Eighteen hundred and fifty-nine patients with primary carcinoma of the breast from New York Medical College-Flower and Fifth Avenue Hospitals were treated by a moderate selective surgical approach between 1950 and 1975. Seven hundred and eleven patients with potentially curable carcinoma of the breast were observed for ten or more years. Based upon strict criteria of evaluation, the series did not have an increased number of prognostically favorable cancers compared with that of other series. The results obtained were most rewarding regarding absolute gross ten year survival rates, local recurrence rates, percentage of skin grafts, management of the other breast, arm and shoulder function and cosmetic appearance, especially in relation to reconstruction of the breast in properly selected patients.