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Sheldon Feldman, MD
SheldonFeldmanMD (Physician - Surgery - Breast (Verified) )| Communities: Breast Cancer | Answers: 20 |
| Member Since: Sep. 2011 |
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Professional Statement
The Clinical Breast Cancer Program at Columbia University is the clinical arm of the Herbert Irving Comprehensive Cancer Center's Breast Surgery Section. The program offers patients the resources of a major academic facility and comprehensive treatment of all forms of breast disease in one location.
Our clinicians are accomplished, caring specialists who have a long-standing commitment to women's health. They apply a multidisciplinary approach to breast health, which includes medical care, educational programs, and support groups. Ensuring that your experience at the Clinical Breast Cancer Program is private, comfortable and dignified is a primary concern of our staff.
Our specialists include breast surgeons, plastic and reconstructive surgeons, dedicated breast imagers, medical oncologists, pathologists, radiation oncologists, gynecologists, geneticists, psychiatrists, physical therapists and nutritionists, as well as physician assistants and specialized nurses. Their dedication, combined with academic and research capabilities and the full spectrum of diagnostic and therapeutic technology, result in the superior care that patients have come to expect from the program.
The program's high survival rate and low complication rate testify to the depth of this team's commitment; compared to national averages, patients treated at the Clinical Breast Cancer Program can expect consistently and significantly better results.
Our clinicians are accomplished, caring specialists who have a long-standing commitment to women's health. They apply a multidisciplinary approach to breast health, which includes medical care, educational programs, and support groups. Ensuring that your experience at the Clinical Breast Cancer Program is private, comfortable and dignified is a primary concern of our staff.
Our specialists include breast surgeons, plastic and reconstructive surgeons, dedicated breast imagers, medical oncologists, pathologists, radiation oncologists, gynecologists, geneticists, psychiatrists, physical therapists and nutritionists, as well as physician assistants and specialized nurses. Their dedication, combined with academic and research capabilities and the full spectrum of diagnostic and therapeutic technology, result in the superior care that patients have come to expect from the program.
The program's high survival rate and low complication rate testify to the depth of this team's commitment; compared to national averages, patients treated at the Clinical Breast Cancer Program can expect consistently and significantly better results.
Professional Info
Credential: MD
Primary specialty: Surgery - Breast
State Licenses: NY
Languages: English
Gender: Male
Medical school: New York University School Of Medicine
Residency: NYU Bellevue Hospital Medical Center
Internship: NYU Bellevue Hospital Medical Center
Board certifications: American Board of Surgery, Fellow American College of Surgeons, Fellow International College of Surgeons
Professional memberships: Alpha Omega Alpha, New York State Society of Surgeons, American College of Surgeons, Society of Surgical Oncology, American Society of Clinical Oncology, The American Society of Breast Disease, The American Society of Breast Surgeons, New York Metropolitan Breast Cancer Group
Areas of expertise:
Oncoplastic surgery
Nipple sparing mastectomy
Minimally invasive breast cancer surgery
Mammary ductoscopy
High-risk patient surveillance
Breast cancer prevention
Research interests:
Environmental factors and breast cancer
Breast endoscopy and intraductal diagnostics and treatment
Sentinel node biopsy
Physician-patient communication
Holistic patient-centered approaches to surgery
Awards and publications:
Compassionate Doctor Award 2009-2011
Best Doctors in America: New York 2009-10
America’s Top Surgeons, “Guide to America’s Top Surgeons”, 2004-2010
Top Doctors New York Metro Area, 2003-2010, Castle Connolly Medical Service
Teacher of the Year Award, Family Practice Residency Program, June 1984
Sister Mary Charles Award, Benedictine Hospital, September 22, 1994
Award for Outstanding Service, American Cancer Society, September, 1998
Physician of Distinction
Legacy of Hope 2004, American Cancer Society, Hudson Valley Region
For publications, see: http://asp.cpmc.columbia.edu/facdb/profile_list.asp?uni=sf2388&DepAffil=Surgery
Hospital affiliation: NewYork-Presbyterian - Columbia
Practice address:
Herbert Irving Pavilion Room 10th Fl., Suite 1005, 161 Fort Washington Avenue
