Find your surgeon
One of the most important relationships you will have during your breast reconstruction procedures is with your reconstructive breast surgeon. Your reconstruction may take place over many months or even years, you might have several revisions and nips and tucks until you have achieved the result you want to consider yourself complete. Because of this it is important to have a good relationship where you can be comfortable and honest, able to discuss the good, the bad and the ugly as you proceed throughout your surgeries.
It is important to understand that every woman is unique and that the type of breast reconstruction that is best suited to you will be a decision made in consultation with your surgeon.
SURGEONS INVOLVED IN MASTECTOMY AND BREAST RECONSTRUCTION
Your mastectomy will be completed by a breast surgeon and your reconstruction either by the same breast surgeon or a specialist plastic surgeon. Breast surgeons perform some types of reconstruction, usually implant. In immediate reconstruction in particular, the breast surgeon plays a very important role because the quality of the reconstruction is interlinked with the quality of the mastectomy. In many cases the breast surgeon will perform the whole reconstruction or work closely together with a plastic surgeon.
Breast reconstruction can be immediate, that is reconstruction following mastectomy in the same operation, or delayed where reconstruction may be performed weeks, months or even years after mastectomy. Sometimes it is a choice you can make with your healthcare team based on personal preference or scheduling, but in other cases your specific situation and the team and facilities at your hospital will determine what is available for you. See also Professor Boyages page "What will I do about my breast"
It is important to understand that every woman is unique and that the type of breast reconstruction that is best suited to you will be a decision made in consultation with your surgeon.
SURGEONS INVOLVED IN MASTECTOMY AND BREAST RECONSTRUCTION
Your mastectomy will be completed by a breast surgeon and your reconstruction either by the same breast surgeon or a specialist plastic surgeon. Breast surgeons perform some types of reconstruction, usually implant. In immediate reconstruction in particular, the breast surgeon plays a very important role because the quality of the reconstruction is interlinked with the quality of the mastectomy. In many cases the breast surgeon will perform the whole reconstruction or work closely together with a plastic surgeon.
Breast reconstruction can be immediate, that is reconstruction following mastectomy in the same operation, or delayed where reconstruction may be performed weeks, months or even years after mastectomy. Sometimes it is a choice you can make with your healthcare team based on personal preference or scheduling, but in other cases your specific situation and the team and facilities at your hospital will determine what is available for you. See also Professor Boyages page "What will I do about my breast"
Reconstructive Plastic Surgeons
Some plastic surgeons are specially trained to perform breast reconstruction. Plastic surgeons have an extensive surgical education and training including a minimum of 12 years medical and surgical education, with at least 5 years specialist postgraduate training. Autologous breast reconstructions are usually performed by plastic surgeons. Understand more about plastic surgeons from the Australian Society of Plastic Surgeons.
Some plastic surgeons are specially trained to perform breast reconstruction. Plastic surgeons have an extensive surgical education and training including a minimum of 12 years medical and surgical education, with at least 5 years specialist postgraduate training. Autologous breast reconstructions are usually performed by plastic surgeons. Understand more about plastic surgeons from the Australian Society of Plastic Surgeons.
“It's that package that inspires trust and confidence that makes you feel like they understand and will do the absolute best they can to get a good outcome.” Chris, online group member |
Oncoplastic Breast Surgeons
A more recent development in Australia is oncoplastic breast surgery. This approach sees plastic surgery come together with breast cancer surgery with the one surgeon. Using this method the surgeon may plan a breast reduction surgery while at the same time remove tissue containing a breast cancer. Oncoplastic surgery aims to remove the breast cancer and reconstruct the breast in a way that you would ideally like. Dr Elisebeth Elder talks about Oncoplastic Breast Surgery. Understand more about advanced breast surgery at Breast Surgeons Australia and New Zealand (Breast SurgANZ). |
Top 10 things to consider when choosing your reconstructive breast surgeon |
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Members of the Breast Reconstruction Online Group have shared some wisdom to help you find your Dr Right. This is a list of the things they have found to have been the most important traits.
- Member of the Australian Society of Plastic Surgeons (ASPS) or is appropriately skilled in the procedure being performed such as through Breast SurgANZ - This is important to ensure you have an appropriately qualified reconstructive breast surgeon to undertake your procedure.
- Approachable – It’s great to have a surgeon who you feel comfortable asking questions of, where no question is a silly one, and who is happy to discuss your fears and concerns.
- Makes you feel like part of the decision making – Being offered options is an important part of decision making however not everyone has this luxury due to their specific situation. A good surgeon asks you questions, listens and helps you to make informed decisions and gives you information and helps you see the different possibilities. They take the time to ensure everything gets covered rather than feeling rushed.
- Contactable – One of the most valuable things you can have is a direct line to our surgeon, whether this is by phone or email. A surgeon who offers their email or mobile number understands you might have further questions or might need to be in touch during out of office periods over the months or years of your relationship.
