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Breast cancer is the second most common malignancy to affect women. In 2017, it is estimated that 255,180 women in the United States will be diagnosed with invasive breast cancer and another 63,410 will be diagnosed with ductal carcinoma in situ (DCIS). 1 Earlier diagnosis and improvements in adjuvant therapy have produced improved long-term survival with lower rates of disease recurrence than ever before. A personalized approach to the management of the disease means individualized decision making regarding not only adjuvant systemic treatments but also surgical and reconstructive choices. The oncologic goal of breast cancer surgery has been to remove all clinical and radiologic evidence of the disease in the breast and stage the axillary nodes. Over the last 30 years, the surgical techniques used to achieve this goal have changed dramatically. At one time the only choice was whether to remove all …