Jacqueline Tsai, MD, FACS
Clinical Associate Professor, Surgery - General Surgery
Bio
Dr Jacqueline Tsai is a board certified general surgeon who completed a breast surgical oncology fellowship at Stanford and specializes in the diagnosis and treatment of all breast diseases and cancer. She is a breast surgical oncologist at Stanford Women's Cancer Center and has experience and interest in all types of breast surgery, including breast conservation, oncoplastic surgery and nipple sparing procedures to provide optimal cosmetic outcomes for all patients. Prior to joining the team at Stanford, she practiced in New York City at Weill Cornell Medical College and New York Presbyterian Hospital in Queens in the field of breast surgery.
Dr Tsai strives to provide compassionate, expert, evidence-based care for all patients. She works closely with plastic and reconstructive surgeons to help patients achieve both the optimal oncologic surgery as well as the desired cosmetic outcomes that patients desire. She is also involved in clinical trials that aim to improve diagnostic and therapeutic interventions for patients with breast cancer.
Clinical Focus
- General Surgery
- Breast Surgery
Professional Education
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Board Certification: American Board of Surgery, General Surgery (2019)
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Fellowship: Stanford Hospital and Clinics - Dept of Surgery (2016) CA
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Residency: Albert Einstein College of Medicine Montefiore Medical Center (2015) NY
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Medical Education: Rutgers New Jersey Medical School Office of the Registrar (2008) NJ
Current Research and Scholarly Interests
My research interests are focused on improving breast cancer surgeries. I am interested in novel techniques in surgery to improve cosmetic outcomes, minimize surgical re-excisions and possible augmented reality technologies to enhance surgery.
Clinical Trials
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LYMPHA Procedure for the Prevention of Lymphedema After Axillary Lymphadenectomy
Not Recruiting
Lymphedema is a chronic, progressive, and debilitating condition that occurs with disruption or obstruction of the lymphatic system, which commonly occurs a result of breast cancer therapy. The purpose of this study is to determine if the use of a low risk lymphatic reconstruction procedure at the time of axillary lymph node dissection will reduce the risk of developing lymphedema. Additionally, to determine if this procedure improves objective outcomes of lymphedema and patient quality of life
Stanford is currently not accepting patients for this trial. For more information, please contact Dung Nguyen, PharmD, 650-498-6004.
All Publications
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Residual cancer burden in two-stage nipple sparing mastectomy after first stage lumpectomy and devascularization of the nipple areolar complex.
Breast cancer research and treatment
2024
Abstract
Ischemic complications after nipple-sparing mastectomy (NSM) can be ameliorated by 2-stage procedures wherein devascularization of the nipple-areolar complex (NAC) and lumpectomy with or without nodal staging surgery is performed first (1S), weeks prior to a completion NSM (2S). We report the time interval between procedures in relation to the presence of residual carcinoma at 2S NSM.Women with breast cancer who received 2S NSM from 2015 to 2022 were identified. Both patient level and breast level analyses were conducted. Clinical staging at presentation, pathologic staging at 1S and residual disease at 2S pathology are noted. Residual disease was classified as microscopic (1-2 mm), minimal (3-10 mm), and moderate (> 10 mm).59 patients (108 breasts) underwent 2S NSM. The median time interval between 1 and 2S for all patients was 34 days: 31 days for upfront surgery invasive cancer, 41 days for upfront DCIS surgery and 31 days for those receiving neoadjuvant therapy. Completion NSM was performed within 6 weeks for 72% of the breasts analyzed. Of the 53 breasts with invasive cancer on 1S pathology, 35% (19/53) had no residual invasive disease and 24.5% (13/53) had neither residual invasive nor in situ carcinoma on final 2S. Among the 50 women who had upfront surgery, 16 (32%) had residual invasive cancer found at 2S NSM, 9 of which had less than or equal to 1 cm disease.Invasive cancers were completely resected during 1S procedure in 65% of breasts. Residual disease was minimal and there was only one case of upstaging at 2S. Added time of two-stage surgery is offset by a reduction in ischemic mastectomy flap complications.
