Are BS better than General Surg & Should I get a second opinion

Personally - I would not go to a General Surgeon for BC surgery. I'd want someone who specialized in/was very experienced with BC for the optimal outcome. General Surgeons are just that - surgeons that do not specialize in any particular type of surgery but do general (all sorts of) surgery.

With that said, my Surgeon was not strictly a Breast Surgeon but a 'Woman's Surgeon' - meaning he only did surgery on women for breast AND reproductive surgery. His reputation is outstanding and he is the one my PA said she would want IF she ever needs surgery for any female issue. He was fantastic.

I have no idea how any individual Dr would react if told that a 2nd (or 3rd or more) opinions are sought. I would assume that different ones would react differently. I did not seek 2nd opinions on any of my Drs or TX plan - it all made sense to me and I really liked all my Drs. If you are questioning and feel you want/NEED a 2nd opinion - get it.

Being IBC, recon at time of UMX was not an option so I had not seen any Plastic Surgeon at the time. By the time, it was an option (a yr later), I had decided that I was fine with being able to do everything I wanted to do (very active outdoor woman) and did not want to take a chance that more surgery could have an effect on that - you can never be sure how any surgery will turn out. We are each so unique - what is 'right' for me may not be for someone else and visa versa.

Have you had a DEXA Test before? If not, it is a lot quicker/easier than any of the Scans. It is basically just X-rays of hip area which will show the density of bones that will show if the density is lowering (as in osteopenia or osteoporosis). I did not have a DEXA test before starting TX as I'd been having them cor yrs so it was already known I was osteopenia (huge family HX).

Are you getting reconstruction? That's what makes the difference. I had a General Surgeon and showed two ladies who'd had plastic surgeons and they both said my incision line was WAY neater than theirs!! Go figure. I had no intention of recon ever and told my surgeon to make me dead flat. He did. Some surgeons will leave extra skin because they think you will change your mind later.

I can wear a tight tank top and have NO bulges or ripples or indents. I am very happy with my surgical results. My chest is not weird to look at.

A doctor who would get mad at a patient for seeking a second opinion or not support one (unless the objection is medically based, such as due to timing considerations) would be behaving in an unprofessional manner.

The main site here has basic information on the second opinion process. There are six sections (see list at upper left of page):

Second Opinons - First section of six : http://www.breastcancer.org/treatment/second_opinion/why

BarredOwl

I felt okay with going with a GS. I interviewed him and since he had worked hand in hand with my PS on many breast surgeries and had done over 300 BMXs in his lifetime I knew he'd be fine. I actually interviewed a breast surgeon who didn't have much experience, even though he was at MD Anderson, and I decided not to go with him because of his limited experience.

As for second opinions, if any physician would "get mad" because his patient sought a second opinion, I'd fire that first doctor. That would simply tell me the first doc had ego problems and was overly arrogant and defensive about his/her expertise. I would not want any doc with those qualities working with me about my health.

Claire in AZ

My Dr. Volunteered that I might want a second MO opinion. My case had been to tumor board and I was completely at ease with my MO. My breast surgeon was first a general surgeon, then specialized in breasts. He was so highly recommended I didnt want to interview another. He also offered

The first surgeon I consulted was, according to my PCP and others, the best general surgeon in town, but he was not a breast specialist or a cancer specialist. I liked him. But when I asked if he had an experienced sentinel node team, he said, "It may be hard to find. If I can't find it, I'll just take them all." What??!! As if an unnecessarily increased risk of lymphedema was not a big deal! So I went elsewhere to a surgical oncologist who does a lot of breast surgery, including sentinel node biopsy. Your PCP may only refer you to others in their group, as mine did, but depending on insurance, you may be able to cast a wider net.

Claire makes a good point that you have to ask about the prospective surgeon's experience and not just their title. Ask how many times per month they do the surgery you are going to have, and how long they have been doing it. Even at a good institution you may encounter a new doctor who is not yet board-certified, and you have to decide if you are comfortable with that. You have to look them up, you have to ask.

I did not feel comfortable having a general surgery perform my BMX, just as I would not feel comfortable having a GP take care of my heart attack or mental illness. I want someone who has extensive training in their field of expertise. As for doctors getting upset about second opinions, well, they can get upset all they want. You do not have to ask permission or even tell them that you are seeking a second opinion. They should be grown-up enough to not take it personally.

I actually did experience this. My PS had discussed implants with me about 6 months ago and I said no, I do not want foreign bodies implanted in my body. Period. When I went to pick up my records to take to another PS, she overheard me and came storming out of a room to berate me in front of God and everybody. She said, "I told you I can just pop some implants in there!" Yeah, I know what you said. I left with my records and never looked back. I did see a second PS, who also wanted to "pop in some implants", so I sought out a 3rd opinion, this time from the group in NOLA. They do DIEP flaps all day, every day, which is what I wanted in the first place. I don't care at all that my original PS is pissed with me. She can go sit on a tack!

