乳癌的手術治療

自1882 年William Stewart Halsted 首次在紐約完成了第一例根治乳房切除手術以來，手術一直是乳癌治療最重要的部分。隨著對於乳癌生物學研究的進步，手術也從最早的根除性乳房切除（radical mastectomy），進展成改良式乳房切除、乳房保留手術。在早期乳癌病人中，腋下淋巴腺的治療也從一律接受廓清手術進展到哨兵淋巴腺切片，甚至在H&E 染色中有一至二顆腋下淋巴腺轉移，接受乳房保留手術及全乳放射線治療的病人中，也不須接受淋巴腺廓清手術。哨兵淋巴腺切片在早期乳癌以外的運用，如接受術前化學治療前後、原位癌等，也逐漸地發展中。除了對於乳癌本身手術的治療，如何讓病人手術後身體形象的維持，也逐漸的重視。對於乳房皮膚甚至乳頭乳暈保留手術及腫瘤整形手術的運用，逐漸的形成共識。

Since William Stewart Halsted performed the first radical mastectomy in 1882 in New York, surgery has remained the most important method in treating breast cancer. Along with research progress in our biological knowledge of breast cancer, the modality of surgery has evolved from radical mastectomy into modified radical mastectomy and breast conserving surgery. With regard to early breast cancer, axillary surgery has also evolved from complete axillary lymph node dissection to sentinel lymph node biopsy. In those patients who have undergone breast conserving surgery, it is no longer necessary to perform axillary lymph node dissection even if one or two sentinel lymph nodes are positive for H&E stain. In addition to being applied to early breast cancer, sentinel lymph node biopsy is also being gradually applied to other scenarios such as ductal carcinoma in situ, before or after neoadjuvant chemotherapy. Besides the therapeutic efficacy of breast cancer surgery, more and more effort has been put into how to maintain the patient's body image after surgery. Furthermore, consensus has been growing as to the benefits of skin-sparing mastectomy, nipple areola complex preserving surgery, and oncoplastic surgery as data accumulates about the cosmetic benefits and oncologic safety of these procedures.