The Fellow on Call: The Heme/Onc Podcast Episode 055: Breast Cancer Series, Pt. 4-Surgical management for breast cancer
May 3, 2023
Dr. Carla Fisher, an Associate Professor and Medical Director of Breast Surgical Oncology, discusses vital topics in breast cancer management. She explains the criteria for breast conservation surgery and the role of imaging, such as when to order an MRI. Dr. Fisher also covers the timing of surgical interventions post-neoadjuvant therapy and the significance of sentinel lymph node biopsies. Additionally, she highlights the complexities of breast reconstruction and when prophylactic mastectomy is indicated. Valuable insights for patients and healthcare professionals alike!
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Thoughtful Use Of MRI And Tumor–Breast Ratio
- Dr. Carla Fisher uses tumor-to-breast ratio and imaging to decide breast conservation versus mastectomy.
- She orders MRI selectively for young patients, dense breasts, lobular histology, or when neoadjuvant chemo is planned.
Always Clip Biopsied Nodes Pre‑Chemo
- Place clips at biopsy sites in the breast and axilla to permit localization after neoadjuvant therapy.
- Use clip-localizers to ensure the originally positive node is removed and to assess pathologic response.
Timing Surgery After Neoadjuvant Chemo
- Schedule surgery about four to six weeks after finishing cytotoxic neoadjuvant chemotherapy.
- Aim earlier (around 3–4 weeks) for triple negative disease but balance toxicity and being off systemic therapy.