Let's be clear that most "breast surgeons" ARE general surgeons. There is no official certification called "breast surgeon" (http://www.abms.org/member-boards/specialty-subspe...). However, general surgeons can belong to the American Society of Breast Surgeons: https://www.breastsurgeons.org/new_layout/membersh...

General surgeons can also say that they specialize in breast surgery but have little to no experience or training to back that up.

My excellent surgeon is a general surgeon who is a member of the American Society of Breast Surgeons: https://www.uchealth.org/provider/denise-m-miller-...

I am new to group and am not sure if this is the correct forum as I have multiple concerns and having few friends or family to lean on, I'm feeling terribly anxious. My pathology report from surgical excision reads invasive well differentiated ductal carcinoma with tubular feature, grade 1, 4 mm in size, 1 mm from margin, expressing ER and PR, and negative for HER2 over-expression. My story started with ultrasound report of two very small benign cysts. I didn't feel comfortable with diagnosis, so I went to a breast surgeon for an opinion. Surgeon suggested a fine needle aspiration to be positive. The report came back as basically benign papilloma and some ? cells. Surgeon suggested surgical excision to get them out. The pathology report came back as stated above positive for Idc. Was a surprise to the surgeon who basically reassured me it was not a malignancy. Went for Mri and surgeon says it looks good and all this taking place within a week, I am scheduled to have a lumpectomy in four days. I feel I am rushing into surgery and should be getting another opinion, but am afraid I will get more confused. I live in Freehold, NJ and the surgeon is a reputable, competent surgeon in area, but there are other surgeons like Debra Camel, Dr Dultz etc. who are well known and reputable also. I am considering cancelling surgery due to high anxiety. Would anyone from my area be familiar with the local doctors like Camal, Adams, Dultz or others and can share their thoughts or experience? Sorry to ramble. Not sure if this post will even show up on forum.
Thank you,
Roche

Hi Roche:

Welcome. The diagnostic process and developing a treatment plan is very stressful and anxiety provoking. If you are suffering from anxiety, please do not hesitate to discuss it with your surgeon, who may prescribe an anti-anxiety medication. Many patients find this extremely helpful during this stressful time.

It sounds like your surgeon recommended an "excisional biopsy," which revealed a small, ER+PR+HER2- "ductal carcinoma with tubular feature, grade 1, 4 mm in size". So far, your surgeon's judgment regarding the appropriateness of needle aspiration and then excisional biopsy proved correct, which is a good. You have also had an MRI, which is a very sensitive method used to assess the potential extent of disease.

Because excisional biopsies are "exploratory" in nature, they are not intended or designed to achieve good surgical margins. If cancer is found, then a further surgical "re-excision" is quite common, as has been recommended for you.

With a diagnosis of invasive disease, a "sentinel node biopsy" is also typically recommended (to check axillary (underarm) lymph nodes. If not, then I would be inclined to seek a second opinion to confirm that advice.

The overall approach recommended for you is a "lumpectomy." Most of the time, with some exceptions, lumpectomy is combined with a course of radiation, although those with more favorable pathology findings may be candidates for more limited types of radiation regimens. Therefore, many patients consult with a Radiation Oncologist prior to surgery to get an idea of what may be recommended (although the results of sentinel node biopsy and re-excision may lead to a different recommendation in some cases). If you have not already done so, you may wish to consult a Radiation Oncologist at your current treatment center.

Lumpectomy (plus radiation when indicated) is an excellent choice for many. The other main surgical option is mastectomy. Many patients who receive a mastectomy can avoid radiation. However, sometimes certain pathology findings may lead to a recommendation for post-mastectomy radiation. Many find this post about Lumpectomy versus Mastectomy to be very helpful:

Beesie's post Lumpectomy v Mastectomy (invasive disease):

https://community.breastcancer.org/forum/82/topics/848049?page=1#post_4802494

You mentioned having received an ultrasound and MRI. Have you had diagnostic bilateral mammograms? Guidelines from the National Comprehensive Cancer Network (NCCN) for breast cancer (Version 2.2016) recommend:

"The recommended workup of localized invasive breast cancer includes: history and physical exam; bilateral diagnostic mammography; breast ultrasonography, if necessary; determination of tumor hormone receptor status (ER and PR determinations); determination of HER2–receptor status; and pathology review. . . "

Guidelines indicate what is generally recommended in the typical case. (Additional imaging or testing may be recommended in the appropriate case, as well as genetic counseling, fertility counseling, etcetera.)

