Surgical procedures for advanced local and regional malignancies of the breast

Surgery remains an integral part of the therapeutic plan for locally advanced breast cancer. Advances in systemic therapies have transformed the role of surgery for this population of patients from palliation to largely curative intent. Further, in the last decade, the integration of surgical care into the management algorithm of locally advanced breast cancer patients has also changed substantially with increasing use of neoadjuvant chemotherapy and more recently neoadjuvant endocrine therapy and targeted therapies for HER2-positive disease. Such neoadjuvant strategies have provided new opportunities to downsize the tumor burden and scope of surgical intervention. Advances in reconstructive techniques have also provided new opportunities to improve on quality of life of these heavily treated patients, although the need for radiation therapy in patients with locally advanced breast cancer remains an area of particular challenge for optimal timing of reconstruction.