The role of the surgeon in a multidisciplinary approach to breast disease is unique because the surgeon interacts with the clinician, the radiologist, and the pathologist. Yet often, the surgeon is the first to see a patient with a breast problem.

Like any other physician, the surgeon must be aware of the incidences of the most common breast lesions and their clinical presentations. Using that information, he or she can determine the most appropriate surgical management. The surgeon should also know the limitations of mammography and should not rely simply on a negative mammogram in the presence of a palpable lesion.

Today's surgeon not only must know the relevant anatomy and possess the appropriate surgical skills, but must also be prepared to communicate with the radiologist and the pathologist. With the radiologist, the surgeon must be able to discuss mammography and ultrasound findings and guide-wire placement (in cases of imaging-guided needle biopsies). With the pathologist, the surgeon must seek to better understand the lesion so as to choose the most appropriate surgical treatment. (Seventy years ago, Bloodgood, a famous breast surgeon, said that the surgeon should also be his own pathologist. While that statement probably was true then, today it simply is not possible.)

The procedures that a surgeon has in the surgical armamentarium to diagnose and treat a breast lesion are

• fine-needle aspiration biopsy,

• core biopsy,

• incisional biopsy, and

• excisional biopsy.