Present and future of sentinel node lymphadenectomy in breast cancer.

Up to about 1960, it was generally thought that breast cancer was mainly a local-regional disease. This concept, inherited from Halsted, led to increasingly aggressive treatments of the primary lesion and the regional lymph nodes. Total mastectomy, which in the form developed by Halsted was already an extensive operation, became enlarged to include extensive removal of skin and use of skin transplants, sacrifice of important vessels and nerves such as the thoracodorsals, and meticulous dissection of the regional nodes, sometimes including those of the internal mammary chain via thoracotomy. Radiotherapy was given to the axillary, supraclavicular and retrosternal lymph node areas, as well as to the mastectomy scar.