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May 20, 2019 02:42PM
I'm in Toronto, but just on the edge of Mississauga. When I was diagnosed 13 years ago, I was referred to Trillium Mississauga but wanted a second opinion, and requested one from Princess Margaret Hospital downtown. I'm not sure if that option is available to you because PMH is in Toronto and you are in Mississauga. So I don't know if these days you would be able to get into PMH for a second opinion. The problem is that they are so much in demand that they have to limit their referrals and I know in another case that they refused a second opinion referral for someone who was from outside of metro Toronto.
In my case, I wanted a second opinion because:
- My surgeon was recommending a MX because the extensiveness of my DCIS and I didn't want the MX and wanted to know if a lumpectomy was an option.
- Because I had a microinvasion of IDC (found in the excisional biopsy pathology), I had to have my nodes checked. Sentinel node biopsies were a new procedure in those days and Trillium was not going to be able to perform one on me. I knew that I wanted the fewest number of nodes removed and wanted the SNB.
- If I was to have a MX, I wanted immediate reconstruction and I wanted a PS who specializes in breast reconstruction, not a more generalized PS. The PS I was referred to at Trillium was their head of PS but he did not specialize in breast reconstruction.
So I went for the second opinion at PMH.
- Before the appointment, the surgeon at PMH had their pathology department review my biopsy slides, which confirmed my diagnosis with no changes. He also ordered an MRI, which had not be offered by Trillium. The MRI showed that a lot of DCIS remained in my breast, confirming the need for a MX. Despite that, the surgeon said that he could attempt a lumpectomy first to see if he could achieve clear margins, but the MRI results had me reluctantly accepting that a MX was the right choice.
- The surgeon agreed that my diagnosis was suitable for an SNB and said that he would be able to perform one, rather than remove the whole first level of nodes, as the surgeon at Trillium was going to do.
- The surgeon offered to refer me to the breast reconstruction plastic surgeon at Toronto General (PHM and TGH are both part of The University Health Network and their surgeons work together) and agreed that my diagnosis was suitable for immediate reconstruction.
So with all that, I made the decision to stay at PMH rather than have my surgery at Trillium.
As I said, I don't know if Toronto Hospitals accept 2nd opinion referrals from Mississauga these days but you can try. You would need to have a doctor refer you - in my case, my first surgeon was actually happy to make the referral but I would think even your GP could make the referral. PMH is great, as is Sunnybrook. You could also try Mt. Sinai since many of the PMH doctors work at both hospitals (they are right next door to each other). Or Women's College.
To your question, yes, OHIP would cover a MX after a lumpectomy.
As for reconstruction, unfortunately wait times for breast reconstruction specialists in Ontario are very long, as in one or two years. And if you don't have reconstruction done at the time of your MX surgery, then yes, it is in your own hands to find a PS. At that point the surgery is not part of your active treatment for breast cancer and is not considered urgent. But if you are having reconstruction done (or started, anyway, since it's usually a long process with at least a couple of operations) at the time of your MX, then you can get into one of these breast reconstruction specialists immediately - which is why the wait time is so long for everyone else.
Hope that helps.
Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole