Subgross Morphology, the Sick Lobe Hypothesis, and the Success of Breast Conservation

Breast carcinoma has a complex subgross morphology in the majority of cases. The malignant transformation usually involves a single breast lobe and may demonstrate peripheral, segmental, or lobar growth patterns in the in situ phase. During the invasive phase, the tumor may grow beyond the borders of the affected lobe. The dimensions of the involved lobe and the pattern of its involvement determine the extent of the disease in the early phase, with the size, type, and position of the invasive foci being additional determinants in more advanced cases. Breast carcinomas of limited extent (occupying a tissue area <40mm) are proper candidates for breast-conserving surgery. In other cases, careful individual preoperative assessment of disease extent is necessary in making decisions about the most appropriate surgical approach, taking into account the position of the lesion(s) within the breast, the dimensions of the breast, and patient preference.