving toward minimizing surgical burden without compromising oncological safety, with future progress likely driven by improved patient selection, imaging, and integration of systemic therapy response.

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Cite

BibTeXRIS
BibTeX
@article{izzo2026breast,
  title = {{Breast Cancer Surgery: Past, Present and Future—A Narrative Review}},
  author = {Paolo Izzo and Marcello Molle and Pierfrancesco Di Cello and Paolo Meloni and Silvia Lai and Luciano Izzo and Simone Sibio and Daniela Messineo and Sara Izzo},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = may,
  doi = {10.3390/jcm15103778},
  url = {https://doi.org/10.3390/jcm15103778},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Breast Cancer Surgery: Past, Present and Future—A Narrative Review
AU  - Paolo Izzo
AU  - Marcello Molle
AU  - Pierfrancesco Di Cello
AU  - Paolo Meloni
AU  - Silvia Lai
AU  - Luciano Izzo
AU  - Simone Sibio
AU  - Daniela Messineo
AU  - Sara Izzo
PY  - 2026
DA  - 2026/05/14
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15103778
UR  - https://doi.org/10.3390/jcm15103778
AB  - Breast cancer surgery has evolved from radical procedures to increasingly individualized and less invasive approaches. This narrative review contextualizes this evolution, synthesizes current evidence supporting surgical de-escalation, and examines emerging strategies that may further reduce the need for surgery. The manuscript is based on a structured appraisal of PubMed/MEDLINE literature and major international guidelines, prioritizing randomized trials, prospective studies, and consensus statements. Contemporary practice is characterized by progressive reduction in both breast and axillary surgery, enabled by advances in tumour biology, neoadjuvant systemic therapy, sentinel node strategies, and oncoplastic techniques. Emerging approaches-including selective omission of axillary surgery, targeted axillary dissection, and investigational strategies aiming at omission of breast surgery in exceptional responders-highlight a shift toward response-adapted and biology-driven care. While technological innovations such as robotic surgery and intraoperative radiotherapy may influence surgical practice, their role in true de-escalation remains limited or context-dependent. Overall, the field is moving toward minimizing surgical burden without compromising oncological safety, with future progress likely driven by improved patient selection, imaging, and integration of systemic therapy response.
SN  - 2077-0383
ER  -