Over the last years there has been a trend towards less extensive surgery for improving quality of life in the multimodality treatment of breast cancer. Based on randomized evidence for the safety and efficacy of breast-conserving surgery (BCS) and sentinel nodel biopsy (SNB) as well as the efficacy of empirical cytotoxic and targeted (anti-HER2, anti-ER) agents, early-stage breast cancer treated by minimal surgery has been increased . However, longer than 10-years survival results have demonstrated a local recurrence risk after BCS ranging between 10 and 20%% suggestive how carefully should candidate patients be selected for BCS [2,3]. Recently, a landmark meta-analysis study has demonstrated that one of four patients who develops local recurrence die of the disease and overall survival can significantly be reduced by inadequate local control . With the wider clinical use of SNB and a trend towards sparing (ALD) even by positive SNB emerge similar harms for nodal recurrence and overall survival?