Jacqueline Tsai, MD, FACS

All Publications

• Retained Foreign Body in the Breast Following a Motor Vehicle Collision: A Case Report. Case reports in surgery Bresciani, D., Tsai, J. 2024; 2024: 5262600

  Abstract

  Background: Unintentionally retained foreign bodies in the breast are a rare phenomenon. Most reported cases are iatrogenically derived from surgeries and procedures. Only a handful of reported cases refer to noniatrogenic causes, including bullets, a sewing needle, and a headscarf pin. However, there are no reports to date that describe a retained foreign body in the breast after a motor vehicle collision or a similar traumatic event or from a decorative steering wheel emblem decal. Case Description: We report the case of a 25-year-old female who was involved in a motor vehicle collision with airbag deployment that led to a left breast retained foreign body, a steering wheel emblem decal. On presentation to the emergency room, she reported left chest pain associated with a puncture wound lateral to the left nipple. Imaging at that time was consistent with a metallic object embedded in the subcutaneous tissue of the left breast. Four months after the accident, the patient continued having daily burning pain in the associated area. As such, surgical excision was recommended, and wire-localized excision of the foreign body was subsequently performed. Grossly, the foreign body appeared as a metallic object with rhinestones, which the patient confirmed was a decorative emblem decal that was on her steering wheel. The postoperative course was uncomplicated, and follow-up examinations revealed resolution of the left breast pain. Conclusions: This case underscores a unique presentation after a common accident-a retained foreign body in the breast after a motor vehicle collision-and its successful surgical intervention leading to a favorable postoperative course. Notably, the National Highway Traffic Safety Administration recently advised drivers against adding decorative emblem decals to their steering wheels for this reason. The case therefore highlights safety precautions that should be taken regarding the addition of this type of accessory.

  View details for DOI 10.1155/2024/5262600

  View details for PubMedID 39410953

  View details for PubMedCentralID PMC11479772

• 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 Thompson, C. N., Chandler, J., Ju, T., Tsai, J., Wapnir, I. 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

• Can Completion Axillary Lymph Node Dissection be Omitted after Neoadjuvant Endocrine Therapy? Beck, A., Troxell, M., Tsai, J., Wapnir, I. SPRINGER. 2024: S117

  View details for Web of Science ID 001185577500253

• Interactive Shape Sonification for Tumor Localization in Breast Cancer Surgery Schuetz, L., El Chemaly, T., Weber, E., Doan, A., Tsai, J., Leuze, C., Daniel, B., Navab, N., ACM ASSOC COMPUTING MACHINERY. 2024

  View details for DOI 10.1145/3613904.3642257

  View details for Web of Science ID 001255317906042

• Frailty Analysis and Outcomes of Breast Cancer Surgery in Elderly Patients Aged 85 and Older Foulad, D., Wapnir, I., Xu, A., Stone, K., Dirbas, F., Karin, M., Najafzadeh, P., Allison, K., Tsai, J. SPRINGER. 2023: S331-S332

  View details for Web of Science ID 000999257500037

• Nipple-areola-complex preservation and obesity-Successful in stages. Microsurgery Daly, L., Tsai, J., Stone, K., Wapnir, I., Karin, M., Wan, D., Momeni, A. 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

• Age is Just a Number: A Single Institution Review of Surgical Management of Breast Cancer in Elderly Patients Aged 85 and Older Foulad, D. S., Tsai, J., Najafzadeh, P., Allison, K., Wapnir, I. SPRINGER. 2023: S106-S107

  View details for Web of Science ID 001046841200220

• Characteristics and Management of Breast Lesions in Elderly Patients Aged 85 and Older Foulad, D. S., Wapnir, I., Najafzadeh, P., Allison, K., Tsai, J. SPRINGER. 2023: S250

  View details for Web of Science ID 001046841200551

• Two-stage nipple-sparing mastectomy does not compromise oncologic safety Thompson, C., Chandler, J., Ju, T., Wapnir, I., Tsai, J. SPRINGER. 2022: 204-205

  View details for Web of Science ID 000780965900146

• 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 Pajcini, M., Wapnir, I., Tsai, J., Edquilang, J., DeMartini, W., Ikeda, D. 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

• 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 Pajcini, M., Wapnir, I., Tsai, J., Edquilang, J., DeMartini, W., Ikeda, D. 2021; 3 (5): 583-590

  View details for DOI 10.1093/jbi/wbab049

  View details for Web of Science ID 000702260800009

• Correction to: Two-Stage Versus One-Stage Nipple-Sparing Mastectomy: Timing of Surgery Prevents Nipple Loss. Annals of surgical oncology Ju, T., Chandler, J., Momeni, A., Gurtner, G., Tsai, J., Nguyen, D., Wapnir, I. 2021

