Selecting A Surgeon

I was fortunate to have my chemotherapy up front, which allowed us to actually see the tumor respond and shrink......therefore also get any cells that may have escaped (the REAL Bad Guys). This also allowed me time to really explore my surgical options. I had a fabulous general surgeon and interviewed 3 plastic surgeons. I learned that a nipple sparing mastectomy might be an option, even though I was told by at least one surgeon that it was not an option. I subsequently learned that very few surgeons do this new proceedure. Anyway, I found out through a friend of a friend of a friend (litterally) that there was a great surgeon at Emory who did the nipple sparing proceedure. I met with him and he felt that I would be a good candidate (small breasted and the tumor was far enough away from the nipple). Also, he was an oncoplastic sugeon, meaning he would do the entire proceedure himself, mastectomy and reconstruction. This meant a more cohesive surgey and less time under anesthesia. I have to say, the before and after photos did make a difference to me as well. No visible scar and a natural nipple, not a tatoo. I feel so Blessed to have even had a CHOICE. I am Blessed :o) I was his 50th nipple sparing mastectomy. I was fortunate to have my chemotherapy up front, which allowed us to actually see the tumor respond and shrink......therefore also get any cells that may have escaped (the REAL Bad Guys). This also allowed me time to really explore my surgical options. I had a fabulous general surgeon and interviewed 3 plastic surgeons. I learned that a nipple sparing mastectomy might be an option, even though I was told by at least one surgeon that it was not an option. I subsequently learned that very few surgeons do this new proceedure. Anyway, I found out through a friend of a friend of a friend (litterally) that there was a great surgeon at Emory who did the nipple sparing proceedure. I met with him and he felt that I would be a good candidate (small breasted and the tumor was far enough away from the nipple). Also, he was an oncoplastic sugeon, meaning he would do the entire proceedure himself, mastectomy and reconstruction. This meant a more cohesive surgey and less time under anesthesia. I have to say, the before and after photos did make a difference to me as well. No visible scar and a natural nipple, not a tatoo. I feel so Blessed to have even had a CHOICE. I am Blessed :o) I was his 50th nipple sparing mastectomy.

I just wanted to say that both Dr. Attai's and Jody's answers are great, and I wanted to offer confirmation of both based on my experience.

As Dr. Attai said, having an involved primary care doctor counts for a lot. I had been seeing mine for many years, and he recommended my surgeon because they work together a lot. I figured my surgeon would be good because my PCP is pretty picky, but I later found out he's very highly regarded and doctors send their own family members to him. I did find out he's board certified and did ask him if he does a lot of breast surgery as a general surgeon, and he said, "All the time."

To support what Jody said (great question!), bedside manner is a deal breaker for me, but I'll trade bedside manner for skills when you're wielding a scalpel in my direction. I was blessed to have both, as my surgeon is as famed for his bedside manner as his considerable surgical skill. (Nurses tell me how good my breast/gallbladder scars look and then say, "Oh, you had Dr. K.") And a big yes to those nurses! I had never had surgery before and was so relieved when my PCP's nurse told me how much my surgeon's patients like him. Every OR nurse I talked to said "He rocks" or "You hit the jackpot" or something like that, and I KNOW nurses are picky. I asked one OR nurse what she does when she hears about a doctor who's not so great, and she said there's not much you can do. She tries to casually bring up the name of someone good, as in "Oh, did you know Dr. So and So also does that?" (hint hint--so keep that in mind if a nurse says that to you :) )

Excellent discussion! Dr. Attai,I'm not sure we realize how lucky we are to have you explaining all this stuff. It's more helpful than you know. Thanks for your question - it is difficult to determine if any physician is "good", just like any other professional whose services you rely on - attorney, accountant, car mechanic...

The obvious initial things to check are board certification, and training location such as medical school and residency. Professional society memberships usually indicate an interest in staying current and following the latest treatment recommendations. Some professional societies relevant to breast surgeons are the American Society of Breast Surgeons (http://breastsurgeons.org/) the American Society of Breast Disease (http://www.asbd.org/) and the Society of Surgical Oncology (http://www.surgonc.org/).

Publications and research are important, but realize that many excellent community / private practice surgeons stay current and practice state of the art care by reading the literature and attending meetings but may not have the time or resources to be involved with research themselves.

Referrals from a good, engaged primary care physician should count for a lot - if that primary care physician is working closely with his or her patients, they will have feedback from their patients regarding the surgeon's personality, practice style, and of course results.

Talk to other patients, local hospital (and operating room) nurses. Many hospitals have a "doctor finder" physician referral service - it can be a good start. Talk to the mammographer or nurse navigator at the breast center where you get your mammograms done, or talk to the mammography technologist - these women see patients back from all the surgeons and often hear the good and bad stories. There are a tremendous number of on-line patient resources as well - as just one example, http://www.savisisters.com/about-savi is an on-line resource and support site for all women with breast cancer, but it focuses on women who are undergoing 5-day partial breast irradiation - patients have the opportunity to talk to other patients who have "been there, done that" and get some feedback.

Also ask your surgeon - "do you have any patients with my similar type of tumor/proposed surgery, etc that I can talk to to get their experience?". Very reasonable question.

At the end of the day, you have to make a decision and it can be overwhelming especially if you've received input from multiple sources. Interview all the doctors, and keep an open mind. Take notes, and bring someone with you who can help ask questions but also be an objective observer. After you've received your opinions, review them just like you'd review any other important proposals. And don't hesitate to call or return for a follow up visit to get clarification on issues to help finalize your decision.