Dr. Mardi R. Karin is a board certified surgeon with over 20 years of experience, specializing in breast surgery and is Clinical Associate Professor of Surgery in Stanford University Department of Surgery, Section of Surgical Oncology. She was appointed the first Clinical Director of Breast Cancer Care at Stanford Cancer Center South Bay after the new cancer center opened and served in this role from 2016-2019. Dr. Karin specializes in the surgical treatment of breast diseases and cancer. In addition to providing outstanding care, her focus and leadership in breast cancer care includes improving coordinated care for breast cancer treatment both within the Cancer Center and the community.
Dr. Karin has extensive experience in breast surgery, including complex breast cancer skin and nipple sparing procedures in coordination with the plastic surgeon for immediate breast reconstruction and optimal appearance with excellent outcomes. She collaborates closely with Plastic and Reconstructive Surgery to provide the best options to patients, including Oncoplastics for optimal aesthetic appearance with breast conservation treatment, and also Lympha for lymphedema prevention, in addition to mastectomy with nipple sparing and immediate breast reconstruction. Her clinical research is focused on improving patient outcomes in different aspects of breast surgery, including nipple sparing mastectomy by utilizing MRI blood flow information to preserve important blood flow to reduce complications. She also is involved with advancing surgical techniques to decrease lymphedema rates after axillary lymph node dissection, with lymphatic preservation and patients are offered the LYMPHA procedure by the Plastic Reconstructive Microsurgeons. In addition, she works in close collaboration with Medical Oncology to offer the latest most advanced treatments for breast cancer.
- General Surgery
- Breast Cancer Treatment and Surgery
Clinical Professor, Surgery - General Surgery
Clinical Director of Breast Cancer Care, Stanford Cancer Center South Bay (2016 - 2019)
Residency: University of Iowa Hospitals and Clinics Surgery Residency (1990) IA
Medical Education: UCLA David Geffen School Of Medicine Registrar (1985) CA
Board Certification: American Board of Surgery, General Surgery (1991)
Residency, The University of Iowa Hosptials and Clinics, General Surgery (1990)
Patient perspectives on window of opportunity clinical trials in early-stage breast cancer.
Breast cancer research and treatment
Window of opportunity trials (WOT) are increasingly common in oncology research. In WOT participants receive a drug between diagnosis and anti-cancer treatment, usually for the purpose of investigating that drugs effect on cancer biology. This qualitative study aimed to understand patient perspectives on WOT.We recruited adults diagnosed with early-stage breast cancer awaiting definitive therapy at a single-academic medical center to participate in semi-structured interviews. Thematic and content analyses were performed to identify attitudes and factors that would influence decisions about WOT participation.We interviewed 25 women diagnosed with early-stage breast cancer. The most common positive attitudes toward trial participation were a desire to contribute to research and a hope for personal benefit, while the most common concerns were the potential for side effects and how they might impact fitness for planned treatment. Participants indicated family would be an important normative factor in decision-making and, during the COVID-19 pandemic, deemed the absence of family members during clinic visits a barrier to enrollment. Factors that could hinder participation included delay in standard treatment and the requirement for additional visits or procedures. Ultimately, most interviewees stated they would participate in a WOT if offered (N = 17/25).In this qualitative study, interviewees weighed altruism and hypothetical personal benefit against the possibility of side effect from a WOT. In-person family presence during trial discussion, challenging during COVID-19, was important for many. Our results may inform trial design and communication approaches in future window of opportunity efforts.
View details for DOI 10.1007/s10549-022-06611-6
View details for PubMedID 35538268
Nipple-sparing mastectomy with internal mammary artery perforator preservation based on breast MRI reduces ischemic complications
SPRINGER. 2022: 205-207
View details for Web of Science ID 000780965900147
Impact of Incision Placement on Ischemic Complications in Microsurgical Breast Reconstruction.
