Surgeon doesn't believe me ...

christmas718

Went back to tell surgeon my final decision today - lumpectomy or masectomy for recurrence of DCIS - I am choosing double masectomy. But he seems shocked I don't want to go into immediate reconstruction - he said why ? Especially when I said I would like as much skin removed as possible. He said he'd rather leave some skin in case 'I change my mind"

Did u all run into this ? Surgeons not really understanding going flat ? Thx

Meow13

I have run into many in the medical community that dont agree with me. They always think they know better.

Do what you want, youre the one living with it.

Sara536

I think most insurance allows for a second opinion or even a third for surgery. Maybe try a female surgeon. It is most important that you find someone who is able to make the effort to try to understand where you are coming from whether they are male or female. I've been thinking a lot, lately, about this breast oriented society we live in and how women are often defined by the size or shape of their breasts. Do we want breasts because men expect them or do we need them because they are an integral part of our self image? How much pain are we willing to put up with? How many surgeries? Would we be less likely to suffer a recurrence if we choose this or that? These are hard decisions but the one thing I am certain about is that I wouldn't want anyone to make them for me and I wouldn't want to wake up with any surprises. Maybe even put the decision and surgical plan in writing.

Outfield

This kind of surgeon comment has come up I don't know how many times in the Facebook group, Flat and Fabulous. Frankly, it's condescending. I'm in medicine, and we talk about how "back in the day" doctors thought they knew everything and they just ran the ship in terms of treatment, but now in medicine we are "patient-centered." What a bunch of hooey. A surgeon, who probably hasn't known you that long or that well in the general scheme of things, is basically saying he knows what you want better than you do. Paternalistic medicine, alive and well in the 21st century, and it's not uncommon.

If you want to be flat and you're not sure he will, see if you can get it in writing from him that he will not intentionally leave extra skin. If he won't, find another. I am so sad for the women who post on Flat and Fab that they want to be flat but were left all this extra skin "just in case" and they then need extra surgery. If that happened to me, I'd try to find some way to sue. We doctors don't like to be sued.

Do be aware that it's often hard to get the incision to close without puckers. Sometimes surgeons just can't get it flat right off because the breast is an irregular shape, as is the chest wall, but they're not the same irregular shape. Imagine opening up a football and trying to sew it down flat on a basketball. Your surgeon isn't talking about this problem at all - he's talking about wanting you still to "look" a certain way even though the rates of complications with reconstruction are much higher than for simple mastectomies.

Wicked

My BS is recommending BMX for my extensive LCIS in both breasts and ILC in the left. I was adamant about no recon and she respects that. If you feel this surgeon does not respect what you want, find another. Too many women come out of surgery to find out that extra skin was left that they did not ask for. This is unacceptable.

debiann

Include a plastic surgeon on your team who will give you a nice cosmetic result after the breast surgeon does his job. They will work together during surgery. If you need any revision work afterwards for dog ears or some fat grating to fill in the divots you will follow up with the PS. My PS was great and was all on board for giving me a nice flat finish, but then I changed my mind and did DIEP recon instead. Totally my choice, he didn't push me at all. The discussions about what the end product would be like were with the PS only. The breast surgeon's job was just to remove the breasts. I think a PS has the skills to do flat right. Perhaps the BS doesn't?

CrawfordsMommy

I just fired a PS because he was really pushing me to do reconstruction and wouldn't shut up about implants. Now I'm shopping around for somebody else who can get me a nice 'flat' finish because with this guy and his attitude, I was concerned that he might "rush" the job with me and not clean me up the way I've specified.

I really wish I'd hired a PS to close after my BS did my BMX, but at the time I didn't realize that this was even a thing and no one mentioned it. I'm stuck with horrible puckers, divots, dog-ears and flaps probably until next year. It's ugly and embarrassing. I don't even know what I'm going to do when it comes time to go back to the gym on a regular basis.

Meow13

The first plastic surgeon I interviewed only did implants. She was so rude she threw a tissue expander at me to catch. I was like this would be under my skin, hmm I didnt care for that idea. Then she went on to question my expectations and showed me pictures of her work. I was not at all impressed then I said I would like to look good in a bathing suit. She responded oh your expectations are way too high. I am 5 feet 3 inches and at the time weight 123 pounds and had a very fit body. Excuse me I would like to wear a bathing suit and not feel deformed. I left that office never to return. I heard others had terrible experiences. She would positively not work with radiated skin. Well I wasnt having radiation. I went to our university hospital and found a very nice plastic surgeon that did the DIEP. Wow it turned out great, flat tummy bonus.

BarredOwl

Hi christmas718:

When I asked breast surgeon #1 about her plan, she said she would try to achieve a result as flat and smooth as possible, unless a delayed reconstruction was presently intended and planned. Breast surgeon #2 agreed with this approach, and given my zero interest in reconstruction, she achieved flat and smooth (without the aid of plastic surgeon.)

Unfortunately, others have not been so lucky and it is an outrage. There are members here where who specifically requested no reconstruction, and asked to be made as flat as possible, but their breast surgeon did not comply with that request (i.e., made no attempt at flat). Instead, the surgeon substituted his judgment and intentionally left large amounts of extra skin for the purposes of a delayed reconstruction, because he thought the woman would change her mind or he thought she should seek reconstruction because of his value system, despite her express wishes and statements to the contrary.

If you have any doubt that your wishes will be respected, do not hesitate to find a different breast surgeon.

