The Surgical Approach to the “Sick Lobe”
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.
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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