Plastic and reconstructive surgery
1800; 149 (2): 316-322
BACKGROUND: Nipple-sparing mastectomy is associated with greater patient satisfaction than non-nipple-sparing approaches. Although various nipple-sparing mastectomy incisions have been described, the authors hypothesized that incision location would impact the rate and location of ischemic complications to the mastectomy skin flap.METHODS: A prospectively maintained database was queried to identify patients who underwent nipple-sparing mastectomy with immediate microsurgical reconstruction with a minimum postoperative follow-up of 12 months. The impact of incision location on postoperative ischemic complications was investigated. Major complications were defined as those that required reexploration in the operating room or inpatient management; minor complications were amenable to outpatient management. Multivariable logistic and linear regression were performed to investigate risk factors for postoperative complications following breast reconstruction.RESULTS: Eighty-seven patients met inclusion criteria. The following nipple-sparing mastectomy incisions were used: radial with a periareolar extension (39 percent), inframammary fold (31 percent), vertical with a periareolar extension (22 percent), vertical (6 percent), and radial (2 percent). Seven patients (8 percent) had major complications, whereas twenty-six patients (29.9 percent) developed minor postoperative complications. Inframammary fold incisions were associated with significantly greater rates of mastectomy skin flap necrosis (p = 0.002), whereas periareolar incisions were associated with significantly greater rates of postoperative nipple-areola complex necrosis (p = 0.04).CONCLUSIONS: The authors report a significant association between incision location and ischemic complications to the breast skin envelope in microsurgical breast reconstruction. The authors observed a significant association of inframammary fold and periareolar incisions with mastectomy skin flap and nipple-areola complex necrosis, respectively.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
View details for DOI 10.1097/PRS.0000000000008770
View details for PubMedID 35077404
Utilizing Breast MRI Blood Flow Data to Improve Clinical Outcomes Following Skin Sparing Mastectomy and Nipple Sparing Mastectomy
ELSEVIER SCIENCE INC. 2021: E13
View details for Web of Science ID 000718306700033
Prevention of Postoperative Lymphedema for Breast Cancer Surgery with Axillary Lymph Node Dissection Combined with Lympha and Lymphatic Preservation: Patient Selection and Outcomes
ELSEVIER SCIENCE INC. 2021: E17-E18
View details for Web of Science ID 000718306700045
Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for Lymphedema Prevention after Axillary Lymph Node Dissection-A Single Institution Experience and Feasibility of Technique.
Journal of clinical medicine
2021; 11 (1)
While surgical options exist to treat lymphedema after axillary lymph node dissection (ALND), the lymphatic microsurgical preventive healing approach (LYMPHA) has been introduced as a preventive measure performed during the primary surgery, thus avoiding the morbidity associated with lymphedema. Here, we highlight details of our operative technique and review postoperative outcomes. For our patients, limb measurements and body composition analyses were performed pre- and postoperatively. Intraoperatively, axillary reverse lymphatic mapping was performed with indocyanine green (ICG) and lymphazurin. SPY-PHI imaging was used to visualize the ICG uptake into axillary lymphatics. Cut lymphatics from excised nodes were preserved for lymphaticovenous anastomosis (LVA). At the completion of the microanastomosis, ICG was visualized draining from the lymphatic through the recipient vein. A retrospective review identified nineteen patients who underwent complete or partial mastectomy with ALND and subsequent LYMPHA over 19 months. The number of LVAs performed per patient ranged between 1-4 per axilla. The operating time ranged from 32-95 min. There were no surgical complications, and thus far one patient developed mild lymphedema with an average follow up of 10 months. At the clinic follow up, ICG and SPY angiography were used to confirm intact lymphatic conduits with an uptake of ICG across the axilla. This study supports LYMPHA as a feasible and effective method for lymphedema prevention.
View details for DOI 10.3390/jcm11010092
View details for PubMedID 35011833
- The Impact of Device Innovation on Clinical Outcomes in Expander-based Breast Reconstruction PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7 (12)
The Impact of Device Innovation on Clinical Outcomes in Expander-based Breast Reconstruction.
Plastic and reconstructive surgery. Global open
2019; 7 (12): e2524
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