Recent Advances in Early Breast Cancer Surgical Management

The surgical management of early breast cancer has undergone profound transformation over the past decade. Driven by a deeper understanding of tumor biology, the integration of neoadjuvant systemic therapies and the rapid evolution of surgical techniques, the field is moving toward increasingly individualized, precision-guided approaches without compromising oncological safety. This Research Topic aims to provide a comprehensive overview of the major themes shaping current practice, highlighting key advances and emerging therapeutic perspectives across the full arc of early breast cancer surgical care.Axillary management remains one of the most dynamic and debated areas in breast surgical oncology. The prognostic significance of lymph node involvement continues to inform surgical decision-making, yet its interpretation varies meaningfully across tumor subtypes. For triple-negative breast cancer (TNBC) and HER2-positive disease, the implications of nodal status differ substantially from those seen in ER+/HER2-negative tumors, and this Research Topic welcomes contributions that explore these distinctions in the context of upfront surgical planning. Equally important is the question of de-escalation: the selective omission of sentinel lymph node biopsy (SLNB) is gaining traction in appropriately selected patients, yet the risk of under-treatment demands rigorous scrutiny, and the boundaries of safe omission remain an active area of investigation. Throughout, surgical decisions on both the primary tumor and the axilla should be considered alongside the extent and type of radiotherapy planned or delivered, given the close interplay between local surgical extent and adjuvant radiation strategy.In the post-neoadjuvant chemotherapy (NAC) setting, axillary surgical strategy is further complicated by the need to accurately assess residual nodal disease. The evolving roles of SLNB, targeted axillary dissection (TAD), and axillary lymph node dissection (ALND) after NAC represent a critical frontier, with significant implications for locoregional control and patient morbidity. Here too, decisions on the extent of surgery after neoadjuvant therapy should be discussed in relation to the extent and type of radiotherapy, reflecting their combined impact on locoregional outcomes.Beyond axillary management, innovation in surgical technique is reshaping the patient experience. Endoscopic and robotic approaches to breast surgery offer the potential for reduced morbidity and improved cosmetic outcomes, and their oncological equivalence to conventional methods warrants continued evaluation. In breast reconstruction, the field is witnessing growing interest in exclusive lipofilling following mastectomy — a less invasive alternative with evolving evidence — alongside established autologous options such as the transverse upper gracilis (TUG) flap, which offers reliable soft tissue reconstruction in carefully selected patients.Finally, the integration of genomic assays on pre-operative biopsy specimens is beginning to inform surgical decision-making in new ways, offering the potential to better align the extent of surgery with individualized tumor biology from the outset of care.Together, the contributions to this Research Topic will reflect the breadth and momentum of progress in early breast cancer surgery, with the shared goal of refining practice to achieve the best possible oncological and patient-centered outcomes.Please note: Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent clinical or patient cohort, or biological validation in vitro or in vivo, which are not based on public databases) are not suitable for publication in this journal. Topic editors: Gilles Houvenaeghel, Brian J Czerniecki, Laura Sabiani, Monique Cohen Source: https://www.frontiersin.org/research-topics/81412/recent-advances-in-early-breast-cancer-surgical-management