  View details for DOI 10.1245/s10434-021-10553-6

  View details for PubMedID 34341890

• Two-Versus One-Stage Nipple-Sparing Mastectomy: Timing of Surgery Prevents Nipple Loss. Annals of surgical oncology Ju, T., Chandler, J., Momeni, A., Gurtner, G., Tsai, J., Nguyen, D., Wapnir, I. 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

• Two-Stage Versus One-Stage Nipple-Sparing Mastectomy: Timing of Surgery Prevents Nipple Loss Ju, T., Momeni, A., Gurtner, G., Nguyen, D., Wapnir, I. SPRINGER. 2021: S214-S215

  View details for Web of Science ID 000650046500027

• Are We Over-Imaging the Axilla in Patients Undergoing Neoadjuvant Chemotherapy? Tsai, J. SPRINGER. 2021: S305-S306

  View details for Web of Science ID 000650046500099

• Surgical excision of BioZorb device eroding through the nipple-areolar complex one year postoperatively: A case report. The breast journal Ju, T., Tsai, J. 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

• ASO Visual Abstract: Two-Stage Versus One-Stage Nipple-Sparing Mastectomy: Timing of Surgery Prevents Nipple Loss. Annals of surgical oncology Ju, T., Chandler, J., Momeni, A., Gurtner, G., Tsai, J., Nguyen, D., Wapnir, I. 2021

  View details for DOI 10.1245/s10434-021-10596-9

  View details for PubMedID 34448056

• Feasibility of Lumpectomy Surgery for Large Ductal Carcinoma In Situ Edquilang, J., Tsai, J., Park, Y., Wapnir, I. SPRINGER. 2020: S333

  View details for Web of Science ID 000538247800059

• A randomized phase II study comparing surgical excision versus NeOadjuvant Radiotherapy followed by delayed surgical excision of Ductal carcinoma In Situ (NORDIS) Wapnir, I., DeMartini, W., Allison, K., Stone, K., Dirbas, F., Marquez, C., Ikeda, D., Pal, S., Tsai, J., Yang, R., West, R., McMillan, A., Telli, M., Horst, K. 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

• The Impact of Device Innovation on Clinical Outcomes in Expander-based Breast Reconstruction PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN Momeni, A., Li, A. Y., Tsai, J., Wan, D., Karin, M. R., Wapnir, I. L. 2019; 7 (12)

  View details for DOI 10.1097/GOX.0000000000002524

  View details for Web of Science ID 000512700800009

• The Impact of Device Innovation on Clinical Outcomes in Expander-based Breast Reconstruction. Plastic and reconstructive surgery. Global open Momeni, A., Li, A. Y., Tsai, J., Wan, D., Karin, M. R., Wapnir, I. L. 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

• Pretreatment Tattoo Marking of Suspicious Axillary Lymph Nodes: Reliability and Correlation with Sentinel Lymph Node ANNALS OF SURGICAL ONCOLOGY Patel, R., MacKerricher, W., Tsai, J., Choy, N., Lipson, J., Ikeda, D., Pal, S., De Martini, W., Allison, K. H., Wapnir, I. L. 2019; 26 (8): 2452–58

  View details for DOI 10.1245/s10434-019-07419-3

  View details for Web of Science ID 000474357200022

• Pretreatment Tattoo Marking of Suspicious Axillary Lymph Nodes: Reliability and Correlation with Sentinel Lymph Node. Annals of surgical oncology Patel, R., MacKerricher, W., Tsai, J., Choy, N., Lipson, J., Ikeda, D., Pal, S., De Martini, W., Allison, K. H., Wapnir, I. L. 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

• Pathological confirmation of pre-chemotherapy biopsied and tattooed axillary lymph nodes Patel, R., MacKerricher, W., Tsai, J., Wood, L., Allison, K., Wapnir, I. SPRINGER. 2018: 426–27

  View details for Web of Science ID 000433587300141

• Lymph Node Ratio Analysis After Neoadjuvant Chemotherapy is Prognostic in Hormone Receptor-Positive and Triple-Negative Breast Cancer. Annals of surgical oncology Tsai, J., Bertoni, D., Hernandez-Boussard, T., Telli, M. L., Wapnir, I. L. 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

• Disease-Free Survival Using Lymph Node Ratio Analysis After Neoadjuvant Chemotherapy Tsai, J., Bertoni, D., Tsai, C., Hernandez-Boussard, T., Wapnir, I. SPRINGER. 2016: 162–63

  View details for Web of Science ID 000384566800159

• Internal hernia associated with perforated Meckel's diverticulum JOURNAL OF PEDIATRIC SURGERY CASE REPORTS Hui, V. W., Tsai, J., Gokarn, N., Statter, M. B. 2016; 4: 52–53

  View details for DOI 10.1016/j.epsc.2015.11.014

  View details for Web of Science ID 000370155000015