I will do my best to clear the exact pathology by CNB or review the specimen but some times these are not enough and I must do excisional biopsy to reach the final pathology.

in this condition if the patient has huge breast with an oncoplasty approach in first step we can extract the lump with an acceptable cosmetic outcome although if there is high suspicious of malignancy you have to place opac clips in order to further possible RT.this approach never interact with SLNB procedure if become necessary in future.

but if the breast is small most of the times I schedule the patient with frozen section, and I choose smallest  incision which can be in the field of future oncoplasy and if incisional BX  is not diagnostic I try to lumpectomy W/O margin via that incision.

I agree with Dra esfehani, she is correct; but it is also possible to adopt the following conduc. t.Firstly you must listen to the patient. What she wants after being informed of any risks or benefits. If she is satisfied with your breasts, your best bet is not to "spoil" them, so remove enough tissue that has normal breast tissue across its surface. and maintain the breast therewith unchanged.

For one who is not satisfied with their breasts, this is an opportunity to take advantage of adversity. You should use techniques of oncoplastias for removing as much tissue without compromising margins and condition to reconstruct the breasts of the best way to improve body image. For one who is dissatisfied and would like to perform the surgery as Angelina Jolie, one should offer you this possibility.

For patients  with confirmed breast cancer, in my opinion, the best treatment for this pathology is the removal of the entire gland, with preservation of the skin and CAP, if possible, that is the most radical surgical treatment among conservative treatments, able to provide maximum margins free of cancer, what is sought in the conservative treatment of breast cancer.

In this case, first, is the  cancer surgery, to be performed with the most thorough oncologic criteria, to be followed by the best cosmetic treatment and for this it is necessary to conduct a proper symmetrization of the breasts. Thus, whenever indicated conservative treatment of breast, duty will provide patients, who after being informed of the risks and benefits of surgery; the best treatment is  TIBR, that is adenomastectomy bilateral with prothesis , and surgery of breast with cancer, a  adenomastectomy of treatment and contralateral breast without cancer, mastectomy of symmetrization.

I mysellf prefer to have an reliable pathology before surgery. that is i consult for second opinion or even re-biopsy (core needle biopsy ) if needed. of course familial and personal history and imaging data is critical of decision making.

if all data didn't help for planning, with consult of radiologist i will excise with a wider margin via oncoplastic surgery in order to obtain a secure clean margin.

May be intra-operative US will be helpful with specimen radiograph to assess margins. This will provide an oportunity to take wider margins if required. 

The best recipe to have negative margins when removing a breast lesion of uncertain nature  is the incision  1 cm