Published on June 15, 2020
How to Choose the Right Breast Cancer Surgeon
Excerpted from Bald Is Better with Earrings: A Survivor’s Guide to Getting Through Breast Cancer. Published by HarperCollins, © 2015 by Andrea Hutton
The most important thing about choosing the right surgeon is knowing his or her level of experience in breast surgery. If possible, choose someone who only does breast surgery. Breast surgery, like all surgeries, is part science, part art. Some of what’s done in the operating room is, simply, the surgeon’s call, based on how much what he sees in you corresponds to what he knows. You’ll want someone who has seen almost everything there is to see, done almost everything there is to do. Make sure you know your surgeon’s point of view as well. Yes, surgeons have a point of view. Is she known for breast conservation or for being aggressive? Be sure you know where the surgeon’s coming from so you can determine if that view meshes with your own. If possible, get a second opinion from someone with a different frame of reference so you can make the choice that feels right to you.
When they remove the tumor, it’s all about the margins, the buffer zone of healthy tissue they take out with the tumor to make sure they’ve got it all. You need someone who can not only recognize where the margins of the tumor are but who is skilled and practiced enough to know how to take out just the right amount of tissue, no more, no less. In addition, some types of surgery require “sentinel node biopsies,” where the surgeon takes out specific lymph nodes — sentinels are a kind of early-warning system — to perform an on-the-spot test for signs of cancer. Your surgeon needs to be able to determine the right sentinel nodes in your case. With all this going on, you can see why experience is paramount.
Finally, make sure the pathology lab in your surgeon’s hospital has a great reputation. These are the people who will be doing the tests that determine the type of tumor you have, as well as whether there is node involvement. If they don’t have a great rep, you have two choices:
- Choose another surgeon;
- Have the lab results sent out for a second opinion.
Do your homework. Find out who the head of breast surgery is, and meet with him or her. Ask everyone who the best surgeons are, and meet with them. I asked the radiologist who did my MRI, my oncologist, my friends. Then we met the people they recommended and chose the one we were most comfortable with. This is one time in your life when reputation is key.
Keep in mind that there is an advantage to having your oncologist and breast surgeon in the same hospital. Hospitals have tumor boards that meet weekly, and they discuss the cancer cases. If your oncologist and your breast surgeon are affiliated with the same hospital, all your records are under the same roof, and they can easily get in touch with each other if they need to.
At the end of the day, you have to feel comfortable with the hospital, the surgeon, and her staff.
This does not mean to you have to like her. You’ll only have a few interactions with your surgeon, so personality is far less important than the results of her work. This isn’t Grey’s Anatomy. This is your life. You just have to feel confident that she knows what she’s doing.
I met with two surgeons before I picked one. They both had superior reputations, and they were both obviously highly skilled. One was like a breast surgeon rock star. (Wonder what those concert T-shirts would look like?!) He was such a star that he’d left the big hospital, wooed by a smaller place to build its reputation. Good for him, bad for my boob. I didn’t like the smaller hospital. I was worried about the quality of his support. The staff in the operating room comes from the hospital, as do the people in intensive care. I wanted the best of both worlds. I chose the surgeon from my oncologist’s hospital, the one who told us he was a truffle hunter on weekends. Why he told me this, I don’t know, but for some reason it made a difference. In the end it really doesn’t matter what they say until they say something that makes you more or less comfortable.
TOP 5 TIPS FOR CHOOSING A SURGEON
- Being able to talk to a human being, not voice mail goes a long way toward a positive experience. When you call your surgeon with a question, you want a person on the other end. My surgeon has two nurses on staff to answer patient questions. It was invaluable to know that I could always call and one of them would be there to talk to.
- You will have about six weeks of aftercare with your surgeon, so you’d better feel comfortable with him or her. That still doesn’t mean you have to like him or her. You need to feel confident in the surgeon’s education, skills, and knowledge. You should feel heard and treated like a human being. But at the end of the day, you don’t need to love your surgeon — just his work.
- If the differences are negligible, or if you don’t know how else to choose, pick the surgeon with the hospital where you feel the care is the best.
- Research the reputation of the pathology lab in the hospital where your surgeon works. Ask other doctors, friends, relatives, and so on to learn what you can. If you hear something you don’t like, ask the surgeon about it. The response may give you something to go on.
- After you do the research and decide, stop fretting. Even if lots of other people talk about some other rock-star surgeon, it doesn’t matter. You’ve done your homework and made the best choice for you.
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