When do I get second opinion?

Hi Nikki! I’m also in NC just a short drive away from Mooresville. My path was made pretty clear as the puzzle pieces came together. If you’re given the option of a lumpectomy with rads, your choices at that point are the lumpectomy or a mastectomy. Choosing between the two is a personal decision. There are multiple threads on BCO that address choosing so I won’t belabor the point. Often second opinions are desired when what the surgeon/MO is recommending is not standard of care for your diagnosis, you want confirmation that the path the dr is laying before you is the only or the best path, you would like a second look for peace of mind, and/or you’re looking at reconstruction options. Sometimes a dr will push one path over another because they think it’s what is best for you (ie lumpectomy vs mastectomy or different recon options). Many times that push is based on what they would want or doing the minimum to get the desired outcome. That’s why 2nd opinions are important. You also want to seek another opinion if you feel the dr is not listening to what you want (ie dr shuts you down if you talk about mx when he says lumpectomy, dr disregards your desire to go minimal or maximal treatment or your desire for additional scans, dr dismisses your wants on recon outcome). My second opinion fell in the recon option realm. The surgeon in 1 breath was telling me I was really not a good candidate for implants then in the next breath was referring me to a PS that only did implant recon. Many PSs never mention any other type of recon other than implants. I went home and searched recon options, decided to go with natural tissue recon and did a phone consult with NOLA for a 2nd opinion. They agreed I was not a good implant candidate and evaluated me for DIEP flap recon at same time as BMX. Here I am 1 year later and very happy I sought the second opinion and went with it. Let me know if I can help.

I never got a second opinion. Part of that is that I'm in Canada and it seems all our doctors are following essentially the same province wide protocols, and every patient is followed by a large interdisciplinary team, and there's a weekly tumour board which hashes out any weird or unusual presentations. Second (& third etc) opinions are kind of built into the system automatically. So for me it was just a matter of 'clicking' personally with the docs and so far I've liked them & trusted what they were saying. My BS was selected for me by my GP and I trusted her to refer me to who she thought would be best. And he was great, and super fast. I had my surgery very quickly after diagnosis & I was so glad.

FWIW, technically your final pathology isn't determined until you have your surgery and the pathologist looks at your tumor, and your lymph nodes are biopsied. For me, my bs recommended lumpectomy + radiation as the location and size of my lump made a breast conserving surgery relatively simple. He did say if I was adamant about mastectomy they'd do it but it was not his recommendation. We rarely do prophylactic contralateral mastectomies here - not unless you're at high genetic risk - so a BMX didn't even come up (I'm still waiting for genetic testing so that might change eventually) Hanging around on these boards for a couple months now I notice that US patients seem to do mastectomies more often; would be interesting to tease out why that is.

After surgery I got handed off to the oncologist who made the recommendations for chemo.

Unless your friends & family are oncologists I'd take their advice with a huge grain of salt. Cancer research has rapid changes and the protocols that doctors are using are based on the current best evidence guidelines so I tend to just lean on their expertise. By all means question the protocols and why doctors are recommending one thing v. another but at the end of the day, I listen to them.

best wishes as you navigate this. It's hard but we're all here to support each other.

When I was diagnosed, I read a lot about the importance of second opinions. I asked my BS (to whom I was referred by my OB/GYN). She wholeheartedly agreed and recommended another BS at Hopkins. That BS wanted copies of everything and they actually ended up repeating my pathology.

I've primarily been treated by a local cancer cancer. They have a tumor board that meets to discuss patients. They're also affiliated with Anderson and I had my MO contact them for review of plan of care (they agreed). So I've seen 2 BS's, had 2 pathology reviews, had 1 MO and 1 tumor board review and 1 additional review for oncology. I also saw 2 RO's. Only 1 PS because I changed my mind about type of surgery and for was pressed for time!

I think second opinions are very important. Even if the plan of care seems pretty straightforward, it helps to hear it from multiple sources. And it's important to feel comfortable with your decisions and your team.

I'm currently planning to physically see another MO (Hopkins) to get their recommendation for follow up care. My MO seems pretty uninvolved at this point - which is fine if nothing further is needed. But I'll need to hear that from another source to feel comfortable.

It’s your life do get as many opinions as you think you need. Also be your own advocate. Ask questions and if you choose not to go the way they advise it’s okay. Again it’s your life - your call.

Diane