Being sent to breast surgeon

This is appropriate. Yes, radiologists, not surgeons, usually do core needle biopsies, but seeing as how your first mass was >1 cm on CT, there was a delay on getting diagnostic mammography, you were having pain & rapid weight loss and diagnostic imaging showed two masses with blood flow to each other, your doctor is right to be concerned. If you were asymptomatic, core biopsy would have been indicated; but the pain, weight loss, and second mass appearing would indicate you would be safer having the masses removed ASAP. The fact you're seeing a breast surgeon tells me they believe it's more than just atypia and you will need at least a lumpectomy anyway; and that if there are various surgical options, a breast surgeon would be best equipped to explain them and obtain a good cosmetic result from what would likely be more extensive than a single small lumpectomy.

They're being proactive and you are in better hands than if they had a radiologist do a couple of core biopsies, wait for the path report and then send you to see the surgeon. Many patients aren't even offered a breast surgeon, but rather a general surgeon who does other stuff like appendectomies, hernias and the like.

The 23d is less than 2 weeks away—and good breast surgeons are in high demand and book even further out unless they feel a sense of urgency, which your doctors apparently do. See if you can get in sooner, but two weeks is still okay. They'd like to enable you to start adjuvant treatment sooner rather than later if the masses turn out to be malignant.Hang in there!

Yes. This is the normal step to take. Remember that you can choose your own surgeon. Also, it can take time for each of these steps.

My thought is because of your age and the indeterminate finding of your mammo, your primary is hoping to spare you the headache of a biopsy by first sending you to a breast surgeon, who is the best person to (non-radiologically) assess a breast lump.  Lots of docs examine breasts, but the breast surgeon only examines those with lumps and bumps.  Most likely, your doc is hoping the surgeon will feel the biopsy is unnecessary.  The only way to be sure, of course, is with an actual biopsy.  Chances are your new surgeon will either recommend timing for your next mammo, or send you back to the radiologist for that biopsy.  If not, you now have a lumps and bumps expert on your team and can call on him or her with future concerns.  If the biopsy is still in your future, no problem.  As Sandy indicated, you have only delayed the test by a couple of weeks and in the world of breast cancer, that is considered insignificant.

Well, they don't exactly decide; they recommend.  Whatever your surgeon thinks, your radiologist is in favor of the biopsy, so it is probable that your surgeon will say something like, "I am not concerned about this lump, but as your radiologist recommends a biopsy, you might want to schedule the procedure just to be sure there is nothing worrisome going on."  Yes, lots of nothing and you have to make the decision.  I would add here, that if it were my lump, I'd want the biopsy.  Statistics tell us, by the way, that something like 85% of biopsies turn out to be negative.

Heather

Often the biopsy by the radiologist and the followup by the breast surgeon are scheduled at the same time as a practical matter. If the biopsy is benign the surgical appointment can be cancelled. If you wait for the path to come back before scheduling the surgical appointment, you can expect to delay the process for weeks.

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"......and you are in better hands than if they had a radiologist do a couple of core biopsies"

None of the breast surgeons I have worked with in the past 30 years did their own image guided biopsies. They don't have the time, proper equipment or a tech certified in breast US. There have been a few general surgeons over the years that have done their own FNA's by palpation in their offices but many of those come back as "inadequate sample for diagnosis" and come to us in the end for a definitive diagnosis.