View details for DOI 10.1007/s10549-024-07348-0
View details for PubMedID 38713288
View details for PubMedCentralID 5293653
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Can Completion Axillary Lymph Node Dissection be Omitted after Neoadjuvant Endocrine Therapy?
SPRINGER. 2024: S117
View details for Web of Science ID 001185577500253
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Frailty Analysis and Outcomes of Breast Cancer Surgery in Elderly Patients Aged 85 and Older
SPRINGER. 2023: S331-S332
View details for Web of Science ID 000999257500037
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Nipple-areola-complex preservation and obesity-Successful in stages.
Microsurgery
2023
Abstract
The superiority of nipple-sparing mastectomy (NSM) on breast aesthetics and patient-reported outcomes has previously been demonstrated. Despite 42.4% of adults in the United States being considered obese, obesity has been considered a contraindication to NSM due to concerns for nipple areolar complex (NAC) malposition or ischemic complications. This report investigates the feasibility and safety of a staged surgical approach to NSM with immediate microsurgical breast reconstruction in the high-risk obese population.Only patients with a body mass index (BMI) of >30 kg/m2 who underwent bilateral mastopexy or breast reduction for correction of ptosis or macromastia (stage 1), respectively, followed by bilateral prophylactic NSM with immediate microsurgical breast reconstruction with free abdominal flaps (stage 2) were included in the analysis. Patient demographics and surgical outcomes were analyzed.Fifteen patients with high-risk genetic mutations for breast cancer with a mean age and BMI of 41.3 years and 35.0 kg/m2 , respectively, underwent bilateral staged NSM with immediate microsurgical breast reconstruction (30 breast reconstructions). At a mean follow-up of 15.7 months, complications were encountered following stage 2 only and included mastectomy skin necrosis (5 breasts [16.7%]), NAC necrosis (2 breasts [6.7%]), and abdominal seroma (1 patient [6.7%]) all of which were considered minor and neither required surgical intervention nor admission.Implementation of a staged approach permits NAC preservation in obese patients who present for prophylactic mastectomy and immediate microsurgical reconstruction.
View details for DOI 10.1002/micr.31043
View details for PubMedID 37013250
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Age is Just a Number: A Single Institution Review of Surgical Management of Breast Cancer in Elderly Patients Aged 85 and Older
SPRINGER. 2023: S106-S107
View details for Web of Science ID 001046841200220
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Characteristics and Management of Breast Lesions in Elderly Patients Aged 85 and Older
SPRINGER. 2023: S250
View details for Web of Science ID 001046841200551
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Two-stage nipple-sparing mastectomy does not compromise oncologic safety
SPRINGER. 2022: 204-205
View details for Web of Science ID 000780965900146
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Influence of Imaging Features and Technique on US-guided Tattoo Ink Marking of Axillary Lymph Nodes Removed at Sentinel Lymph Node Biopsy in Women With Breast Cancer.
Journal of breast imaging
2021; 3 (5): 583-590
Abstract
To describe tattoo ink marking of axillary lymph nodes (TIMAN) and the elements leading to successful removal at sentinel lymph node biopsy (SLNB).An IRB-approved retrospective image review was conducted of breast cancer patients who underwent SLNB after TIMAN from February 2013 to August 2017, noting patient and tattooed lymph node (TLN) features, initial biopsy type, time to surgery, if the TLN was identified at surgery, and correlation with the SLN. Cases were divided into two groups: the presurgical group, which had primary surgery, and the pre-neoadjuvant chemotherapy (NACT) group, which underwent surgery after completing NACT.Of 30 patients who underwent 32 TIMAN procedures, 10 (33.3%) were presurgical and 20 (66.7%) were pre-NACT. The average lymph node (LN) depth from the skin was 1.6 cm, with an average of 0.3 mL of tattoo ink injected. Of 32 procedures, 29 (90.6%) had US images demonstrating the injection. Of these, 10 (34.5%) were injected in the LN cortex surface and 19 (65.5%) in the middle cortex. Seven (24.1%) were injected in the LN lateral aspect, 12 (41.4%) in the mid aspect, and 10 (34.5%) in the medial aspect. Of 32 LNs, 28 (87.5%) were tattooed immediately after initial biopsy and 4 (12.5%) at a later date. At SLNB, all 32 (100%) TLNs were identified, all correlated with the SLN, and 10 (31.3%) were positive for cancer.Using an average of 0.3 mL of tattoo ink, all TLNs were successfully identified for removal at surgery, despite variability in LN and injection factors.
