How important is the experience of a breast surgeon?

I agree with Deanna.  For your own peace of mind, get a 2nd opinion, then you can decide which surgeon you want to use after the fact.  

She may very well be competent, but if you're not comfortable, if anything goes not as planned, you're going to be questioning things, and you need to feel that you have received the best care possible.   

bella-  I agree with the others.  She may be perfectly capable, but your gut, your instinct, is your most important self protection.  It is talking to you, listen.  As you appear to be in Boston, you should have plenty of excellent choices.  Perhaps put up a post that you are looking for a BS and PS (if you are having MX) in Boston.  I bet you will get recommendations from BCO women who know the best.  Wishing you a smooth journey.

FWIW, they deal with people getting 2nd opinions all the time.  A good Dr. will not only understand but will welcome you getting another opinion and should not give you a hard time.  If she were to give you a hard time, that would be a red flag to me that you would want a different surgeon.   

IT may very well be that your current BS is knowledgeable and competent, but that doesn't matter as much as it does that you are comfortable with your care.  

I also wanted to mention that my mom had BC and her initial biopsy showed DCIS with a small spot of possible IDC.  Once she had the mass removed, there was much more IDC noted on the pathology.  It would make me question not having a sentinel node biopsy, but I don't know, perhaps that is the standard of care if they suspect it is only DCIS.  Anyway, just more reason to get a 2nd opinion, and you can go outside of your breast care center for a 2nd opinion if you choose to.   

Another thing to consider is if your surgeon is board certified. It doesn't mean that if they aren't certified they aren't any good (certification in the US is voluntary) but it does mean, if certified, they have met more than the minimum criteria they needed to get their medical licence.

http://www.certificationmatters.org/  

Hi there all,

Just an FYI...one can certainly do consecutive SNB's on a breast.  I had DCIS the first time, and the second an invasive (that had not gone to the nodes) and they did SNB both times.  They simply inject the dye and check them to see where it went first.  The sentinel node is not a "specific" node, it is a node that picks up the dye first.  Hence the sentinel terminology. 

If one has had many nodes removed,  they still do it in many cases, as if any nodes are left, the "sentinel" node will still pick up the dye first.

That said, go with your gut, honey.  If you are not comfortable and your gut is telling you (and we all seem to agree on this one) that this Dr. seems inexperienced, it is your life and your body.  I'd absolutely get a second opinion.  Sounds like you are getting all the right info!

Best of luck to you, my dear.

JB, There are many different organizations which rate doctors and hospitals. I think everyone is more familiar with the US News and World Report publication which rates and ranks hospitals in different areas of specility and overall rankings of hospitals. I don't know how accurate their system is but am always happy to see a facility I use ranked highly.

I think they also do one called "Top Doctors," but I haven't seen it so far for 2010. You can go online too and google "top doctors in ..." and various enrties should appear which you can then search.

There is one in particular which comes to mind but unfortunately, I cannot recall the name of it at the moment, If you like, you can send me a PM and I will get the name for you.

There are numerous sites out there, you just have to look. I don't think any of them are the final word, but are a good place to start.

Hugs,

Sandy

I chose to ignore my gut and instead went ahead with a surgeon I wasn't comfortable with. I live in a small town and figured it would just be too awkward to fire my surgeon and risk running into her in the grocery store or on the golf course. Long story short . . . go with your gut!!

I'd also really have concerns about having a mastectomy without having a SNB. I could understand if it was a prophylactic mastectomy. As others have mentioned, no one can rule out have invasive cancer until the pathology report comes back. By then,it is too late to have a SNB. If you were having a lumpectomy and all tests point to it being DCIS, I personally would not have a SNB since you can have it after the fact if need be. That said, I did have a SNB with my first lumpectomy . . . a more experienced surgeon would have given me the choice. I was not given one and was not told about the associated risks. Hope your new referral is a perfect fit.

Hi Bella,

 I'm in the Boston area as well. As for 2nd opinions, I'm glad you're getting one. I would have suggested getting it from someone in a different practice, because who knows, everyone in the same practice may think the same way and so you may be getting the 'group think' opinion. But it sounds like you're seeing someone with a good reputation, so it may not matter.

My initial dx and consultations were at Harvard Vanguard, but I ultimately had my surgery at Lahey Clinic and then got 2nd opinions about having radiation from Dana Farber. I feel good that I triangulated all the medical opinions from different institutions to arrive at decisions that made sense for me.

