It has been more than 90 years since Halsted proposed radical surgery for breast cancer in 1984. During this time, it has been challenged by the expanded radical surgery represented by Margottini and Urban in the 1950s and by the expanded surgery represented by Dahliverson’s super radical surgery and by the reduced scope surgery represented by Patey’s modified radical surgery. After all, Halsted radical surgery has its historical limitations, as it is based on local anatomy and influenced by Virchow’s cytopathology, which considers the occurrence and development of breast cancer as a local disease and treats regional lymph nodes as a mechanical barrier for cancer cells to pass through. Despite repeated expansions in the scope of surgery, there has been no significant improvement in long-term outcomes. With further research on the biology and immunology of breast cancer, Fisher clearly pointed out that breast cancer is a systemic disease with no fixed pattern of cancer cell metastasis. Regional lymph nodes have an important biological and immunological role, but they are not an effective barrier for cancer cell filtration, and blood flow diffusion is more important. According to the above theories, the current surgical approach is gradually reduced. However, for the past surgical modalities are still in use. Standard style radical surgery for breast cancer: Halsted’s proposed radical surgery for breast cancer is the basis. Surgical approach: The free skin is removed, internally to the inner border of the sternum, externally to the mid-axillary line, superiorly to the subclavian bone, and inferiorly to 3-5 cm below the glabella. The subcutaneous tissues of the free skin area, the large and small chest muscles and all the breast, together with the fatty tissues, fibrous connective tissues and lymph nodes of the lateral axilla, are removed. The skin is preserved in such a way that there is no obvious tension on the incision suture. If the suture is difficult to close, skin implant can be used to solve the problem of incision suture. Expanded radical surgery for breast cancer: Based on the standard radical surgery for breast cancer, the scope of surgery is expanded. It is suitable for medial breast cancer and more advanced stage III breast cancer. The main scope of resection will be: removal of supraclavicular lymph nodes and mediastinal lymph nodes (second station). Surgical method: Excision of the 2nd-5th ribs cartilage and intercostal muscles, exposure of the internal thoracic artery, removal of lymph nodes and adipose tissue near the vessel along the vessel. Modified radical surgery: Based on the standard surgical approach, the scope of surgery is reduced and the pectoralis major muscle is mainly preserved, so that the chest wall is not significantly depressed and the aesthetic aspect is improved. The upper extremity function is better. It is mainly adapted to stage I and II. Disadvantages of surgery: There is some difficulty in revealing the axillary lymph nodes and subclavian lymph nodes, but if the pectoralis minor muscle is removed, the revealing problem can be completely solved. There is less injury and fewer complications, light deformity, good function, and the long-term results are similar to those of standard surgery. Mastectomy alone : It was replaced by the standard radical breast cancer surgery as an ancient surgery for breast cancer. However, in recent years, with the development of breast cancer biology, total mastectomy has regained importance. Indications: Early stage cases with non-invasive or axillary lymph nodes without metastasis. Palliative treatment is also available for advanced breast cancer (radiation therapy and chemotherapy are also required after stage I and II resection. (Its long-term results are similar to radical breast cancer surgery). Partial mastectomy, segmental mastectomy, quadrant mastectomy, plus axillary lymph node dissection. Local recurrence can be remedied by second-stage surgical excision or adjuvant radiation therapy. The main cause of death from breast cancer is distant metastasis; distant metastasis is through the bloodstream. For complete mastectomy, this is not relevant to bloodstream metastasis. In partial mastectomy, no cancerous tissue should ever be left at the resection margin, which means that it has been removed cleanly. The use of this procedure allows the patient to preserve some of the breast tissue, which is very important from the patient’s aesthetic point of view. It is mainly indicated for early stage breast cancer (stage I cancer) where the resection margin must be 2 cm from the tumor and pathological examination of the resection margin must be negative. Local excision of the breast, plus axillary lymphatic dissection, postoperative radiation therapy and chemotherapy are the developmental directions of surgery for the treatment of breast cancer. Do all breast cancers require chemotherapy after surgery? How is it done? Early stage breast cancer, such as microscopic carcinoma in situ, non-invasive, stage I carcinoma, no lymph node metastasis in the axilla, etc., these patients do not need chemotherapy. Most patients actually have bloodstream dissemination present at the time of surgery or radiation treatment, but it is just undetected. Chemotherapy can improve the 5-year survival rate. Chemotherapy should be a necessary systemic adjuvant treatment for breast cancer, and stage III breast cancer should be treated with a course of preoperative chemotherapy before surgery for better prognosis. The main role of chemotherapy is to reduce the distant metastasis of breast cancer and improve the 5-year survival rate. Chemotherapy must be administered in multiple courses and combined with multiple drugs. Commonly used drugs include