Early Breast Cancer · Breast Conservation vs Mastectomy + Axilla

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Is BCS feasible (contraindications?) + axilla/subtype
   Is breast conservation feasible (any contraindication) + axillary status + molecular subtype?
   • Conservable (unifocal, negative margins achievable, radiotherapy possible) → BCS + whole-breast radiotherapy + SLNB
   • BCS contraindicated (multicentric/diffuse malignant calcification/cannot achieve negative margins/first-second trimester or prior chest-wall radiation/inflammatory cancer) → Mastectomy (± reconstruction)
   • Large/locally advanced tumor, triple-negative or HER2+ (consider neoadjuvant downstaging) → Neoadjuvant downstaging
2. [End] BCS + whole-breast radiotherapy + SLNB
   Conservable → breast-conserving surgery (BCS/lumpectomy, negative margins) + whole-breast radiotherapy (survival equal to mastectomy); axilla: clinically N0 → sentinel lymph node biopsy (SLNB); per Z0011: cT1-2 + BCS + whole-breast radiotherapy with 1–2 positive SLNs may omit axillary dissection.
3. [End] Mastectomy (± reconstruction)
   BCS contraindicated → mastectomy (± immediate/delayed reconstruction; skin-/nipple-sparing for selected cases); axilla likewise SLNB first (clinically N0); adjuvant radiotherapy (chest wall/regional) as indicated.
4. [End] Neoadjuvant downstaging
   Large/locally advanced or triple-negative/HER2+ → neoadjuvant chemotherapy (± anti-HER2 targeted) to downstage, aiming for conservation and assessing pathologic complete response; after treatment, BCS or mastectomy by response + axillary management (cN+ often axillary dissection or targeted axillary surgery).

Source guidelines & references

• Local management of early breast cancer (NCCN; SSO-ASTRO margins; ACOSOG Z0011 axilla)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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