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All TopicsForum: Surgery - Before, During, and After → Topic: Surgeon vs. Surgical Oncologist

Topic: Surgeon vs. Surgical Oncologist

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Feb 5, 2009 04:42PM

Sukiann wrote:

Hi there.  I have been diagnosed but have yet to have my surgery.  I have a surgeon in the local area who does a lot of breast cancer surgery and is known to be very good at what she does.  She is a general and vascular surgeon.  I am scheduled to see an oncologist next week also in the local area.  I also have an appointment to go into Boston for a second opinion with a surgical oncolgogist.  Do you think it is better to go with the surgical oncologist because they specialize in cancer or do you think a general surgeon can do the job just as well.  In other words, is cancer easy to take out or do you need that extra special training to remove it?  What do you all think?  I value your opinions!  Thanks so much.

Sukiann

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Posts 1 - 12 (12 total)

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Feb 5, 2009 05:22PM NatsFan wrote:

Suki - I also started out with a general surgeon who happened to do a lot of b/c surgery.  Then for my second opinion I went to a Breast Center (Hopkins).  After my new patient consultation, I decided that they were going to handle all my surgery.  One reason was that during that exam, the surgical oncolgist found a palpable lymph node that had been missed by the general surgeon in his exam the week before.  They did an immediate needle biopsy on that node and found it was positive, which meant that we knew ahead of time I was going to need a full AND.  Her expertise in finding that node saved me from having a SNB come back positive, then have to go back for more surgery to get the rest of the nodes - it was done all at the same time. 

My bilat mx with full AND was done by the surgical oncologist, and the ps there installed the expanders at the same time, then later did my DIEP.  I benefitted from having an entire team working together and I didn't have to tote records and carry files from mx surgeon to ps - they were already on the same team. All these Centers do is breast cancer, from beginning to end.  They stay on top of the latest research and techniques and treat the patient as a whole.  It was a world of difference to me.

Maybe some of the Boston ladies here can tell you where some Breast Centers are - I think I've heard some people here talk about Brigham and Women's Center, but I'm sure Boston has others as well.  I would highly recommend that you go to a Breast Center for a second or third opinion - even if you don't end up there, it's never a bad thing to have your case reviewed by experts.  

Mary

Dx 12/31/2007, IDC, 2cm, Stage IIb, Grade 3, 1/15 nodes, ER+/PR+, HER2-Surgery 01/30/2008 Mastectomy (Both); Lymph Node Removal: Axillary Lymph Node Dissection (Right); Reconstruction: Tissue expander placement (Both)Chemotherapy 03/04/2008 Adriamycin, Cytoxan, TaxotereHormonal Therapy 07/01/2008 FemaraSurgery 10/09/2008 Reconstruction: DIEP flap (Both)
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Feb 5, 2009 05:25PM Beesie wrote:

Sukiann,

What you are actually looking for is a doctor who does a lot of breast cancer surgery.  Don't worry about the title the doctor uses - titles vary and some titles like "breast surgeon" actually don't mean anything because any surgeon can call themselves a breast surgeon.   My understanding is that the only official titles (i.e. what they graduate as) are general surgeon and surgical oncologist (and I'm not even sure if surgical oncologist is an "official" title).  A surgical oncologist may specialize in cancer surgery but if he or she doesn't do a lot of breast cancer surgery, then that's not the doctor for you.  On the other hand, my surgeon called himself a general surgeon but all he did was breast cancer surgery.  So look for relevant training and experience - training from the standpoint of finding a doctor who had a residency or fellowship in breast cancer surgery, and experience with regard to the number of breast cancer surgeries that doctor does in a year.  The training you can find out by googling the doctor on the web.  The experience you can find out by asking.  This really is important - there have been numerous studies that have shown that surgeons who do more breast cancer surgeries have better long term results among their patients, with fewer recurrences.

Hope that helps!

Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage I, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke

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Feb 5, 2009 05:26PM, edited Feb 5, 2009 05:27PM by AlwaysHope

Natsfan, I agree.  While a general surgeon can do a good job, I would look for a breast specialist/surgeon since their entire focus is on diseases of the breast.