I raise the question about bilateral "diagnostic" mammograms, because I had bilateral "screening" mammograms, and a right "diagnostic" mammogram only, plus bilateral MRI. No left "diagnostic" mammogram was done by my first team (despite then current guidelines recommending it). In my second opinion, a left diagnostic mammogram was recommended, resulting in the diagnosis of bilateral disease (despite density). This was not detected by the prior MRI. Bilateral disease is not very common; however, as my case illustrates, bilateral diagnostic mammography and MRI can be complementary and may further inform surgical planning and success. If you have not received bilateral diagnostic mammography, in light of the recommendation in the NCCN guidelines, you may wish to ask your current team about it, and/or seek a second opinion review of all pathology, imaging, and treatment recommendations.

Some patients choose to seek a second opinion, while others do not. It can be a reasonable choice not to do so. Most of the time, in what appears to be a routine case, the second opinion review and advice should be generally consistent with the first. If for some reason it is not (as in my case), then you would probably want to have that information to inform your decision-making and treatment plan! The challenge is that one cannot know with certainty what the outcome of a second opinion will be, which is part of their value.

Also, when you are not sure about something or are uncertain about proceeding, a second opinion at an independent institution can be very helpful to further discuss available treatment options, to probe the quality of the work-up and medical advice received to date, and to obtain additional explanation and discussion. The process is educational and may give you added confidence in your treatment plan.

General information about second opinions can be found on the Main Site here (see all six sections):

http://www.breastcancer.org/treatment/second_opinion/why

By the way, if you choose to seek a second opinion, look for a breast surgeon who specializes in the treatment of breast cancer or patients at risk of breast cancer as essentially all of their practice, preferably located at a comprehensive breast center. If feasible, an NCI-designated cancer center (confirm insurance coverage and in-network) may be a good option:

https://www.cancer.gov/research/nci-role/cancer-centers/find

You will find a lot of support here. Don't hesitate to ask more questions. You can start your own thread in the newly diagnosed forum at this link:

https://community.breastcancer.org/forum/5

At that link, near the top of the page, click on the big pick button to "Start a new Topic"

BarredOwl

Hello Barred Owl,

Thank you so much for the reassurance that the breast surgeon is following the correct protocol. Feel like I got a shot of calm now. I am planning to read and reread your post. Great information. Surgeon is removing sentinel node for biopsy and widening margin. So I guess I'm having a lumpectomy minus a lump. I'm still reeling from the diagnosis. I don't like any of my choices. Reading and signing consent papers for lumpectomy is in itself stressful. Go in for a lumpectomy and maybe due to unforeseen problems, end up with mastectomy?? I don't like idea of rad or chemotherapy. It's pick your poison. This is especially difficult for me b/c I'm not a fan of conventional medicine, avoiding it most of my life and eat pretty much clean food. Surgeon said rad starts one month after surgery, so I should have time. I go for breast exam and mammography each year, each one 6 months apart. My last mammogram was normal in April, 2016, so I thought. . At my 6 month Gyn check, I had an area of concern and he sent me for ultrasound which they diagnosed as two benign cysts. Not feeling comfortable with the report, I went to breast surgeon. He pointed out a lump that I hadn't been aware of and was overlooked by my Gyn, and after needle aspiration, diagnostic mammo of THAT breast, surgical excision, MRI of both, I have a diagnosis. In a way I am thankful/lucky that the breast surgeon took the US findings further.

I'm not familiar with bilateral disease. Is it ductal tumors in both breast? I'm sorry. It seems whenever a diagnostic mammo is required in my area, these breast centers only check the breast of concern. I'm glad you were aware of the possibility of this condition and able to seek treatment elsewhere. We try to do all the right preventative measures and yet, oversights, carelessness, incompetence, and sometimes dismissal of our concerns cause unnecessary havoc in our lives. I think many times it's all about luck, or maybe a guardian angel watching over.

Roche

In my opinion, if you do not feel confident about the doctor or the plan, you should ask him/her if it is safe to wait long enough to get all your concerns addressed and to get a second opinion. I think it does matter who does your surgery and where. Even for the cosmetic result.

Hi Barred Owl

I am grateful for all info you are sharing. I'm understanding much more. Thank you for your

well wishes. And I hope your journey is/ has been successful and is under control also. To be honest, I'm not sure I will be strong enough to handle this.

Roche

Roche, the steep learning curve and the high-stakes decision making can be exhausting. If your doctor is following appropriate standards and has good credentials, you may decide to just let him manage things while you focus on taking care of your emotional well-being.That is a reasonable option.