Meeting a potential surgeon

Maybe working with a general surgeon is not a problem for a lumpectomy but I would certainly want someone who specializes in breast cancer for a mastectomy. I would imagine that lumpectomies are fairly straightforward to perform, since the tissue is just removed and checked by a pathologist to be sure there are wide margins of tissue that do not contain any DCIS. Someone more experienced with breasts might provide a more attractive outcome. If she needs radiation after a lumpectomy, it might be nice to be closer if her local hospital offers it. However, given that your parents didn't get the best feel from that surgeon, I would be inclined to choose the breast center. It's difficult for medical personnel who specialize in breast cancer to keep up with the current research, so someone who is a general surgeon may be greatly out-of-the-loop. Maybe that's not a problem for performing a straightforward lumpectomy, but since things often pop up along the way, there is the larger treatment path to consider. Finding a caregiver that feels trustworthy is worth a lot.

Your mom is fortunate to have your help! This is a lot to process and negotiate on one's own. Best wishes to you all.

Hello Jade, I understand your concerns. There are many women here who have had surgery with a general surgeon and many who opted to go to a Breast Surgeon. The general consensus seems to be, that a breast surgeon is preferable and so is a breast cancer center, for obvious reasons.

My surgeon is more of a general surgeon, in the country area where he practices now, but he specializes in breast surgery and has been operating on BC patients in London, South Africa and now Australia for a long time. I am in Australia, so I don't have any experience with your insurance system, for us, we can pretty much go, wherever we choose. I chose to stay fairly local to where I live, even though I had a lot of people urging me to go to the big City of Melbourne because they thought I would have received better treatment there, but as it turned out, I couldn't be happier with my decision to stay here and to go with the team I have here. It is a very personal decision.

Has your Mother decided what surgery she wants to have? Does she have a fair idea of the size of her DCIS? Has anyone discussed her options yet?

Have you read the information on DCIS here on BCO? there is a great deal of very easy to read information, which will give you and your Mother a better idea, of what she is facing and will prompt you about questions you may have for the surgeon. If you want to know about his experience in the breast surgery arena, I would just ask him. I was actually give the Dx at a breast clinic by a breast surgeon, but I researched the surgeon I ultimately chose to go with before I decided who to go with.

I too was Dx with DCIS grade 3, not a particular large area, but I decided to go with a UMx and SNB because I wanted to avoid radiotherapy if possible. I had the SNB, because there is always the possibility of an invasive component turning up in the final pathology and having a SNB after the breast is gone, is not an option. Sometimes there is an axillary clearance performed after that, which can then put you at risk of Lymphedema.

I was fortunate, that there was no invasion, so the DCIS was removed, along with my breast. I chose not to have reconstruction and have no regrets about any of my choices.

The usual practice is to do a lumpectomy and radiotherapy for DCIS, and some take Tamoxifen, if it isn't too widespread in the breast. If the area is extensive a UMx, or BMX is offered. It isn't always the case, that you can avoid Radiotherapy if you have a Mx, but I was willing to take that chance and I was one of the lucky ones who managed to avoid any further treatment.

I am not sure if any of this helps you, I am sure there will be others along, it's just so quiet here for the Holidays. Take care and give my regards to your Mother as someone who has felt the same fears from the same Dx.

Your Mother is very lucky to have you to help her navigate through. I have a wonderful Daughter too, who was very helpful to me.

Let us know how you get on and feel free to ask questions about anything, that I may have missed.

Hi Jade, I think that rapport is very important.  Perhaps you will be able to do a consultation with someone else.

That's just wrong Jade, i am so sorry there are not really any other options. I hope, by having this second opinion, it may actually make her feel better about the first surgeon, that can happen.

It may sound presumptuous of me, since I am not in the same region, but is going higher up the chain of management in the insurance company an option? If the people she is speaking to are not helpful, then if it were me, I would be asking to speak to a superior who does have some authority to help identify other options. Sometimes, being the squeaky wheel, is what gets you listened to. Forgive me, if this it not an option for you.

I had a similar experience when my Mother was Dx with BC in the 90's and I was her advocate, I learned very quickly that in our situation, which isn't necessarily yours, I had to be on top of everything.

I wish you both all the very best and hope your Mother feels more comfortable after she has had a second opinion. Let us know how it goes.

Jade, I agree with Ariom and would hope that by being a squeaky wheel you might be able to get somewhere with your insurance company to authorize a second opinion and allow your Mom to see a specialist. I had 3 opinions in deciding between surgeons, 1 general who does a lot of BC work and 2 specialists. I ended up with one of the specialists. She took enormous time with me and I had the benefit of having my pathology and MRI reviewed by the institutions tumor board. If you have no option other than the general surgeon you saw, then make another appointment and make sure all her questions are answered. Once that doctor knows your Mom plans to have the surgery with him hopefully he will spend more time going through the procedure and what to expect. Best if luck.