## 4 Discussion  
The introduction of the once-plastic approach in breast surgery by means of quadrantectomy and \"conservative\" mastectomy techniques [19], when possible, is an emblematic example of the need for an increasingly targeted, personalized, and multidisciplinary treatment. In fact, treatment should consider the oncological radicality, personal risk, satisfaction, and quality of life of the patients [20; 21], guaranteeing as much as possible both an effective treatment in terms of oncological radicality and acceptable aesthetic results, as well as minimizing the negative psychological impact of mastectomy through skin-sparing and ripple-sparing. Figure 1: Disease-free survival curve according to type of surgical treatment received. Figure 2: Disease-free survival curve for patients with Luminal B tumor type (**a**) or a tumor size between 20 mm and 50 mm (**b**) according to type of surgery received. Recent large-scale studies have shown that patients treated with BCS followed by radiotherapy have had better outcomes than those treated with radical mastectomy alone [11; 16]. Specifically, significantly better outcomes were achieved for local relapses, distant metastases, and overall survival when using the conservative approach. From this point of view, patients with a high-risk family history or a confirmed genetic mutation deserve to be discussed separately. Although most tumors are sporadic, a non-insignificant percentage of mammary tumors (5-10%) are, in fact, linked to hereditary factors [22]. More than 2/3 of these result from a mutation of the BRCA-1 and 2 genes, whose presence exposes the patient to the risk of developing mammary and/or ovarian neoplasms in the course of their life in 61-79% and 11-53% of cases, respectively [22; 23]. This is especially the case in patients with a BRCA-1 mutation, who may develop peculiarly highly aggressive triple-negative tumors (ER-/PgR-/HER2-), often with lymph node metastases at the first diagnosis and with a higher rate of long-term relapse [24; 25; 26]. Similarly, the real impact on patient survival in the case of prophylactic mastectomy is uncertain, particularly in non-sick women with mutated BRCA, although this practice reduces the possibility of disease onset in over 90% of cases [27; 28; 29; 30]. However, some studies have shown a significant reduction in mortality in women who have already been operated on for breast cancer [27]. These types of patients, on whom there is also an indication for the prophylactic mastectomy of both breasts, were excluded from our study, as they would have constituted a bias of the study itself. In our experience, there are no significant differences in terms of disease-free survival between patients treated with mastectomy and those treated with BCS, particularly at 10 years, even when differentiating by age and histological characteristics. On the other hand, at 5 years, the relative difference in survival in favor of quadrantectomy (89.9% vs. 81.3%) may be a consequence of the greater share of advanced tumors in patients who received a mastectomy and their consequent higher rate of death in the first few years after this type of treatment. Considering a significance level of 10%, a statistical difference is observed with reference to the disease-free survival of patients with Luminal B tumors and with tumor sizes between 20 mm and 50 mm. In the latter case, the best result of mastectomy is achieved at 5 years, but at 10 years this could be linked to the criterion of greater surgical radicality, especially in large or multiple tumors. We have attempted to explain the data relating to the reduced survival seen in patients with Luminal B tumors treated with mastectomy compared to those treated with quadrantectomy. This could have been due to the detection of a greater number of single bone metastases in patients with Luminal B breast cancer [31] compared to patients in the non-luminal groups, potentiated by the higher frequency of large and multicentric neoplasms present in mastectomies.