Early and locally advanced breast cancer is treated with curative intent.

Surgery for early breast cancer involves either breast-conserving surgery or mastectomy. Breast conserving surgery followed by radiation therapy is as effective as mastectomy for most patients with early breast cancer.

Patients with invasive breast cancer and a clinically and radiologically negative axilla should generally be offered sentinel node biopsy. Axillary treatment with surgery and/or radiation therapy should be considered for patients with nodal disease.

Oncoplastic breast surgery should be considered where appropriate to ensure the patient has the best possible outcome. Surgery may involve the breast surgeon and plastic surgeon working together because some reconstructions are very complex. It is important that patients are given enough time to consider their reconstructive options. This may require more than one appointment with the treating surgeon. It is the responsibility of the multidisciplinary team to ensure the patient is referred in a timely manner to allow for adequate planning of the surgery.

Breast reconstruction surgery

Mastectomy can be performed with or without immediate breast reconstruction. Patients should be fully informed of their options and offered the option of immediate or delayed reconstructive surgery if appropriate.

Timeframe for starting treatment

• Surgery should occur ideally within five weeks of the decision to treat (for invasive breast cancer).
• If being treated with neoadjuvant chemotherapy, surgery is deferred until four to six weeks after the completion of neoadjuvant chemotherapy, ensuring blood counts have recovered.

Training and experience required of the surgeon

• Breast surgeon (FRACS or equivalent, including membership of BreastSurgANZ) with adequate training and experience in breast cancer surgery and institutional agreed scope of practice within this area
• Plastic surgeon with an interest and expertise in breast reconstructive surgery and who contributes to the Australia Breast Device Registry

Documented evidence of the surgeon’s training and experience, including their specific (sub-specialty) experience with breast cancer and procedures to be undertaken, should be available.

Health service characteristics

To provide safe and quality care for patients having surgery, health services should have access to:

• appropriate nursing and theatre resources to manage complex surgery
• a breast care nurse
• a multidisciplinary team
• critical care support
• 24-hour medical staff availability
• 24-hour operating room access and intensive care unit
• specialist pathology expertise
• diagnostic imaging
• in-house access to specialist radiology and nuclear medicine expertise.