New York, NY
10032
Practice phone number: 212-305-9676
Insurance accepted:
Aetna
Affinity Health Plan
Empire Blue Cross Blue Shield
HealthFirst
HIP
SheldonFeldmanMD Activities
An important emerging technology toward the goal of improving the local management of breast cancer is using RFA (radiofrequency ablation) intraoperatively during breast conservation (lumpectomy) surgery. In some centers up to 50% of patients who have a lumpectomy require return to the operating room for additional surgery to obtain clean margins. This is generally performed a few weeks after the initial surgery. The goal of using intraop RFA is to treat the breast tissue around the lumpectomy removal with heat (100 degrees centigrade) so that if the final pathology shows that a margin is not clean enough, it may not be necessary to perform and second surgery since additional margins have been “treated” with the RFA. Additionally this localized treatment may be comparable to a form of localized radiation therapy. If our studies show this to be equally effective it could allow many woman with early stage breast cancer to have successful breast conservation treatments even in areas of the world where radiation treatments are not readily available. The RFA equipment is not expensive and is small and portable and does not require lead lined radiation shielding. Several hundred patients have now undergone this procedure and the early results are very promising.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Conserving Surgery, Breast Cancer, Breast Cancer Surgery, Breast Surgery, Lumpectomy Margins, Breast Surgery Margins, Breast Cancer Treatment, Lumpectomy, Marginal Ablation, Radiofrequency Ablation
1
Answer |
1 month ago
It is usually an incidental finding at the time of core biopsy being performed for an abnormal mammogram (often microcalcifications) and when a breast lump is removed.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Tests, Breast Cancer Surgery, Breast Cancer, Atypical Ductal Hyperplasia (ADH), Breast Surgery, Breast Cancer Treatment, Lumpectomy, Core Biopsy, Mammogram
1
Answer |
1 month ago
For women with ADH and family history of breast cancer, the risk for
developing breast cancer is greatly increased. Serious consideration to
take medications to reduce breast cancer development is prudent. These
medication include; tamoxifen, raloxifene, torimifene and exemestane.
See previous answer as well -http://talkabouthealth.com/what-does-it-mean-if-i-have-a-high-risk-lesion-in-my-breast-what-is-that.
developing breast cancer is greatly increased. Serious consideration to
take medications to reduce breast cancer development is prudent. These
medication include; tamoxifen, raloxifene, torimifene and exemestane.
See previous answer as well -http://talkabouthealth.com/what-does-it-mean-if-i-have-a-high-risk-lesion-in-my-breast-what-is-that.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Aromasin (Exemestane), Atypical Ductal Hyperplasia (ADH), Breast Cancer, Breast Cancer Surgery, Breast Surgery, Evista (Raloxifene), Breast Cancer Treatment, Fareston (Toremifene), Core Biopsy, Nolvadex (Tamoxifen), Family History Of Breast Cancer
1
Answer |
1 month ago
These lesions may be identified when a biopsy is performed for a palpable mass or abnormal breast imaging study. They include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, radial scar and papillary lesions. If they are diagnosed by a core needle biopsy, we generally recommend surgical excision of the area to be certain there is not an associated cancer that requires treatment. This lesions statistically increase a woman’s risk for developing breast cancer and depending on other risk factors it will be important to undergo careful breast surveillance and consideration of risk reducing therapies.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Imaging, Breast Cancer Surgery, Breast Cancer Screening Tests, Papillary Lesions, Breast Surgery, High Risk Lesions, Mammographically Occult Lesions, Breast Cancer Tests, Breast Cancer, LCIS (Lobular Carcinoma In Situ), Atypical Lobular Hyperplasia, Breast Cancer Treatment, Core Biopsy
1
Answer |
1 month ago
This is a FDA approved device which uses the difference in how healthy breast tissue versus cancerous breast tissue interact with an energy source called radiofrequency spectroscopy. The surgeon applies this probe to the surface of the lumpectomy specimen and gets a reading based on the signal generated by this device interacting with the breast tissue. If the signal suggests the margin is not adequate, the surgeon can remove additional tissue to achieve a clean margin. It is user friendly and does not add much time to the procedure. A recent study suggests this device may be an improvement in margin evaluation compared to standard methods.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Tests, Breast Cancer, Breast Cancer Surgery, Breast Surgery, Lumpectomy Margins, MarginProbe, Breast Surgery Margins, Breast Cancer Treatment, Lumpectomy
