Gyno or Plastic Surgeon for operation?

[Gladys700]

Last June I booked an operation to reduce my breasts in April this year (due to a waiting list) with a Plastic Surgeon.  I chose him after comparing him with others and I believe he will do a good job with very little scarring. My Gyno told me to have a Mamogram before the operation to be sure all is well.  He phoned me a week ago to say they have found a cluster of at least 20 microcalcifications in my left breast and as some of them are oval shapes  they are considered "highly suspicious".  I had a biopsy today and must wait 10 days for the result.  My Gyno is sure  I will need surgery.  If the result is benign he wants to take them out (but a small amount of breast cut away) as he is convinced they will turn into cancer within 5 years.  If they are malignant then a larger amount of the breast will have to be removed and he will talk about that with me later to see how much.  He has told me that I should cancel my breast reduction operation but also said that when he takes the cluster away he could maybe reduce my breasts at the same time.  My Plastic Surgeon tells me that he is trained in removing all forms of breast cancer and has already done full mastectomies with lymph glands.  My question is, if I am going to have to have surgery anyway, which doctor should I chose?  I have known my gyno for 30 years and he is probably quite specialised in cluster formation etc.  However, as I was wanting reduced breasts anyway, I feel the Plastic Surgeon is more experienced in this area and if he knows what must be taken away, then he can do both things at the same time.  Do you have any advice of which one I should chose please?

[BhumikaMD]

Hi,

Glad the post was of some help. Let us know if you have any other doubts and do post us the biopsy reports too. discuss them with your specialist too.

Keep us posted.

Best wishes.

[Strike3]

Dear Gladys:

Gynecologists in the U.S. are also surgeons - but they don't do Breast Surgery.

I'm sure training is different in different countries, as you say.

Best of luck to you.

Kind regards,

Strike3

[Gladys700]

Dear Strike3;
I will wait for my results which I'm optimistic will show nothing serious.  There is no breast cancer in my family.  I'm trying to find things out "just in case".  I've been given details of a good surgeon in a cancer clinic in Brussels so I think I'll make an appointment with him to see what he says.  It's just really the waiting game now.  I'm keeping busy finding things out.
I'll get back in touch once I have my results.
All the best.
Gladys

[Gladys700]

Hi there,
I will wait for my results before deciding anything.  I live in Luxembourg and maybe the surgeons and doctors are trained differently here especially as there's only about 1/2 a million of us who live here, so I think that's why gyno's are also surgeons.  But I've been told of a cancer institute in Brussels so I think I will make an appointment there and see what they say.  I'll stay in touch and thanks for your help.

Best wishes.

Gladys

[Strike3]

Dear Gladys:

After you get your biopsy results and IF further treatment (such as additional surgery) is recommended then consult with a specialist.

To find one:  Do you have another doctor - such as a family doctor - one who isn't a surgeon and has no  conflicts of interest in providing a recommendation?

He/she should be able to provide a recommendation on a breast surgery specialist.

Please let me know your results - if it turns out that you require further surgery then please, please, please do as much research as you can so that you can be sure to ask all the right questions and get all the answers you need to feel comfortable.

Do not let this gyno bully you, intimidate you or anything else.  Who cares if he's insulted that you're questioning him on the best course of action.  You should question him as much as you want or need to feel comfortable with your decision.

Remember, as the patient YOU ARE THE BOSS!!!

Kind regards,

Strike3

[BhumikaMD]

Hi,

It would be best to decide about what has to be the further plan of management after the biopsy results come in and also to talk to the plastic surgeon in detail about this.

A gynec does not usually do breast surgeries - either a breast specialist or general surgeon is the person you should contact.

Let us know about how you are doing and if you have any other doubts.

Also post the biopsy results when they come in.

Regards.

[Gladys700]

Thanks for your thoughts.  I will rethink everything once I have the results of the biopsy.    If it comes back with cancer cells I will probably deal with that first and then the reduction after as you've said.  I go round in circles with thoughts.  At least this all keeps me occupied until I get my results.  I had my biopsy done yesterday, so 9 days to go for the result.

[Gladys700]

Thanks for your thoughts.  I will rethink everything once I have the results of the biopsy.    If it comes back with cancer cells I will probably deal with that first and then the reduction after as you've said.  I go round in circles with thoughts.  At least this all keeps me occupied until I get my results.  I had my biopsy done yesterday, so 9 days to go for the result.

[Gladys700]

Thanks for your reply.  I'm from Luxembourg, it's a very small European country and when I suggested to the Plastic Surgeon that perhaps a surgeon who is specialised in removing cancer or pre-cancer cells could perhaps work with him, he said that there are three surgeons who remove cancer and they are a Gyno, a Plastic Surgeon and a General Surgeon.  He behaved as if he were insulted that I should doubt his capabilities.  I know when I talk to my Gyno he will react in the same way.  I guess I must first wait for the results of the biopsy.  If it's a bad result, perhaps I'll forget about the reduction for now and concentrate on getting better.  Anyway, thanks for your input.  It's great that the doctors work together in America.  Here they seem to try and get as much money from the patient as possible so I never know if it's a question of money or if they are really giving good advice.

Good luck with your operation.  It sounds like to me like the best way to go.  I'll be thinking of you too.

[japdip]

Definitely NOT the Gynocologist for any type of breast surgery. I would opt for a surgeon (a breast specialist) but since you are going to have other surgery done by this Plastic Surgeon I suppose he would be an OK choice. I think I would deal with the calcification issue first and put the other surgery on the back burner for the time being. Your biopsy results will be the key to your decision.

[Strike3]

Dear Gladys:

I don't know where you're from - and different countries seem to have different ways of doing things.

Here in the U.S. a gynecologist doesn't do breast surgery.  A General Surgeon - and one with lots of experience doing it - would be the one to do an excisional biopsy, lumpectomy or mastectomy.  If breast reduction or reconstruction is planned a plastic surgeon usually does it - either at the same time as the first surgery (generally considered to offer a better aesthetic result) or at a later date.

My own personal opinion on this is if your biopsy results come back as positive for cancer that you might consider consulting a surgeon specializing in breast surgery and still use the Plastic Surgeon for any reduction or reconstruction that you may want.  They should be able to work together.  They do here in the U.S.

This is what I have planned.  Both surgeons are working together.  The breast surgeon will do her thing (which includes a planned Sentinal Node Biopsy - as well as the bilateral mastectomy) and then the Plastic Surgeon will step in and do his thing.

None of the breast surgeons I consulted ever even considered doing the reconstruction part themselves.  Every one of them told me I would get the best results on that part of the operation from a Plastic Surgeon.

I'm sorry you're going through this. It's horrible to have to wait so long for your biopsy results.

I have found that educating myself on breast cancer and breast reconstruction techniques to be very, very helpful in calming my fears and knowing what questions to ask of the medical experts.

I've had a lot of medical issues and have ceased to worship doctors - especially surgeons.  No matter what they think of themselves they are not gods. Do not let them intimidate you. You're the patient - and therefore THE BOSS.

I wish you all the best.  I am thinking of you.

Kind regards,

Strike3