Abstract
The knowledge of the natural history of the breast carcinoma, its origin in the light of the theories by Tibor Tot, the ultrasound intuitions of Michel Teboul, the detailed studies by Domique Amy and the following anatomopathological evaluations allow us to think in many cases to limited operations, but rationally correct and placing always greater importance to women wellbeing.
Here is the reason why in patients with early breast cancer of a single lobe, radical surgery must be associated with a good esthetic and functional result.
It must be reminded that the functional unit of breast is the lobe, that neoplastic foci may exist, synchronously or asynchronously, in the same sick lobe, and that neoplastic cells are found in the ductal tree in over 30 % of these cases. For this reason it is necessary the extirpation of the whole affected lobe, because the goal is to reach the minimum rate of recurrence associated with the least possible breast alteration.
This result is achieved by performing the complete excision of one lobe using ultrasound as well as dissection of the sentinel lymph node. Results are wholly satisfying.
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Notes
- 1.
The risk of spreading to the nipple is related to the tumor’s size (only 17 % of cases when it is less than 10 mm). When spreads to the nipple, 25 % of cases are invasive cancer, while in 15 % of other cases it is both invasive and in situ. In most cases the tumor is limited to a small area (deeper than 5 mm from surface) and consists of a completely intraductal cellular extension (almost 60 % of the cases).
- 2.
Area of the triangle: half of base times height.
- 3.
Area of the annulus: area of the large circle minus area of the small circle → πR 2 − πr 2.
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Acknowledgment
Thanks to Gianni Botta, Anna Maria Dolfin, Elisabetta Dolfin, Grazia Mannini, Chiara Palieri, and Paolo Tagliabue for the help in writing this chapter and for providing the images.
I want to thank also my son Alberto for the translation.
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Dolfin, G. (2014). The Surgical Approach to the “Sick Lobe”. In: Francescatti, D., Silverstein, M. (eds) Breast Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8063-1_5
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