Evolving techniques in breast cancer surgery for older adults: a narrative review

Abstract

<p>Background and Objective: Breast cancer incidence increases with age. In an era of prolonged longevity, older adults comprise a significant and increasingly vulnerable proportion of the patient population. Surgical management in this group necessitates careful evaluation of tumour biology, comorbidities, life expectancy, and individual patient preferences. This review summarizes current evidence on surgical strategies, examines emerging techniques such as oncoplastic surgery, breast reconstruction, and local ablation in older adults, and highlights knowledge gaps and potential directions for future research. Methods: A literature search was performed in PubMed and Google Scholar, covering the period from January 1900 to April 2025. The search utilized terms related to breast cancer surgery in older adults, with studies selected based on their relevance to surgical innovations, outcomes, and geriatric considerations. The review included only English-language studies. Key Content and Findings: Older adults with breast cancer may benefit from less extensive surgical approaches, such as lumpectomy instead of mastectomy when clinically appropriate. Oncoplastic techniques enable wider excisions with improved cosmetic outcomes, while breast reconstruction remains feasible but underutilized due to perceived risks and lack of referrals. Local ablative options, such as cryoablation, show promising early results. Age alone should not dictate surgical options, and geriatric assessments are crucial for informed decision-making. Conclusions: Surgical decision-making in older adults should be individualized—integrating geriatric assessments, patient preferences, and evolving surgical techniques. Further research is needed to refine patient selection, evaluate the long-term outcomes of emerging techniques, and establish standardized guidelines for this heterogeneous population.</p>