Mammogram Shows Category 4 (Bi-Rads)

you and your surgeon are satisfied that you have good breast health. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

You need to discuss this with your surgeon who has reviewed your films. If a biopsy is recommended, get the biopsy first.

When things have uncertainty or are complex, it’s not uncommon for people to have different opinions.
Your radiologist is following textbook protocol without taking consideration of context and your upcoming surgery.
The radiologist is not doing a third job poorly. It’s possible a biopsy may not be covered by insurance and doing procedures that don’t have textbook justified clear indications Has liability involved.
If you want to pursue the oncological side of your work up properly, then you’ll need to postpone your surgery.
There is no yes or no right or wrong answer for you.
My best suggestion is you work closely with your plastic surgeon and let him or her guide you through this process including decision-making.
Breast cancer is fairly relevant in middle-aged women and screening is extremely important to minimize the chance of undesirable outcomes.
It certainly still possible to screen breast tissue after breast surgery.
There will be inherent changes on ultrasound and mammogram, but most radiologist are usually fairly competent. A differentiating breast tissue changes related to pre-surgery versus changes that may represent neoplasm growth.
Perhaps you can find a medical oncologist to ask to put things into perspective.
I think both the radiologist and plastic surgeons have slight bias seeing things from their perspective and a medical oncologist. Should see things from a little bit more global perspective and can possibly put numbers as statistics to potential decision making differences. I’m not sure if that would be helpful for you, nor do I know what an oncologist would tell you.
It is simply a suggestion.
Whenever doctors are confronted with complex situations, there is often the chance of having different opinions.
When things are clear cut, and there is one obvious way to do something, then typically, everybody agrees.
it is simply the nature of complex situations with the ability to have options comes decision making.
Medical decisions need to be made by both patients and providers together.
It’s not appropriate for us to guide you through this process.
Best,
Mats Hagstrom, MD