- Considerate and respectful – It’s just so nice when your doctor remembers your name, either in their office or at the bedside. A good surgeon will listen to your concerns and attempt to allay fears while offering realistic outcomes. It’s extra good if they consider the potential financial burden of procedures, but that they do not make assumptions about your ability or willingness to pay.
- Dedicated – If most of these points are a yes, then your surgeon is committed to you as a patient. Many surgeons will visit you personally bedside post-surgery but this isn’t always possible and often it’s someone from their team.
- Sense of humour and smiles - A surgeon who smiles and can have a laugh helps to keep things relaxed. Surgery and appointments can be emotional, so this trait can help to break that composed and formal atmosphere that can make you feel intimidated.
- Confident – You want a surgeon who is confident and reassuring, especially if things stray from the plan. You need to be able to trust your surgeon that he or she as the capability to get things corrected and back on track.
- Skilled and experienced - Your surgeon should be able to show you several pictures of their work. Ask to see images of their work and if they have any patients willing to speak to you about their surgery and outcomes.
- Works in a team and consults with colleagues - Many surgeons work as part of a multi-disciplinary team where they discuss cases to make the best judgement in consultation with colleagues.
Be your own advocate
No one else needs to invest in your surgery to the extent that you do. You are living with the outcome for the rest of your life, and in order to put it all behind you you need to bring what you want and need into the conversation. Not everyone is comfortable having these conversations and even the strongest of us can feel intimidated when in the surgeons office and we can get caught up in the flurry of jargon, drawings, measurements. It's common to just agree so that you can get out the door and back to some sense of control.
A good way to overcome this anxiousness is to go to your appointments prepared with the materials and information you have gathered, with a list of questions to ask, a pad and pen to jot things down. Some ladies have said it is empowering to go armed with information even if you don't need it. Another good tip is to tell your surgeon that you are nervous and unsure, and this can sometimes slow things down a bit and help the surgeon to understand where you are at and adjust themselves accordingly.
Even with all the best preparations and ideal relationship with your surgeon, it is still difficult to work out how you feel with any decisions made. This is where it is great to chat to other ladies in our communities, let your community friends know you are off for a consult, see what they say and suggest. Let them know when you get back and talk it over with them to help make sense of it in your own mind. It can help just to know someone understands where you are coming from.
A good way to overcome this anxiousness is to go to your appointments prepared with the materials and information you have gathered, with a list of questions to ask, a pad and pen to jot things down. Some ladies have said it is empowering to go armed with information even if you don't need it. Another good tip is to tell your surgeon that you are nervous and unsure, and this can sometimes slow things down a bit and help the surgeon to understand where you are at and adjust themselves accordingly.
Even with all the best preparations and ideal relationship with your surgeon, it is still difficult to work out how you feel with any decisions made. This is where it is great to chat to other ladies in our communities, let your community friends know you are off for a consult, see what they say and suggest. Let them know when you get back and talk it over with them to help make sense of it in your own mind. It can help just to know someone understands where you are coming from.
Intellectual leverage
"In the context of breast reconstruction you need to be aware of a very powerful thing called intellectual leverage. When you are talking with an expert such as a plastic surgeon, and if they have an inbuilt bias towards a particular technique, they can lead you down a path and encourage you to choose what they want you to choose. Every surgeon is not the same, you need to have information free from intellectual leverage. It can be hard to recognise in the whirlwind of your diagnosis, but the best way to find the best path for you is to do your homework, speak to other women who have had that surgeon or technique and become informed. Your preparation to meet with plastic surgeons will be far greater and more successful with all this information under your belt.
You may get several different opinions when you meet with plastic surgeons, even if you are prepared for the appointment you may still not completely understand their suggestions or what they suggest simply does not make sense to you. If you don't understand what the surgeon is saying, ask them to clarify what they mean, ask them to draw pictures to explain. Listen to the little voice in your head, it might just mean you need to find another surgeon. If you need to travel a bit to do that, do it."
Frank J. DellaCroce, M.D., F.A.C.S., plastic surgeon and co-founder of the Center for Restorative Breast Surgery.
Listen to the audio interview with Dr DelaCroce by breastcancer.org
Communicating with doctors and other health professionals
Your plastic surgery appointment
If you have been through treatment for breast cancer you might becoming familiar with talking to doctors and other health professionals, but if not it can be very intimidating. The conversation about removing and or rebuilding your breasts can be a very difficult one. Empathetic doctors will try to put you at ease, and each time you see them will get easier. Try to have a friend or loved one go with you to appointments, especially at the start. They can listen and talk the details over with you afterwards. Take a pen and paper, jot down some questions to ask them and leave spaces to gather the responses.
A surgeon who is thoughtful understands that you might have all your questions asked and answered during the consultation, but as soon as you walk out the door and think things over, a whole lot more questions arise. Your surgeon might offer you their phone number or email address to ask further questions. Don’t be shy, take the details and don’t hesitate to ask what you need to.
It can be helpful also to do a bit of research prior to your appointment. Get in contact with other women in a similar circumstance as you, read about the different types of reconstruction. This will help you to have a two way conversation which is much more productive.