View details for DOI 10.1093/jbi/wbab049
View details for PubMedID 38424950
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Influence of Imaging Features and Technique on US-guided Tattoo Ink Marking of Axillary Lymph Nodes Removed at Sentinel Lymph Node Biopsy in Women With Breast Cancer
JOURNAL OF BREAST IMAGING
2021; 3 (5): 583-590
View details for DOI 10.1093/jbi/wbab049
View details for Web of Science ID 000702260800009
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Correction to: Two-Stage Versus One-Stage Nipple-Sparing Mastectomy: Timing of Surgery Prevents Nipple Loss.
Annals of surgical oncology
2021
View details for DOI 10.1245/s10434-021-10553-6
View details for PubMedID 34341890
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Two-Versus One-Stage Nipple-Sparing Mastectomy: Timing of Surgery Prevents Nipple Loss.
Annals of surgical oncology
2021
Abstract
BACKGROUND: Devascularization of the nipple-areola complex (NAC) before nipple-sparing mastectomy (NSM) enhances blood flow to the skin. This study analyzed the effect of the interval between stages in two-stage (2S) operations and compared the ischemic events with those of one-stage (1S) NSM.METHODS: Ischemic complications were defined as partial/reversible (PR) or full-thickness/irreversible (FI) skin necrosis of the NAC or flap. The latter encompassed limited areas of the NAC, resulting in loss of nipple height or areolar circumference without affecting the integrity or appearance of the NAC. Outcomes between the two groups were compared using chi-square and both uni- and multivariate analyses.RESULTS: From 2015 to 2019, 109 breastsunderwent 2S NSM and 103 breasts underwent 1S NSM. Grade 2 or 3 breast ptosis was more common in the 2S group than in the 1S group (60.5% vs 30.5%; p < 0.01). The median time between devascularization and NSM was 30 days (range, 11-415 days). After devascularization, ischemic events occurred in 25.7% of the breasts. Nipple loss occurred in 7.8% of the 1S group and 0% of the 2S group. Both PR and FI NAC ischemic events were observed in 66.7% of the breasts when NSM took place fewer than 20 days (n = 9) after devascularization versus 15% when NSM took place20 days or longer afterward (n = 100). Overall, NAC, flap ischemic complications, or both occurred in 35.9% of the 1S group versus 20.2% of the 2S group (p < 0.05). In the multivariate analysis, the odds ratio of ischemic complications in the 2S versus the 1S group was 0.38 (range, 0.19-0.75).CONCLUSIONS: Fewer ischemic complications and no nipple loss occurred in 2S NSM. Ischemic events are fewer when the interval between devascularization and NSM is 20 days or longer.
View details for DOI 10.1245/s10434-021-10456-6
View details for PubMedID 34291379
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Two-Stage Versus One-Stage Nipple-Sparing Mastectomy: Timing of Surgery Prevents Nipple Loss
SPRINGER. 2021: S214-S215
View details for Web of Science ID 000650046500027
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Are We Over-Imaging the Axilla in Patients Undergoing Neoadjuvant Chemotherapy?
SPRINGER. 2021: S305-S306
View details for Web of Science ID 000650046500099
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Surgical excision of BioZorb device eroding through the nipple-areolar complex one year postoperatively: A case report.
The breast journal
2021
Abstract
The recent use of placing a BioZorb device during breast conservation surgery has been shown to improve targeting of adjuvant radiation therapy by significantly reducing target volume to the breast. However, the risks of surgical and/or infectious complications related to a BioZorb placement are largely unknown. In this case report, we describe a patient who underwent BioZorb placement after breast lumpectomy for ductal carcinoma in situ (DCIS), who presented with repeated infections and eventual erosion of the BioZorb through her nipple-areolar complex (NAC), requiring surgical debridement and excision of her NAC and BioZorb 1year postoperatively.
