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Management of Breast Cancer
Breast cancer management isn’t “mastectomy vs lumpectomy.” It’s risk → imaging → tissue diagnosis → staging → locoregional control → systemic therapy, all tailored to tumor biology and patient goals.
In this episode, we walk through the modern evidence base that moved us from Halsted-era radical surgery to breast-conserving therapy + targeted systemic therapy, while keeping oncologic safety front and center.
Key takeaways:
Screening: Average risk = annual mammography starting at 40; high-risk patients may add MRI starting ~30.
Pathology framework: DCIS (basement membrane) vs LCIS (risk marker) vs invasive (ductal most common; lobular often occult on mammo).
Breast conservation: Lumpectomy with negative margins + RT achieves survival comparable to mastectomy; RT dramatically improves local control.
Axilla: SLNB is standard staging in early disease with lower morbidity; many patients avoid completion ALND depending on criteria + adjuvant RT.
Systemic therapy: Endocrine therapy and targeted agents reduce recurrence risk—selection is tumor-marker driven.
Disclaimer: This content is for educational purposes only and is not medical advice.
#BreastCancer #BreastSurgery #PlasticSurgery #GeneralSurgery #Oncoplastic #SurgicalOncology #Residency #SLNB #DCIS #Mastectomy
Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA
YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO
📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/
Citations (AMA):
Saslow D, Boetes C, Burke W, et al. CA Cancer J Clin. 2007;57(2):75-89. doi:10.3322/canjclin.57.2.75. PMID:17392385.
Fisher B, Redmond C, Poisson R, et al. N Engl J Med. 1989;320(13):822-828. PMID:2927449.
Clarke M, Collins R, Darby S, et al. Lancet. 2005;366(9503):2087-2106. doi:10.1016/S0140-6736(05)67887-7. PMID:16360786.
Giuliano AE, Hunt KK, Ballman KV, et al. JAMA. 2011;305(6):569-575. doi:10.1001/jama.2011.90. PMID:21304082.
Fisher B, Costantino J, Redmond C, et al. N Engl J Med. 1993;328(22):1581-1586. doi:10.1056/NEJM199306033282201. PMID:8292119.
Fisher B, Dignam J, Wolmark N, et al. Lancet. 1999;353(9169):1993-2000. doi:10.1016/S0140-6736(99)05036-9. PMID:10376613.
View all episodes
By Plastics in PracticeBreast cancer management isn’t “mastectomy vs lumpectomy.” It’s risk → imaging → tissue diagnosis → staging → locoregional control → systemic therapy, all tailored to tumor biology and patient goals.
In this episode, we walk through the modern evidence base that moved us from Halsted-era radical surgery to breast-conserving therapy + targeted systemic therapy, while keeping oncologic safety front and center.
Key takeaways:
Screening: Average risk = annual mammography starting at 40; high-risk patients may add MRI starting ~30.
Pathology framework: DCIS (basement membrane) vs LCIS (risk marker) vs invasive (ductal most common; lobular often occult on mammo).
Breast conservation: Lumpectomy with negative margins + RT achieves survival comparable to mastectomy; RT dramatically improves local control.
Axilla: SLNB is standard staging in early disease with lower morbidity; many patients avoid completion ALND depending on criteria + adjuvant RT.
Systemic therapy: Endocrine therapy and targeted agents reduce recurrence risk—selection is tumor-marker driven.
Disclaimer: This content is for educational purposes only and is not medical advice.
#BreastCancer #BreastSurgery #PlasticSurgery #GeneralSurgery #Oncoplastic #SurgicalOncology #Residency #SLNB #DCIS #Mastectomy
Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA
YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO
📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/
Citations (AMA):
Saslow D, Boetes C, Burke W, et al. CA Cancer J Clin. 2007;57(2):75-89. doi:10.3322/canjclin.57.2.75. PMID:17392385.
Fisher B, Redmond C, Poisson R, et al. N Engl J Med. 1989;320(13):822-828. PMID:2927449.
Clarke M, Collins R, Darby S, et al. Lancet. 2005;366(9503):2087-2106. doi:10.1016/S0140-6736(05)67887-7. PMID:16360786.
Giuliano AE, Hunt KK, Ballman KV, et al. JAMA. 2011;305(6):569-575. doi:10.1001/jama.2011.90. PMID:21304082.
Fisher B, Costantino J, Redmond C, et al. N Engl J Med. 1993;328(22):1581-1586. doi:10.1056/NEJM199306033282201. PMID:8292119.
Fisher B, Dignam J, Wolmark N, et al. Lancet. 1999;353(9169):1993-2000. doi:10.1016/S0140-6736(99)05036-9. PMID:10376613.