Good luck!!

Rateyourmd is the website to check but take comments with a grain of salt. Usually it is the bedside manner that is in question. I was really unhappy with my first BS not because he wasn't surgically competent but he had religious sayings all over his walls and his attitude seemed to be we will let god decide. I wanted a double MX and he fought me all the way. It sounds like because your doc is new she is not willing to think outside of the box. Those node guidelines are the latest study but most experienced docs would most likely disregard them. Same as a mammo doesn't have to be done before age 50. I know what I think of that.

SO, So glad you choose to get a second opinion.  And remember---3 and 4th opinions are not unheard of!  I had 4 plastics till I found the one I felt comfortable with.  You can also know that with DCIS, you likely have plenty of time to ck out the docs and choose the one for YOU> 

---always trust your GUT, I didn't and can really tell some stories about why I Should have.-------

I do have a question tho: I understand that surgeons get a lot of practice in residency and if they choose a fellowship, even more.  But to have been in private practice not yet 2 years, I do have to question that the first surgeon has done "hundreds" of mastectomies.  As a nurse who worked many years in a university setting, I just don't buy that one.  I'll give her the benefit of the doubt and say she was trying to put you at ease.

The other point made above that I'd like to reinforce: the newest info about not needing nodes removed to ck them out.  The younger docs,, IMO, jump on the newest info from the ivory towers of academia and call it their own so they can appear knowledgeable, but  we should never replace" new info" for experience!  They've been cutting down on node removal for decades, but the new info about NO removals, according to your doc, I really don't think so.   JMHO--have to admit I'm old school.

As far as nipple sparing: keep in mind that with all the tissue removed( and even if  blood supply retained) that nerves to the nipple can also removed and very little, if any,  sensation remains after mastectomy.  JMHO, and if you choose this route, make sure you know what you'll have and what you will not have.

Hi Bella,  I hope your appointment put you at ease and that you've found the doc that is for YOU.  Good going!  We must take care of ourselves.

I found a female surgeon who seemed abrupt and rude, but she has years of experience and last year performed over 300 breast surgeries. She specialized in breast surgery. I called an left a VM asking about the study that came out in Feb 2011 about not removing axillary nodes for some patients. Even if the SN was cancerous, one would procede to chemo and it kills all the cancer anyways. That way the patient would not be subject to lymphedema (or risk would be much lower) and the risk of nicking that shoulder nerve which causes life long numbness would not be a factor.

The surgeon called me at home at read me the riot act. She said "do you want to cancel your surgery?" She belittled me for even inquiring about this study, said it is not standard of practice and said I've been "dinking" around for too long. I had a burst appendix in Feb 2011 which pushed my surgery off a few weeks. Had emergency surgery and was in the hospital for 3 days. Now I'm scared of her. I was crying after her rant to me on the phone, did not give me a chance to speak. Help, what would you do? She has this reputation of being rude, but this was beyond rude, it was belittling and she also told me to stay off the internet lol. What balls! Do I respect that or cancel my surgery?

Bella, I'm glad that your appointment with the 2nd surgeon went well and that you are happy with the recommended approach.  

Rianne, wow!  In your voicemail, did you ask her opinion about the study and/or say that you wanted to discuss it with her?  Or did you say that based on this study, you do not want an axillary dissection if the SNB shows that you have positive nodes?  I don't think the doctor's reaction is right in either case, but I can see why a doctor might get her back up if a patient comes to her and tells her what to do. On the other hand, a doctor has an obligation to address patients' concerns and questions, so if you were simply asking about the study or saying that you wanted to discuss it, then her response was 100% out of line.

In either case, given the discussion that you had with her, and given your concerns about how your nodes will be handled if it turns out that your SNB is positive (which hopefully it won't be), then I would recommend finding another surgeon.  I know that you've had the delay because of your appendix and I know that some invasive cancer has been found (so you're not dealing with pure DCIS) but if you can get into surgery with another surgeon without too much additional delay, I think that might be the best approach.  I'm not one who thinks that it's important that you like your surgeon - for me, experience and trust are the most important criteria for choosing a surgeon - but I would find it difficult to deal with a surgeon who was flat out rude to me. At least phone around to investigate how quickly you might be able to get into surgery with another surgeon.   

So sorry that you had this experience.  What an @$$ your BS is!