cyclophosphamide, methotrexate, fluorouracil, adriamycin, mitomycin, vincristine, cetirizine, fluorotiron, clofluro, calcium methotetrahydrofolate, etc. How does radiation therapy for breast cancer work? Radiation therapy for breast cancer depends on the type of tumor and the postoperative pathology of the surgery. The decision of whether and when to perform radiation therapy depends on the type of tumor, postoperative pathology, axillary lymph node metastasis and other factors. For inflammatory breast cancer, radiation therapy should be given before surgery, and for advanced breast cancer, radiation therapy should be given before removal of the tumor. Radiation therapy after radical breast cancer surgery can reduce some of the recurrence rates, but cannot improve the 5-year survival rate; radiation therapy is not necessary after radical surgery for stage I breast cancer, but must be used after partial mastectomy. If the breast cancer is located in the outer upper quadrant, with more than 4 lymph nodes in the axillary area, with adhesions to the surrounding tissues and penetration of the envelope, radiation therapy should also be administered, mainly to the axillary and supraclavicular areas. Radiation therapy must be used to treat the breast wall and surrounding lymphatic drainage area after radical surgery for stage I and II breast cancer, and no metastasis of axillary lymph nodes, or no more than 4 metastatic lymph nodes, and the metastatic lymph nodes do not penetrate the envelope and do not adhere and fuse with surrounding tissues, all do not need radiation therapy. What is the clinical significance of estrogen receptor aversion (R) assay? Breast cancer is a hormone-dependent tumor and ER detection: biochemical and morphological methods. The clinical significance of ER measurement is the following: (1) Estimation of prognosis of breast cancer. Any tissue differentiation includes both functional and morphological aspects. ER is a protein with specific functions; high differentiation leads to full function, while poor differentiation leads to poor function, suggesting a theoretical basis for good prognosis for ER positive and poor prognosis for negative. It is generally believed that ER-positive patients have a low recurrence rate and a high survival rate, while negative patients have the opposite. (2) Rationalize the comprehensive treatment plan. The overall 5-year survival rate of breast cancer is 53%-71%. The 5-year survival rate of early stage breast cancer is as high as 80%. However, there are still 20%-50% of treatment failures. The main reason for failure is systemic metastasis. Therefore, chemotherapy and endocrine therapy are required after radical breast cancer surgery. Generally chemotherapy is highly sensitive to poorly differentiated breast cancer, but ER-positive breast cancer is well differentiated and poorly sensitive to chemotherapy. This means that ER-positive patients do not respond as well to chemotherapy as ER-negative patients. Therefore, anti-estrogen therapy is used in combination with chemotherapy for ER-positive breast cancer. The rate of ER-negative breast cancer decreases after chemotherapy, and the rate of ER-positive cells relatively increases. The ER positive rate decreases after treatment with triamcinolone acetonide. (3) Chemotherapy and anti-estrogen therapy should be combined regardless of whether the breast cancer is clinically determined to be estrogen receptor positive or negative. How does endocrine therapy for breast cancer work? Endocrine therapy is a non-curative treatment for breast cancer, but it can be effective for estrogen-dependent breast cancer. The higher the level of estrogen receptors (ER) in the plasma and nucleus of cancer cells, the more estrogen-dependent they are. For patients with premenopausal breast cancer, the principle of endocrine therapy is ovarian debulking (surgical removal of ovaries is most commonly used to produce rapid results and relatively complete debulking. Radiation of the ovaries is slow and sometimes incomplete). Of course, ovarian denervation is more effective in estrogen receptor-positive breast cancer patients than in negative ones. The traditional treatment for postmenopausal breast cancer patients is sex hormone therapy. Bone metastases are better treated with androgens, and other sites of metastases are better treated with estrogens. The efficiency of treating bone metastases with androgens is 30%, while treating soft tissue metastases is poor. Testosterone propionate is generally used. Estrogen therapy is best in patients who have been amenorrheic for more than 4 years, while it is best in patients who have been amenorrheic for more than 8 years. The effect of estrogen therapy is slow to appear, and the effect usually starts to appear after 4-6 weeks of treatment, and those who are still ineffective at 8 weeks can be considered as treatment failure. The apparent effect can be manifested as the complete or majority disappearance of the cancer tumor. If it is effective and there are no obvious side effects, it can be used for a long time. The side effects of estrogen or androgen therapy are too great and its recent use is rare. It has been replaced by triamcinolone acetonide. Triamcinolone is a synthetic anti-estrogenic drug. The anti-estrogenic power is very strong, but the side effects are less. Triamcinolone application mainly inhibits ovarian function. The dose is usually 10mg 3 times daily, the dose is based on amenorrhea in premenopausal women. Triamcinolone may be used in conjunction with chemotherapy for better results. Long-term use of triamcinolone acetonide has been reported in the literature to cause endometrial cancer. To avoid this side effect, it can be alternated with megestrol. Triamcinolone can be applied in women of any age and is effective.