1
Answer |
1 month ago
The methods common used include; palpation, specimen radiograph, specimen ultrasound, frozen section and touch prep cytology. Specimen radiograph and ultrasound allow visualization of the distance from the tumor to the margin but not all disease is visible. Frozen section and touch prep can be challenging since they will not determine the margin distance and freezing fatty breast tissue is often difficult. Clinical judgement and surgeon experience are very important factors in successfully evaluating surgical margins.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Touch Prep Cytology, Radiograph, Palpation, Breast Cancer Surgery, Lumpectomy Margins, Breast Cancer Thermography, Ultrasound, Breast Cancer Tests, Breast Cancer, Frozen Section, Breast Surgery Margins, Breast Cancer Treatment, Lumpectomy
1
Answer |
1 month ago
The key to answering this question is to understand that how the breast cancer is best seen radiologically is critically important. If a mammogram well characterizes the cancer, no additional imaging is necessary. This is generally true for woman who have fatty replaced breasts. For woman with dense breast tissue, mammograpghy does not perform as well. In that setting ultrasound and MRI can be helpful preoperatively to help define the extent of breast tissue that should be resected. Unfortunately MRI is not perfect and can over estimate the amount of tissue that should be removed especially if it is performed after a needle biopsy.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Ultrasound, Breast Cancer Tests, MRI (Magnetic Resonance Imaging), Breast Magnetic Resonance Imaging (MRI), Breast Cancer Imaging, Breast Cancer Surgery, Breast Cancer, Breast Surgery, Lumpectomy, Mammogram, Breast Imaging
1
Answer |
1 month ago
This has been a controversial area within the breast surgical community. The largest studies from the NSABP which validate lumpectomy as a safe approach used the criteria of “no ink on tumor”. This means that there is some discernible distance from the cancer to the surface of the lumpectomy specimen. Most surgeons will accept a 1mm margin. Important to note that this does not include the anterior (skin) or posterior margins where skin and muscle fascia after often removed as part of the lumpectomy specimen.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Surgery , Breast Cancer, Breast Surgery, Breast Surgery Margins, Lumpectomy Margins, Breast Cancer Treatment, Lumpectomy
1
Answer |
1 month ago
Unfortunately thermograms are not a replacement for mammograms. The idea of a non radiation based breast screening method is very appealing. There is no evidence to suggest that mammograms cause cancer. Unfortunately I have seen many patients with breast cancer who have normal thermograms
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Screening, Mammagram, Breast Cancer, Breast Cancer Imaging, Thermography, Breast Imaging, Mammography
6
Answers |
1 year ago
My opinion is that properly performed nipple sparing mastectomy does not have increased risks for cancer recurrence.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Nipple Sparing Mastectomy Risks, Nipple Sparing Mastectomy, Surgery Risks, Breast Surgery Risks, Breast Surgery, Surgery
1
Answer |
1 year ago
The decision about when to start screening young women should be individualized for each women based upon her risk factors and breast density. Best to discuss with primary physician.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Screening, Breast Cancer, Screening Guidelines, Screening Baseline, Screening Recommendations
1
Answer |
1 year ago
The nipple can be saved unless there is cancer involving the nipple. However for patients with large ptotic(droopy)breasts, saving the nipple may not be good from a cosmetic point of view since the nipple position will be very low on the reconstructed breast and will not have a good appearance.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Nipple Sparing Mastectomy, Breast Surgery, Surgery
1
Answer |
1 year ago
This technique requires a highly trained breast cancer surgeon. It involves making small cosmetically placed incisions through which all of the breast tissue is removed. It is important that the entire core of breast tissue going into the nipple is removed and checked to be certain that it does not contain cancerous breast tissue. This must be done in a very delicate way to be certain that the blood supply to the nipple is preserved so that the nipple stays alive.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Nipple Sparing Mastectomy, Breast Surgery, Nipple, Surgery
