Surgical considerations following preoperative systemic chemotherapy

The indications of neoadjuvant chemotherapy for breast cancer are extending to a larger population of breast cancer patients. The aims of this therapy are to transform the cancer to an operable form, downsize the tumor volume to allow a lumpectomy instead of a mastectomy, or to perform an in vivo test of the effect of the treatment on breast cancer in a specific individual. Along with these benefits, there is concern about the safety of lumpectomy and sentinel lymph node biopsy after neoadjuvant chemotherapy. In this review, we discuss the experience of breast conservation therapy after neoadjuvant chemotherapy and the reported recurrence rates in the preserved breasts. An overview of the studies that utilized sentinel lymph node biopsy after neoadjuvant chemotherapy is presented, summarizing the identification rates and false-negative rate.