Don’t be afraid to get a second opinion. You are making a lifetime commitment to this surgery, so it can be wise to shop around a little. Like many professionals, surgeons often specialise in their preferred procedures, so a different surgeon might suggest a different procedure for you.
Meeting with several surgeons can be costly, and timing may not permit or you may be satisfied with the first one you find. However this may be a long relationship, so it can be reassuring to make a good choice at the start if you have the opportunity.
If you have been through treatment for breast cancer you might becoming familiar with talking to doctors and other health professionals, but if not it can be very intimidating. The conversation about removing and or rebuilding your breasts can be a very difficult one. Empathetic doctors will try to put you at ease, and each time you see them will get easier. Try to have a friend or loved one go with you to appointments, especially at the start. They can listen and talk the details over with you afterwards. Take a pen and paper, jot down some questions to ask them and leave spaces to gather the responses.
A surgeon who is thoughtful understands that you might have all your questions asked and answered during the consultation, but as soon as you walk out the door and think things over, a whole lot more questions arise. Your surgeon might offer you their phone number or email address to ask further questions. Don’t be shy, take the details and don’t hesitate to ask what you need to.
It can be helpful also to do a bit of research prior to your appointment. Get in contact with other women in a similar circumstance as you, read about the different types of reconstruction. This will help you to have a two way conversation which is much more productive.
Don’t be afraid to get a second opinion. You are making a lifetime commitment to this surgery, so it can be wise to shop around a little. Like many professionals, surgeons often specialise in their preferred procedures, so a different surgeon might suggest a different procedure for you.
Meeting with several surgeons can be costly, and timing may not permit or you may be satisfied with the first one you find. However this may be a long relationship, so it can be reassuring to make a good choice at the start if you have the opportunity.
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Not everyone is comfortable having these conversations and even the strongest of us can feel intimidated when in the surgeons office and we can get caught up in the flurry of jargon, drawings, measurements.
Things your surgeon may ask you
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Your surgeon will advise you if any other tests are required, such as blood tests, X-ray examinations or an Electrocardiograph (ECG) to assess your heart. Prepare a “recovery area” in your home. This may include pillows, ice packs, a thermometer and a telephone within easy reach. Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic. Someone should also stay with you for at least 24 hours after you return home. Your surgeon should give detailed preoperative instructions. Follow them carefully. For further information visit Australasian Foundation for Plastic Surgery website: |
Questions to ask your surgeon |
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One way to get the right answers for your situation is to understand the right questions to ask. Getting to know the language and terminology used will help you to make informed decisions and to get responses to you need. Members of the Breast Reconstruction Online Group have shared their hot tips to get the answers you need at your appointment.
Pre-surgery questions
- Am I a candidate for an immediate skin/nipple sparing breast reconstruction at the time of mastectomy?
- How quickly do I need to decide about my options? Do I have time to wait a little longer to be sure I have thought over my options?
- What factors impact on the timing of this type of breast reconstruction?
- I have had some lymphodema – is this surgery likely to make it worse or might it be improved?
- What are the specific steps in each stage of the procedure that best suits me? What are the risks related to each stage
- What's the projected timeline for each stage? How flexible is this timeline?
- What are the options for my other breast? How and when is contralateral surgery done? What are the advantages/ disadvantages and risks?
- Am I able to keep my own nipples? If not what are the options and when do I need to make any decisions regarding this?
- If my nipple/s are saved, will I have sensation/feeling in them? What will they look like?
- How will reconstruction affect my skin sensation?
- Where will my incisions be on my breasts and my tissue donor area?
- How do you recommend to manage scars post-surgery?
- Is there any preparation I can do before the surgery to improve the reconstruction outcome?
- Will I be able to be discharged with drains or do you prefer to discharge without drains?
- How should I expect my reconstructed breast/s to look and feel?
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Questions about implant reconstruction:
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Questions about autologous reconstruction:
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Questions for post-surgery
- What follow up appointments and procedures will I need including revisions and nipples reconstruction?
- Will I need to wear a compression garment? How long do I need to wear compression garment for?
- When can I commence walking and exercise, lifting and driving again?
- Exactly what exercise is required to regain full movement in arms post-surgery
- What/how will I feel post-surgery - swollen, bruised, stinging, and stabbing pain? And if I have other illnesses, can you treat me with relevant medication if needed?
- What care is recommended at home post-surgery?
- What is the expected overall recovery time for my type of surgery?
- Will I need to see a physiotherapist in hospital/outside hospital to help with recovery?
- How will my physical functioning be restricted during my extended recovery period?
- How much time will I need to take off work (specify occupation)?
- Who can help me with techniques to get in and out of bed post-surgery?
- When will it be safe to resume sexual activity post-surgery?
- What are the warning signs of potential problems?
- If unexpected problems occur when I am recovering at home, what should I do and who can I call?
- What are my options if I am unhappy with my reconstruction results?
