With or without a plastic surgeon? How common is a mastectomy and reconstruction without p.surgeon

Redgina

Hi everyone,
my family member’s breast cancer doctor said she can perform her mastectomy and reconstruction without the help of a plastic surgeon. This makes my family member nervous. As she was told by friends theirs was done in tandem with a plastic surgeon. Whilst she is happy to have the cancer removed, the mastectomy is the finish line hopefully at the end of the chemo. She will be able to keep her nipples and needs a reduction and removal of skin as has lost weight and only wants the smallest of implants/expanders put in. Her surgeon said she does this all of the time by herself. My question is how common is this? She feels she may want a second opinion.

Julez1958

Hi @Redgina
There are a number of reconstructive procedures the main ones being implants versus using your own tissue ( must common is DIEP).
Yoy would definately need a plastic surgeon for the second type and I believe you would have a better outcome with a plastic surgeon for the implants as well.
I was referred by my breast cancer surgeon to see a plastic surgeon when it became clear I would need a mastectomy and wanted to consider reconstruction .
If you ask to join the private group on here “ Choosing Breast Reconstruction  “ there are lots of stories and photos I found most helpful.
I ended up having the DIEP reconstruction and am very happy with the results.

Redgina

thank you so much for taking the time to share this point of view. I actually found it difficult to find this information in google.

Julez1958

@Redgina
Also worth looking at the website “ Reclaim Your Curves”.

iserbrown

It's commendable you are researching for your family member however every case is individual.   
The family member needs to understand the treatment and if the mastectomy is also nipple saving and if the cosmetic changes you mention are included.  They should be speaking to the Surgeon with an understanding of what the surgery entails before heading off for a second opinion. 

arpie

'General surgeons' are not necessarily 'plastic surgeons' (who require way more extensive training) and I know many regional patients discovered that, sometimes, with unhappy results.  This is why I went to Sydney for my surgery.  

I only had 'minor' fat redistribution with my specialist breast surgeon, who removed my nipple & replaced it after removing the tumour - and my Onc can barely notice the difference between my good one & the bad one  ... I don't believe my surgeon is a plastic surgeon 'as such'.  If I'd had more extensive surgery I probably would have gone down the Plastic Surgeon road tho ... 

You should be able to google your family member's current surgeon and see comments on their ability (similar to trip advisor.) .. but with a bigger procedure... a 2nd opinion from a dedicated breast plastic surgeon would be a good idea. 

Take care and all the best for your buddy.

Abbydog

My Mastectomy with axillary clearance was done by a Breast Surgeon.
He did not talk about reconstruction in any detail, prior to surgery to remove the cancer, and have 20weeks Chemo and 5weeks R/T.
After all of that, he talked about Recon.
He told me which ones could do confidently and with experience.
He referred me for an opinion for DIEP to a PS. That is very long 10-12 hrs and is microsurgery.
I wasn't suitable.
I sought a second opinion from a different PS, who also decided that I wasn't suitable. Based on a CT scan of my abdominal blood vessels.
I don't know why, but had my surgery with the second PS, mostly based on one personal recommendation from a friend from work. She was very happy.
I believe any of these Drs could have done my surgery well.
I had a Lat Dorsi (Cancer side) and prophylactic Mastectomy to other side (actually done by my breast surgeon, present in theatre at the same time) I had Bilateral tissue expanders and closed by the PS.
The PS did most of the surgery. Perhaps the Breast surgeon can identify and remove breast tissue better. 
I don't know if a General surgeon would do a Breast Reconstruction.
My story and photos are in 'Choosing Reconstruction'

Vetty

I had immediate reconstruction and it was done my a general surgeon who specialises in breast reconstruction.  If I’d had delayed reconstruction then I would have been refer to someone in plastics. I have to admit that I just assumed a PS would do the surgery and was shocked when I found out it was a general surgeon who was doing it.  But after some investigation, I found this was common practice in the public system and the surgeon I was referred to was highly revered for his work which put my mind at ease. 

Afraser

I had a mastectomy in the private system and chose no reconstruction but my surgeon, who
has an excellent reputation, would have done it (and still would if I changed my mind!). It very much depends on the practice, the individual patient and the surgeon, which is not so very different from how you relate to your oncologist or other health professional. Checking out satisfaction with other patients may be possible. My not doing reconstruction had nothing to do with my surgeon who I still see, ten years on, and who is still highly regarded.