1
Answer |
1 year ago
Best to consult with a physical therapist to help design a program for increasing flexibility and scar management.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Scars, Arm Flexibility, Flexibility, Breast Reconstruction, Side Effects, Scarring, Pain, Breast Reconstruction Side Effects, Surgery Side Effects
1
Answer |
1 year ago
Oncoplastic surgery combines the principles of breast cancer surgery with complete removal of the disease with plastic reconstructive methods to maintain a normal breast appearance. The advantages are preserving normal body image. The potential disadvantage is that the surgery can take longer to perform. It can be used both for mastectomy and breast conservation surgery.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Surgery, Lumpectomy, Oncoplastic Surgery, Surgery, Mastectomy
1
Answer |
1 year ago
Risk stratification based upon family history and established risk factors is essential. There are models such as the GAIL model which can calculate risk based upon age, age of menarche, age first live birth, # first degree relatives with breast cancer, hx breast biopsies and finding of atypia. For patients determined to be at high risk, genetic counseling to discuss possible benefit of BRCA testing is important. Surveillance may include self, exam, clinical breast exam, mammography, ultrasound and MRI depending on the level of risk.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Screening, High Risk Surveillance, High Risk, Surveillance, Breast Cancer High Risk, High Risk Of Breast Cancer, Genetic Screening
1
Answer |
1 year ago
Yes, there are CDs with guided meditations that are extremely helpful. Comprehensive pain management approaches including pre-emptive analgesia with nerve blocks and the use of pain pumps is also very beneficial.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Surgery Recovery, Pain Management, Holistic Treatments, Surgery Preparation, Meditation, Recovery, Reiki, Surgery
2
Answers |
1 year ago
It is important that patients receive educational materials specific to their problem so that they can fully understand their disease and treatment options. Patient can record the conversation during their visit so that they can listen again to the discussion. Providing the opportunity for patients to speak with “experienced” patients is extremely helpful to be certain that all questions are answered. Open access via email so that additional questions can be answered is also valuable.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Doctor-Patient Communication, Patient Communication, Patient Questions
3
Answers |
1 year ago
Yes, I believe that surgeons at many centers have growing awareness and interest in CAM(complementary alternative medicine). Helping patients prepare for surgery using mind-body techniques such as meditation and audio relaxation tapes is become fairly routine. Additionally patients are becoming more proactive in assuming responsibility for their care incorporating other modalities to ensure rapid healing.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Complementary Treatments, Complementary And Alternative Medicine, Surgeons
4
Answers |
1 year ago
I am doing mammaprint on all patients with tumor 1cm or greater.
Mammaprint is a 70 gene assay that can be used determine if a breast cancer is high risk or low risk for recurrence. Additionally it allows for tumor subtyping so that we can know if the tumor is luminal, basal or her2neu over-expressing. This can be very helpful for helping patients make decisions about the potential benefit of chemotherapy as well as helping to decide which medications are most effective. This assay can only be done on fresh tumor tissue either obtained at the time of core biopsy or during surgery.
Mammaprint is a 70 gene assay that can be used determine if a breast cancer is high risk or low risk for recurrence. Additionally it allows for tumor subtyping so that we can know if the tumor is luminal, basal or her2neu over-expressing. This can be very helpful for helping patients make decisions about the potential benefit of chemotherapy as well as helping to decide which medications are most effective. This assay can only be done on fresh tumor tissue either obtained at the time of core biopsy or during surgery.
New answer by SheldonFeldmanMD (Physician - Surgery - Breast (Verified)) in topic(s) Mammastrats, Breast Cancer Tests, MammaPrint, Tests
1
Answer |
1 year ago
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