View details for DOI 10.1111/tbj.14168
View details for PubMedID 33491290
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ASO Visual Abstract: Two-Stage Versus One-Stage Nipple-Sparing Mastectomy: Timing of Surgery Prevents Nipple Loss.
Annals of surgical oncology
2021
View details for DOI 10.1245/s10434-021-10596-9
View details for PubMedID 34448056
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Feasibility of Lumpectomy Surgery for Large Ductal Carcinoma In Situ
SPRINGER. 2020: S333
View details for Web of Science ID 000538247800059
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A randomized phase II study comparing surgical excision versus NeOadjuvant Radiotherapy followed by delayed surgical excision of Ductal carcinoma In Situ (NORDIS)
AMER ASSOC CANCER RESEARCH. 2020
View details for DOI 10.1158/1538-7445.SABCS19-OT3-09-04
View details for Web of Science ID 000527012500151
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The Impact of Device Innovation on Clinical Outcomes in Expander-based Breast Reconstruction
PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN
2019; 7 (12)
View details for DOI 10.1097/GOX.0000000000002524
View details for Web of Science ID 000512700800009
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The Impact of Device Innovation on Clinical Outcomes in Expander-based Breast Reconstruction.
Plastic and reconstructive surgery. Global open
2019; 7 (12): e2524
Abstract
Staged expander-based breast reconstruction represents the most common reconstructive modality in the United States. The introduction of a novel tissue expander with an integrated drain (Sientra AlloX2) holds promise to further improve clinical outcomes.Patients who underwent immediate expander-based pre-pectoral breast reconstruction were identified. Two cohorts were created, that is, patients who underwent placement of a conventional tissue expander [133MX (Allergan)] (Group 1) versus AlloX2 (Sientra) (Group 2). The study endpoint was successful completion of expansion with the objective being to investigate differences in outcome following expander placement.Fifty-eight patients underwent 99 breast reconstructions [Group 1: N = 24 (40 breasts) versus Group 2: N = 34 (59 breast)]. No differences were noted for age (P = 0.586), BMI (P = 0.109), history of radiation (P = 0.377), adjuvant radiotherapy (P = 1.00), and overall complication rate (P = 0.141). A significantly longer time to drain removal was noted in Group 1 (P < 0.001). All patients with postoperative infection in Group 1 required surgical treatment versus successful washout of the peri-prosthetic space via the AlloX2 drain port in 3 of 5 patients in Group 2 (P = 0.196). Furthermore, both cases of seroma in Group 1 required image-guided drainage versus in-office drainage via the AlloX2 drain port in 1 patient in Group 2 (P =0.333).The unique feature of the AlloX2 provides surgeons easy access to the peri-prosthetic space without altering any of the other characteristics of a tissue expander. This resulted in a reduced time to drain removal and facilitated management of postoperative seroma and infection.
View details for DOI 10.1097/GOX.0000000000002524
View details for PubMedID 32537287
View details for PubMedCentralID PMC7288893
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Pretreatment Tattoo Marking of Suspicious Axillary Lymph Nodes: Reliability and Correlation with Sentinel Lymph Node
ANNALS OF SURGICAL ONCOLOGY
2019; 26 (8): 2452–58
View details for DOI 10.1245/s10434-019-07419-3
View details for Web of Science ID 000474357200022
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Pretreatment Tattoo Marking of Suspicious Axillary Lymph Nodes: Reliability and Correlation with Sentinel Lymph Node.