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Feb 5, 2009 06:43PM Sukiann wrote:

Thanks so much ladies (or gents - don't want to assume as I know men can get bc).  I spoke to the general surgeon today. She called me to aks me if I wanted to go ahead and schedule the surgery. She was very nice and supportive of me getting a second opinion.  She does a lot of breast surgery (she's the one to go to around here if you need surgery on your breast).  We talked a lot about the differences of local vs. Boston.  She trained at the Faulkner so she does have a lot of experience with breast cancer since that is a very big breast center here in the boston area.  She said that most likely I would be coming back here for radiation because it is just such a pain to travel in and out of Boston for that everyday.  99% of patients do it local.  That being said, she went on to tell me that my main focus should be on the oncologist end.  Breast cancer is not like pancreatic cancer or colon cancer.  She said those types of cancer need a different type of surgery - definitely more specialized surgeon would do that. So, I guess I will go on with my plan of meeting with the local oncologist (who she said is wonderful) and then go for my second opinion in Boston.  She did tell me that I am Her2 negative (which I have been waiting to hear about).  She said that is more favorable but if I was positive that Herceptin would work (so those of you who are her2 positive - keep up the positive attitude!).  Thanks again for your replies.

Dx 1/14/2009, IDC, 2cm, Stage IIa, Grade 2, 1/9 nodes, ER+/PR-, HER2-
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Feb 5, 2009 07:07PM jancie wrote:

I am having my surgery done by a breast surgeon - no he is not a surgeon oncologist but he was highly recommended and he specializes in breast surgery.  Not only that he is in close contact with the oncologist and the plastic surgeon who came here from MD Anderson Cancer in Houston, Texas.  He did my sentinel lymph node biopsy - he knows what the heck he is doing.  I don't care that he doesn't have "oncologist" in his title.  I was told by the breast care center that I needed a "general" surgeon to do my breast surgery so I called around and found the one that everyone goes to for breast surgery.  Now I wouldn't have just gone to any general surgeon that occassionally does breast surgery - I wanted someone with a ton of experience.

Never Alone - My TaTa Sisters are always with me!

Dx 12/30/2008, IDC, 4cm, Stage IIb, Grade 1, 0/5 nodes, ER+/PR+, HER2-
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Feb 5, 2009 08:14PM hopefor30 wrote:

I started out with a general surgeon who did a lot of breast surgery.   He was a wonderful doctor and I liked him, but since I am in the Boston area, I did go for a second opinion at Beth Israel -- and I liked the surgical oncologist there even better.    If you have the opportunity to go into Boston, where you can get some of the best care available in the country -- why not?   If you want the name of my surgeon, who I would highly recommend, you can send me a private message.

M.

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Feb 8, 2009 03:21AM mawhinney wrote:

I used a surgical oncologist that works at a cancer center.  From the minute I called the cancer center I felt welcome and in good, caring hands. I did not get the same feeling when I contacted a general surgeon's office. At the cancer center they use a team approach.  All the doctors -surgical oncologist, radiologists, oncologist, plastic surgeon - involved in treating breast cancer meet regularly and all review and discuss each case giving their opinions. Many eyes are  looking over tests results and expressing their thoughts on the best treatment for my case. All of the doctors get copies of all reports. 

I also called several nurses I knew and asked who they would and would not use.  Nurses get an inside view of the medical community and are a good source of information.

Dx 5/18/2008, IDC, <1cm, Stage Ib, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Feb 8, 2009 03:39AM southport wrote:

I would be sure that your surgeon, whatever his/her title has done many, many procedures similar to the one that you will have.  I had a double mast. at Hopkins and I thought both my breast surgeon and plastic surgeon were both excellent.  When I asked the PS how many TE/implant reconstructions he had done, he said about 400!  

But...although I thought the surgeons were excellent, I had a very difficult time getting any information/time/attention from the oncology dept.  I was not able to see an oncologist until four weeks after my surgery, they sent out the wrong sample for oncotype testing, and I was passed on to another oncologist after the first one decided to move out of town.  I had a very difficult time getting in to see the second oncologist because they did not consider me a "high priority patient."  The NP explained that because I was only stage 1, I'd have to wait.  Needless to say, I switched from Hopkins to a local hospital where I have an oncologist who spends lots of time with me.  

Remember that if you go to a big research center, the surgeons will be very experienced and the oncologists very knowledgeable, but their focus is on research.  As a run of the mill stage 1 cancer patient, there was not much to research and I did not get much attention. 

You will (hopefully) only have 1 surgery.  But, you will be followed by your oncologist for years.  Make sure you get someone who cares and with whom you feel comfortable.

