The earliest records of surgical treatment of breast cancer date back to 3000 BC to 2500 BC in ancient Egyptian medical books, when people mainly used various methods to get rid of the lumps on the breast, but the results were not effective. would only make the disease worse. Interestingly, Hippocrates and Gallen at that time believed that breast cancer was a systemic disease, which is somewhat similar to some of our understanding of breast cancer today. Patients treated surgically have a shorter survival time than those treated non-surgically. So the initial surgical treatment of breast cancer should be considered a failure. By the 18th and 19th centuries, more damaging forms of surgical treatment for breast cancer gradually emerged in Europe, with an emphasis on expanding the removal of some of the tissue surrounding the breast lump or even removing the entire breast, in addition to removing the lump itself, which was still fairly rudimentary. These surgical treatment modalities led to some improvements in the efficacy of breast cancer treatment (Figure 1). The modern surgical treatment of breast cancer began in the mid-19th century, when the German pathologist Rudolf Virchow (Figure 2), after studying the pathological anatomy of cadavers, proposed the theory that breast cancer originated in the ductal epithelium and spread along the fascia and lymphatic vessels, which was completely different from Gallen’s theory of humoral pathogenesis. This theory was completely different from Gallen’s theory of humoral pathogenesis, which considered breast cancer as a limited disease that could be cured by surgery, and laid the foundation for the surgical treatment of breast cancer in the late 19th and 20th centuries. The German pathologist Rudolph Virchow (1821-1902) had a great influence on an American physician, William Halsted (Figure 3), who traveled to Europe in the late 19th century to study with many of Virchow’s students before Halsted returned to the United States. Halsted returned to the United States and worked as a surgeon at Johns Hopkins Hospital, where Halsted described the scope of the classic Halsted procedure: the entire affected breast, pectoral muscle, and axillary lymph nodes were removed together. As this procedure significantly improved the local control rate, the local recurrence rate was reduced from 58%-85% to 6%; the 5-year survival rate reached 30%. As a result, this surgical treatment is rapidly gaining popularity. Figure 3 American physician William Halsted (center) and colleagues in Berlin With the great success of Halsted’s surgery for breast cancer, there was a trend to expand the surgical treatment of breast cancer: Stibbe (1918) described the distribution of internal breast lymph nodes by autopsy and concluded that in addition to the axillary lymphatic route, the internal breast lymph nodes were also the first point of metastasis for breast cancer. Margottini (1949) and Urban (1951) proposed an extended radical procedure for breast cancer by combining radical surgery with extrapleural and intrapleural removal of internal breast lymph nodes, respectively; Andreassen and Dahl-lversen (1954) proposed a super radical procedure by combining radical surgery with removal of supraclavicular lymph nodes and internal breast lymph nodes. However, such extended surgical treatment brought serious surgical complications, and Wangensteen (1956) reported a 12.5% mortality rate for super radical breast cancer surgery. At the same time, clinical observations did not reveal that expanded surgical scope resulted in greater improvement in breast cancer treatment outcomes. After the boom in expanding the scope of breast cancer surgery, some surgeons began to focus on whether it was reasonable to reduce the scope: Patey and Dyson (1948) reported a modified radical procedure that preserved the pectoralis major muscle and removed its fascia; Auchincloss (1963) reported another modified radical procedure for breast cancer that preserved the pectoralis major and minor muscles. Through long-term follow-up, it was found that the results of modified radical breast cancer treatment did not differ from those of the classic Halsted procedure. The proportion of Halsted US surgery decreased from 75% in 1950 to 3% in 1981, while the proportion of modified radical surgery increased from 5% to 72%. After preserving the pectoralis major and pectoralis minor muscles, research into reducing the scope of breast cancer surgery did not stop there. Professor Umberto Veronesi (Figure 4) in Italy led one of the first large prospective randomized clinical studies: the National Cancer Institute of Milan clinical trial comparing segmental mastectomy plus postoperative radiotherapy with modified radical surgery; during the same period, Professor Bernard Fisher (Figure 5) in Pittsburgh, USA, led the NSABP B-06 clinical trial, which was the largest study of similar content. the largest prospective randomized controlled clinical study to examine similar content. Both studies, after more than 20 years of follow-up, found a mildly increased risk of local recurrence after breast-conserving treatment, but reduction in the extent of surgery did not affect survival rates. Therefore, for breast cancer patients who are suitable for breast-conserving surgery, undergoing breast-conserving surgery and postoperative radiotherapy can achieve the same survival rate as total mastectomy, while breast-conserving treatment can minimize the impact on the patient’s body shape and achieve a good cosmetic outcome. Figure 4 Prof. Umberto Veronesi Figure 5 Prof. Bernard Fisher Currently, the standard first-line treatment for breast cancer is still modified radical surgery and breast-conserving surgery. From an oncologic perspective, these two procedures are the basis of treatment. As breast surgery has evolved, other surgical procedures including lumpectomy-assisted breast cancer surgery and immediate breast reconstruction have been performed on the basis of these two procedures.