**4. Surgical treatment of breast cancer**

Primary management of breast cancer is surgery. Most of the women diagnosed with early breast cancer underwent surgery. It may be wide local excision or mastectomy. Mastectomy is indicated when there is a presence of polycentric invasive cancer spots, inflammatory carcinoma, intraductal carcinomas, large primary tumors and patient preference [36]. Skin-sparing mastectomies followed by immediate reconstruction are now one of the most popular forms of reconstruction [36]. The status of the axillary lymph nodes is an important prognostic factor in early stages of breast cancer. During the operation, the lymph nodes in the axilla are also considered for removal. Axillary lymph node dissection remains the standard of care for patients with clinically palpable or positive histological confirmed lymph nodes [36]. Sentinel lymph node biopsy(SLNB) is an advanced technique and is very helpful in the management of axilla [37]. SLNB technique is based on the observations that tumor cells migrate from the primary cancer site to one of the nearby lymph nodes before moving to other distant lymph nodes [38]. In patients with a negative lymph node biopsy, there is no requirement of axillary lymph node dissection (ALND) [39]. This in turn reduces the risk of lymphedema and other complications such as nerve injury and muscular problems, associated with the axillary lymph node dissection surgery [40].