Annals of surgical oncology
2019
Abstract
BACKGROUND: Tattooing is an alternative method for marking biopsied axillary lymph nodes (ALNs) before initiation of treatments for newly diagnosed breast cancer. Detection of black ink-stained nodes is performed under direct visualization at surgery and is combined with sentinel node (SLN) mapping procedures.METHODS: Women with newly diagnosed breast cancer who underwent fine or core-needle biopsy of suspicious ALNs were recruited. The nodal cortex and perinodal soft tissue was injected with 0.1-1.0ml of Spot (GI Supply) black ink under ultrasound guidance. Intraoperatively, black stained nodes were removed along with SLNs, noting concordance between the two.RESULTS: Sixty-six evaluable patients were enrolled (2013-2017). Nineteen received surgery first (Group 1) and 47 neoadjuvant therapy (NAT, Group 2). The average number of nodes tattooed was 1.16 for Group 1 and 1.04 for Group 2. The average interval from tattoo to surgery was 21days (range 1-62) for Group 1 and 148days (range 71-257) for Group 2. The tattooed node(s) were visually identified at surgery and corresponded to the sentinel lymph node(s) in 98.5% of cases (18/19 in Group 1 and 47/47 in Group 2). Of the 14 patients in Group 2 whose nodes remained positive following NAT, the tattooed node was the SLN associated with carcinoma.CONCLUSIONS: Tattooing is an alternative method for marking biopsied ALNs. Tattooed nodes coincided with SLNs in 98.5% of cases. This technique is advantageous, because it allows for fewer procedures and lower costs compared with other methods.
View details for PubMedID 31087176
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Pathological confirmation of pre-chemotherapy biopsied and tattooed axillary lymph nodes
SPRINGER. 2018: 426–27
View details for Web of Science ID 000433587300141
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Lymph Node Ratio Analysis After Neoadjuvant Chemotherapy is Prognostic in Hormone Receptor-Positive and Triple-Negative Breast Cancer.
Annals of surgical oncology
2016; 23 (10): 3310-3316
Abstract
Lymph node ratios (LNR), the proportion of positive lymph nodes over the number excised, both defined as ranges and single ratio values are prognostic of outcome. Little is known of the prognostic value of LNR after neoadjuvant chemotherapy (NAC) according to molecular subtype.From 2003 to 2014, patients who underwent definitive surgery after NAC were identified. LNR was calculated for node-positive patients who received axillary dissection or had at least 6 nodes removed. DFS was calculated using the Kaplan-Meier log rank test for yp N0-3 status, LNR categories (LNRC) ≤0.20 (low), 0.21-0.65 (intermediate), >0.65 (high), and single LNR values.Of 428 NAC recipients, 263 were node negative and 165 (38.6 %) node positive: ypN1 = 97 (58.8 %), ypN2 = 43 (26.1 %), and ypN3 = 25 (15.2 %). Among node-positive cancers, the median number of LN removed was 14 (range, 6-51) and the median LNR was 0.22 (range, 0.03-1.0). Nodal stage was inversely associated with 5-year DFS: 91.5 % (ypN0), 74.5 % (ypN1), 49.8 % (ypN2), and 50.7 % (ypN3) (p < 0.001). LNRC was similarly inversely associated with DFS: 69.1 % (low), 71.4 % (intermediate), 49.3 % (high) (p < 0.001). Significant associations between LNRC and DFS were demonstrated in hormone receptor (HR)-positive and triple negative breast cancer (TNBC) subtypes, p = 0.02 and p = 0.003. A single-value LNR ≤ 0.15 in node-positive, HR-positive (94.1 vs 67.7 %; p = 0.04) and TNBC (94.1 vs 47.8 %; p = 0.001) groups was also significant.Residual nodal disease after NAC, analyzed by LNRC or LNR = 0.15 cutoff value, is prognostic and can discriminate between favorable and unfavorable outcomes for HR-positive and TNBC cancers.
View details for DOI 10.1245/s10434-016-5319-8
View details for PubMedID 27401442
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Disease-Free Survival Using Lymph Node Ratio Analysis After Neoadjuvant Chemotherapy
SPRINGER. 2016: 162–63
View details for Web of Science ID 000384566800159
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Internal hernia associated with perforated Meckel's diverticulum
JOURNAL OF PEDIATRIC SURGERY CASE REPORTS
2016; 4: 52–53
View details for DOI 10.1016/j.epsc.2015.11.014
View details for Web of Science ID 000370155000015