What is your approach to women with breast cancer who opts for a staged approach with up-front lumpectomy and SLN biopsy (pN-) when there are indications for adjuvant radiation therapy but she plans for a later mastectomy (=>6 months)?   

Patient will not have any chemotherapy in the interim. Would this change if the patient was pN+ and still not receiving chemotherapy? We are seeing this approach increasingly for women who want to preserve the nipple and areola so they have a lumpectomy and lift, and then significantly delayed mastectomy. Also seeing this in patients to get them to surgery faster because of delays due to coordination of plastic surgery and breast surgery schedules.