Be sure your surgeon understands that you will not change your mind and and respects your wishes to be as flat and smooth as possible. Until such time as the medical profession does a better job in this area, to avoid any possible misunderstanding, some here have recommended documenting the choice of non-reconstruction and the desire for a surgical result that is as flat and smooth as possible and feasible in writing in your medical records, and/or on your surgical consent form. Request copies of all such documentation for your records. It is also good practice to remind the surgeon of your choice in pre-op.

Best,

BarredOwl

Meow13

I would get another surgeon who says I will not leave extra skin. In my case my tumors were close to the skin so all skin was taken very flat. I had reconstruction, DIEP skin and tissue taken from abdomen . To say as a surgeon I'll leave extra skin for the plastic surgeon is totally unnecessary almost ignorant on the breast surgeons part. And really has no business whatsoever saying I'll do it because she may change her mind and need this flappy skin.

tessu

Finland has a public health system, so I was unable to ask for a second opinion (actually, could have, but it would have been very expensive and difficult, the one private cancer clinic I know of is over 400km distant). The surgery for my grade 3 very high Ki67 and HER2+ tumor was delayed over a week, because the surgeon refused to believe I did not want reconstruction --- ever. Sent me home to "think it over again" grrrr. Of course she left lots of extra skin when she finally agreed to do the mastectomy. And I'm stuck with it, because I'm scared any new surgery would make my lymphedema worse.

Some surgeons are so full of their own egos that they truly could care less about their patients' wishes and quality of life. God only knows how much higher chance of relapse/mets I have because of her arrogance in delaying the surgery.

Icietla

Listen to BarredOwl -- find another Surgeon. Mine is one of those horror stories about which BarredOwl wrote. You can see about mine and some others' here:

https://community.breastcancer.org/forum/82/topics/818608?page=18

Besides being stuck with my (somewhat deflated) breasts, I was stuck with severe distress. It took three very long, very miserable months of very miserable, very humiliating Doctor-shopping in three States for me to have proper mastectomy surgery arranged.

Tessu, I am so sorry about your suffering from such cruel practice. That is so mean, for the Surgeon to hold your treatment and recovery hostage to force her way with your chest -- and then to Violate you after all! Outrageous!

Clearly, one thing this World needs is an multinational chain of reliable, ah, chop-shops, staffed with Surgeons who are in their profession to be Healers.

Meow13

tessu is kind of stuck, no choices in Finland with their public health system.

Icietla

Yes, Meow13, tessu is stuck, and it angers me that she too has been victimized -- not only with her mastectomy site condition, but also in having her urgently needed surgery withheld/delayed/held up hostage for her knowing and stating her own preference.

The first part of my prior post was meant for christmas718. I am sorry for any confusion I caused by not making that clear in my post there.

hsant

My BS strongly recommended that I meet with PS before making my final decision to go flat. I was very clear about my decision and declined.

I absolutely agree with poster who said to get it in writing that patient requests no extra skin or fat, because future reconstruction won't be necessary.

My BS put my request to be "completely flat" in writing on his own. He was obviously protecting himself in case I changed my mind at some point.

I think in the case of my BS, he's been practicing for over 30 years, and has seen women change their mind in his experience.

hsant

I also highly recommend showing your BS a photo of what you want to look like after surgery. You can find numerous pics on the Internet. Also, requests photos of his work on women who opted out of reconstruction

CrawfordsMommy

I also highly recommend showing your BS a photo of what you want to look like after surgery. You can find numerous pics on the Internet. Also, requests photos of his work on women who opted out of reconstruction

---

Oh, that's the perfect idea. I'm going to save some pictures I found on the internet of women who have results like I would prefer, and take them to me when I meet up with my second PS. This guy is SUPPOSED to be an expert working with cancer survivors. We shall see...

jkbrca2

I highky recommend showing your surgeon pictures of your expectations to clarify. I showed my BS photos of women with with similar body type and no reconstruction and it was extremely helpful for her because she understood what I wanted, like a hairdresser for a new haircut style. She also knew my intentions were real and I'd researched the subject. It was helpful for me because she made it clear which ones I would not look like (horizontal scars) and which ones I would (diagonal). I was lucky my BS respected I wanted to be flat. She did ask me to consult with a plastic surgeon and I did. He was great, but it sealed my gut feelings that reconstruction wasnt the best choice for me. Recovery was much faster, easier and simpler than reconstruction would have been. And I can move on from this and not worry about MRIs to detect and do surveillance for any cancer under an implant, or having to get new implants every 10 years (which would be approximately 3 more surgeries since I'm now 40).

After a year of post BMX recovery, now that all swelling is gone, I'm admittedly not just flat but a little concave, and one side has a small indent. But I love being flat. I'm able to wear a wide variety of clothes. My scaring is low enough. I go flat sometimes and other times not. It's not so big a difference people would notice! At first it amazed me. I'd walk around strangers and think, "can't you see how flat I am?!" But really, no one noticed! They only notice if you have cleavage, not that it's "missing".

radgal

Though I have a different diagnosis and treatment outcome than you, what I did when I was facing surgery decisions was that I met with three different surgeons.

It was important to me to ask questions and ask myself how comfortable I felt with them.

Was I just another patient to them or did they really seem to care what was best for me and what I wanted?

Interestingly, the second breast surgeon I met with was a woman and I found her to be a lot more indifferent and rougher during the physical exam than the male surgeons.

If you have any doubts whatsoever, see other breast surgeons and interview them.

Going into surgery, I felt very safe and confident with my breast surgeon and am very grateful I didn't impulsively go with the first breast surgeon or the first woman breast surgeon I met.