Primary treatment of breast cancer succeeds when the primary tumor and its regional lymph node spread are completely extirpated or destroyed in the absence of established systemic metastases. The classical radical mastectomy has been extended to include en bloc in continuity excision of the internal mammary lymph node chain. This procedure removes the primary breast cancer in continuity with both of its primary lymph node deposits, axillary as well as internal mammary, and should result in better local control and an improved salvage rate. The patients most likely to benefit from this extended procedure are those with a high risk of internal mammary node metastases.
Stage I carcinoma of the breast is defined as an early lesion confined to the breast, with no clinically suspicious axillary lymph nodes and no distant metastases suspected. Not infrequently, pathologic examination of the operative specimen will disclose metastatic axillary nodes in some clinical stage