Diagnosed age 44 with BL BC Sept. 08; right side 5mm, left side 1cm. BL mast. Oct. 08, expanders, exchange to silicone implants Feb 09. Taking tamoxifen.

Dx 10/2/2008, IDC, 1cm, Stage I, Grade 2, 0/5 nodes, ER+/PR+, HER2-
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Feb 8, 2009 08:56AM 55Barbara wrote:

Sukiann, You don't mention what type of breast surgery you are considering. One aspect to consider is if you desire reconstructive surgery if you are having anything more extensive than lumpectomy. It is important to have the breast surgeon and plastic surgeon working together on some reconstructive options. I too went to BIDMC in Boston only for the reconstructive portion and was very pleased with my experience. For chemo I chose Dana Farber and radiation choose a community option of BWMC. I feel very fortunate to live so close to Boston where there are so many excellent options available. 

Dx 6/30/2006, IDC, 2cm, Stage II, Grade 1, 4/14 nodes, ER+/PR+, HER2-
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Feb 8, 2009 01:32PM bettelou68 wrote:

I went to a surgical oncologist at the Breast Center at Hopkins after a local surgeon, who does do a lot of breasts, failed to recognize or take seriously my red, inflamed, sore breast, which happened to be inflammatory breast cancer. At Hopkins, it was suspected and tested for right away.I saw a medical oncologist for 90 minutes that same day. I had an SNB, port placement, and was in chemo within a week. I. After chemo, I had an Mx with TE at Hopkins. They work with the medical and radiation oncologists here in my hometown, 2.5 hours away. I will go back there for my DIEP flap reconstruction. I am treated like family at the Breast Center, and I really feel they saved my life my catching the IBC before it spread to the rest of my body.

Bette 

www.caringbridge.org/visit/bettedietrick "Yet in all these things, we are more than conquerors through Him who loved us."Romans 8:37

Dx 8/20/2008, IBC, 6cm+, Stage IV, Grade 3, 0/6 nodes, mets, ER-/PR-, HER2-
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Feb 8, 2009 04:08PM CAZ wrote:

A comprehensive Breast Center makes all the coordination so much easier.  Mayo has been fantastic from the very beginning.  When I met with the BS the first time he said, "we'll take good care of you."  I almost cried with relief.  You have to like your PS even more than your BS due to all the follow-up (at least with tissue expanders).  Good luck.

Carol(AZ)

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Feb 8, 2009 07:50PM, edited Feb 8, 2009 07:51PM by vegas

Sukiann, it is always good to get second and even third opinions! What I would recommend, though, is to first figure out what type of reconstruction YOU want. Then I would interview surgical teams that specialize in that particular type of reconstruction. I opted to fly to New York for my surgery. I had a surgical oncologist that specializes in breast cancer (he and his father started their own breast care center) and the PS works with them on a regular basis.

WARNING: most surgeons will only recommend the type of surgery THEY like to do, not necessarily the procedure that would suit your lifestye and emotional needs best. You need to really check out your options for recon. Here's a link to a simple online text that gives you the basic pros and cons of all the options, plus it describes two of the newer cutting edge techniques (DIEP and the one step implants with no expanders). Plus the author even lists surgeons around the country that specialize in the newer procedures.

http://www.breastrecon.com/index.html

Once you decide on what kind of recon you want, then you can contact surgical teams who do that surgery routinely. You are likely to have better results and fewer complications using a team that specializes in what you want.

You are lucky to live in Boston which has some outstanding surgeons and is also next to New York which has even more. You can't believe what a beautiful job these docs can do. Mastectomy - that totally scary word - is not what it was 20 years ago at all. My imagination had conjured up all sorts of horrendous things - the actual surgery, recovery and results were a very happy surprise.

Southport brings up an excellent point - you will be with your oncologist for a long time! You can travel for surgery and it is not a big deal since it is over and then (hopefully!) done with, but you will be seeing your oncologist many many times and it helps to have a good one close by. Again, feel free to interview! I passed on the first two and then got a gem on my third try. I do have to go across town to get to her, but she is worth it. I almost cried on my last appointment when she told me I had "graduated" to six months at a time.

Good luck with your interviews and keep us posted. Remember to bring a list of questions you make up ahead of time and an extra set of ears to listen to the answers.

Diann

Dx 11/3/2006, IDC, 1cm, Stage IIa, Grade 2, 2/13 nodes, ER+/PR+, HER2-