Which option would you pick for surgery?

9lives70 · February 2017

I'm getting ready to finalize my surgery option for my double mastectomy and reconstruction.

My two choices have been narrowed down to:

1.) A reconstructive surgeon who is consistently referred to as the best in town by other surgeons but is known to have a "difficult" personality. He works with a very kind Breast Surgeon. He's extremely arrogant and every time I deal with him I feel annoyed, anxious, or upset but I keep sticking with him as an option because he's "the best"

2.) A young, cutting-edge surgical duo from University of Washington in Seattle Cancer care alliance. Really like them both a lot and I can tell they are extremely skilled with great reputations however I feel like it's a bit of bait and switch as I found out after the consults from the grapevine that residents do a great portion of the surgery. This is something they did not bring up or address at all. Having a hard time feeling comfortable with residents operating on me even though they are "under supervision at all times"

In option one the doctor will not insert expanders until a second surgical procedure which is also a downside he will not do it at the time of mastectomy. the team at the UW/ cancer care alliance starts the reconstruction at the time of the mastectomy which is very appealing as it means less surgeries.

So do I go with the "best" and suck up his personality or do I resign myself to residents operating on me?

What would you do?

leftfootforward · February 2017

it's a personal choice.

I for one would go with the people I like better. I will tell you I had bilateral a bilateral mastectomy done at the U of W.

I did not have reconstruction done as I had to do radiation as soon as I was healed. My expanders would have had to come back out for that. If you are going to do radiation, I would ask about that- do you have time to comfortably be expanded before radiation treatment. If not, then I'd choose the two part reconstion.

As far as residents doing part of the surgery, they will be supervised at all times by the surgeons you like. In my case, they did not do the main part ( of course I have no way of knowing this).

U of W is a teaching hospital so it is something you have to consider. But just because they are present does not mean they are the ones doing the actual procedure. Ask you surgeons what the residents typically do? It might make you feel better or not. In my experience they were very honest about it.

It sounds like you are in good hands either way. It just comes down to what feels best to you.

Good luck

9lives70 · February 2017

thanks;)

I did ask them a lot of specific questions about who would be doing what during surgery and as it turns out the residents are involved in the surgery from start to finish. Even the Anesthesia can be administered by a resident. I'm a bit of a control freak which is why this is a little difficult for me to swallow makes me feel like a bit of a guinea pig!

Who were your surgeons at UW?

Goincrzy8 · February 2017

Technically you really are not in control anymore. sorry I am a take charge person, and I have been shown, I am not in control of my life anymore.

Good Luck on your choice.

coachvicky · February 2017

Dear 9Lives70,

First, congratulations on the choices you are making. Had I ever dreamed implants would be this wonderful I would have had them years ago! I am 15 days reconstruction post op.

In the hospitals where I have had surgery (lumpectomy, double mastectomy, port insertion, implant reconstruction, and upcoming hysterectomy), I am asked to sign an agreement for students, residents, observers to be in the operating room. I always decline because I want to ensure my surgeon of focused on me.

In all the medical relationships on this cancer journey, the relationship with my Plastic Surgeon has been the most important. He is the person that I believe understood what I wanted to be whole again.

I had a rough start with my Oncologist. For the first two visits he gave me bad news (4cm lobular cancer found in the other breast, necessity for chemo, mastectomy surgery immediately ...). It got to the point that I asked my Surgeon to stop the Oncologist from telling me any more bad news and only bad news could come from my Surgeon. Really. This relationship was headed south. My husband reminded me that the Oncologist was working to save my life. I worked to have a restart with my Oncologist. I backed away and started to look at what he was good at. I am glad I stayed with my Oncologist. He has a dry sense of humor I can now appreciate.

I share this to offer that maybe talking with the "arrogant one" and sharing your concerns might get you a restart. That is, if you want to leave surgery without your expanders and endure another surgery. You also have the option of defining with the "dynamic duo" who you expect to do the surgery and make that very clear. I suspect if they are as good as their reputation, you will be fine under their knives. (As a side note, my husband make pictures of my breasts that I asked my Surgeon to mark exactly where my incisions would be.)

Leaving without tissue expanders was not an option for me. I told my Surgeon and Plastic Surgeon the size I woke up with did not matter but I must wake up with some sort of breasts. This was critical to my healing and self confidence.

Best wishes.

Coach Vicky

MinusTwo · February 2017

9lives - I went with the arrogant a$$ for a PS. First because I loved my BS and she said his work was the best. Second because he is head of plastics at a major hospital. Third because he took over from the BS during surgery and put in the TEs. Eventually - several months down the road & just before exchange surgery, he developed a personality - or maybe somehow he just got used to my questions.

That said, I would not have wanted a 2nd surgery to place the TEs under any condition. In retrospect - I still feel that way. Another major surgery would have been unacceptable. And you still have exchange ahead, so that would be a 3rd surgery. As a bonus, because my TEs were placed during BMX, it was the PS who 'closed' & my scars were good. He did the exchange through the same scars - and they are now almost invisible

Is it just that he and the BS can't figure out how to split the surgery time? Or he won't share the glory? If it's a radiation question, many people have rads with TEs in place.

Finally - I wouldn't worry about having residents. Many are more exacting th

9lives70 · February 2017

minus two:

So the reason he won't place the TE's at the time of surgery is really, I believe, because he does not want to be inconvenienced. Seriously. He's used to working with patients AFTER they've had Mastectomy surgery doesn't ever typically do the surgery at the same time as the breast surgeon. He claims this is because he wants to get the tissue time to "heal"

But I believe it's more because he doesn't want to be bothered by operating alongside another surgeon and he doesn't like to leave his own surgical suite to operate in the hospital. He's told me this. I sent him an email Friday asking if he be willing to do it one more time so far he hasn't answered me.....

9lives70 · February 2017

minus two:

So the reason he won't place the TE's at the time of surgery is really, I believe, because he does not want to be inconvenienced. Seriously. He's used to working with patients after they've had Mastectomy surgery and doesn't ever typically do the s and doesn't ever typically do the surgery at the same time as the breast surgeon. He claims this is because he wants to get the tissue time to "heal"

But I believe it's more because he doesn't want to be bothered by operating alongside another surgeon and he doesn't like to leave his own surgical suite to operate in the hospital. He's told me this. I sent him an email Friday asking if he be willing to do it one more time so far he hasn't answered me.....

MinusTwo · February 2017

9 lives - sorry to hear but not surprised. Many surgeons think of themselves as "god". Hope you find a happy middle ground.

mustlovepoodles · February 2017

Honestly, 9lives? I dont think I'd stuck with your PS. He really sounds like a piece of work. You need to have a strong working relationship with your PS, because you'll be working with him for months, possibly years. I ditched my first MO, supposedly the top MO in Atlanta. Everyone else thought he was fantastic; I thought he was silly and not at all reassuring.

I wouldnt worry too much about the residents. Surgical residents have completed 3 years of medical school and have also completed at least 5 years practicing general surgeries alongside a teaching surgeon. Surgical residents are closely supervised by a surgeon who is scrubbed in and ready to take over should the situation call for it. Plastic surgery residents complete at least 6 years in plastic surgery residency, in addition to the 5 years of general surgery. Medical students never perform plastic surgery.

MinusTwo · February 2017

9Lives - I posted a long detailed answer on your other thread.

Luckynumber47 · February 2017

Looking back I feel like the most important part of the whole diagnosis/surgery experience was that I felt cared for. Starting with the biospy radiologist who jumped in when I was at my lowest and most confused and got me a referral and appointment for an MRI, gave me recommendations for a couple surgeons and got me in right away, to my surgeon who assured me repeatedly that I would be fine to my MO who made me feel confident with my choices.

Probably any competent, experienced surgeon will do a fine job, it's how you feel about them that can make a big difference. Who do you feel like you can trust?

This might be totally off the wall but it's the times when I've micromanaged something to death that I've been the most disappointed because it could never be as perfect as I wanted.

Luckynumber47 · February 2017

oh, yeah, 2 more things. I'm a big believer in avoiding extra surgeries as much as possible

Also, a dr friend of mine told me to avoid residents in July when they're new but they're ok after that

mustlovepoodles · February 2017

Thankfully, by the time you get a new plastic surgery resident they've already been performing general surgeries for 5 years (gallbladder, appendectomy, port placements, hernias, etc.)

Di2012 · February 2017

I had bilateral mastectomy at UW/Valley.....I have a very wonderful EXPERIENCED breast surgeon, and she ask me I wanted "Drive thru" or overnight, I chose overnight as I slow or stop breathing after surgery and I needed a nurse to nudge me, MX done and in my room by 7pm, had dinner room service, and began discharge instructions 13 hrs later.

I did not have reconstruction until a month later, since I had a post operative infection 3 weeks after a different kind of surgery (12 years previous) which put me back into the hospital for several days, (I was a sick puppy), and my wonderful PS did not was to risk another for my sake. (My BMX was a piece of cake) I was doing push ups about 5 days later, even though the drains were still in. I will say lifting my pecs muscles (ouch!) to get my TEs in, a month after my MX surgery, was done in PS's surgical suite rather than in the hospital, was not a long surgery, in & out from being wheel in to OR to walking into my house was less than 2.5 hour. The incisions for both surgeries were both under my "Foobs" (& vertical incision to remove nipple/areola for MX).....NOT the slice across the center (from left to right).

For my MX I did have a young woman introduce herself as a student studying to be a paramedic if she could observe me being intubated.....I agreed....I know if I ever need a paramedic to save my life or anyone else's life, they would NEED to know how to do it.

I had observers for other in hospital procedures.....like taking out a catheter

Di

Which option would you pick for surgery?

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