Breast Surgeon Choice and Survival Odds

SummerAngel

I was reading another thread ( https://community.breastcancer.org/forum/96/topic/... ) that links to studies that conclude the odds of survival go up with a surgeon who specializes in breast surgery and/or performs a high volume of breast surgeries.

How would a person find out this information about their surgeon? I have scheduled my surgery with the only surgeon in my town (pop. 100,000) who does breast surgeries and she seems very competent and I like her, but I know that breast surgery is not her specialty. There is a surgeon in a nearby town who specializes in breast surgery, but I'm not interested in causing myself extra stress and expense just to switch surgeons if there's no need. Has anyone looked into the statistics around their surgeon, and if so, how did you do it?

SpecialK

That information would have to come from the surgeon - I don't believe there is any independent tabulating entity. This is the reason many choose a breast surgeon, since that is all they do, but that does not mean your local surgeon is not competent.

SummerAngel

Thanks for the reply! Has anyone actually asked their surgeon something like that, though? I would need to know how many breast surgeries she performs and the statistics on recurrence or death. I don't know, it seems rather unlikely that I would get a straight answer to something like that. I do know that my surgeon has a ton of experience, 37 years.

nmh35

not my Breast surgeon, but I did ask my plastic surgeon how many Breast reconstructions he does per week, per year, per career etc. and also what his failure rate was. He was very open to yhe questions. I think you have every right to ask that surgeon how many she does so you can have an idea how experienced she is

Anonymous

I chose a surgeon that specializes in breasts mainly because I wanted a nipple sparing mastectomy. Also they have more experience dealing with Sentinal node biopsy, removing maximum breast tissue without comprising aesthetics of the breast, etc, etc. I also wanted my plastic surgeon and breast surgeon to have done surgeries together. My plastic surgeon ended up being the one who introduced and trained my breast surgeon in nipple sparing 10 years prior , so I waited 2 months for my surgery in order to coordinate their schedules together (the PS was about to embark on a month long vacation out of the country).

I'm glad I did wait and do my research. I really liked my outcome and had zero complications or extra surgeries.

I doubt they have data on recurrence of former patients, but so far so good for me.

Warrior_Woman

I think this is very important. I went to three surgeons before selecting the one who did my BMX. The highest level of qualifications for this is an oncological breast surgeon. She needs to specialize in breasts and cancer of the breasts. I live in a rural community and no one here met that criteria. And so I traveled. I made many many 6 hour trips to see her and I still do for follow-up. I have a lot of doctors in my family and everyone gave me the same advice - Get to the best surgeon you can. Chemo and radiation can be done locally but travel for surgery if you must. With reconstruction, select a plastic surgeon who specializes in the procedure you're planning for. I had bilateral LD flaps and it all came out great. However, I've seen terrible outcomes for women who went with anybody. It's a highly specialized procedure.

SummerAngel

Thanks everyone! I did more research into the surgeon I currently have and found that she does specialize in surgical oncology, which is good. I do trust her, she's the one who thought I should have the lump that came back as a fibroadenoma removed anyway, and she was right about that. I'm currently waiting for a call back from her nurse, I'll ask her about the surgeon's experience with breast surgery. I also am waiting for a call back from my oncologist to get his opinion as well. The plastic surgeon I've chosen does work with this surgeon, too, so that's good.

dlb823

Summerangel, this is something I feel very passionate about after my own experience. My first local surgeon had great credentials and breast oncology experience, but she still let me down -- something I didn't even realize until the pathology from my first surgery came back with enough questions that I finally took the advice of my sister, who has been in breast cancer research for many years and is also a bc survivor, and went to an NCI-designated cancer center (UCLA) for a second opinion. My bio page tells the rest of the story.

Not trying to scare you or anyone else. Many times if things are simple and straight forward a general oncological surgeon will do a fine job. But I would never take that chance again and always encourage people to go to someone who is tops in their field, no matter what their health issue is. There is just no substitute for extensive experience.

treelilac

I did a little research: The American College of Surgeons does not have a specialty in breast (breast is listed under General Surgery) so doctors who "specialize" in breast usually did an extra training in breast surgery after medical school. But I feel that does not mean much because that type of training can be as short as just a few months. On the other hand, doctors who have whole intentions to focus on breast surgery might not go through the extra training. I recently went to a NCI designated cancer center for second opinions. To my surprise, some of the breast surgeons there list themselves as specializing in soft-tissue cancers so they include something like stomach lining etc. I really don't know if that's better than a general surgeon who is exclusively interested in breast surgery. When there is nothing else to compare, I like doctors who have the FACS (Fellow of the American College of Surgeons) qualification, which means they go beyond the regular standards.

tgtg

Treelilac points out some very relevant info about the rather unspecific and unrecognized "specialty" of "breast surgeon." Her point about dealing with a surgeon who is an FACS member is very important.

I added another dimensions to my "statistics" research about the FACS surgeon whom our hospital's breast health center suggested. After he more than "passed muster" that way, I then called some physician friends who practice at the same hospital (which has a cancer center) and asked, "If [your wife's name} found herself in my position next week, which surgeon would you want to do her surgery?" And his name universally came up at the head of the list. I was looking for a "doctor's doctor." (I'm not a fan of Angie's List or the backyard fence advisory system, since that often boils down to "I liked the person" rather than a professionally-based judgment.) I did the same for the med. and rad onc selection, for the same reasons, and was happy with them too. But my diagnosis was a simple, straightforward one, as you can see below; had it been a complicated or dire one, I would have looked further afield, to a large teaching hospital that is on the cutting edge of research, (even though that could mean becoming a "lab rat" statistic in their research studies).

labelle

I think this is one reason many women w BC choose to go to a breast center-the surgeons and plastic surgeons there specialize in breast surgery, the radiologists in breast radiology and the oncologists in cancers of the breast. If you are just beginning this whole ordeal I strongly suggest you check out a breast center. The surgeons are just the beginning of health care providers that you will need to get lined up. I started w a local surgeon, but quickly switched to a breast center to deal with my diagnosis. I just found it so much easier even though it meant a longer drive.

Since I chose to have a lumpectomy w SNB I did ask all the surgeons I interviewed (3) what percentage of the time they had to go back in due to bad/dirty margins-2 were very forthcoming in their answers-the private non-breast center surgeon hemmed around and was quickly eliminated from my list of possible surgeons for the job.

SummerAngel

Thanks again all! I'm feeling good about my situation now. My surgeon does breast cancer surgery almost exclusively, and according to her nurse she performs hundreds of these surgeries per year. She is a FACS surgeon, has been for years. The hospital has a cancer center and she's a big part of the cancer board. I also definitely believe (and the studies show) that experience pays off. I am still waiting to get my oncologist's opinion, I've researched him already and trust his opinion.