Breast Surgeons and Plastic Surgeons
This is a compilation of what we’re learning to ask using resources from the book Positive Results, speaking to other women who have gone through prophylactic surgeries due to a BRCA mutation as well as those who have had cancer, and from reading blogs, articles, and websites. This is not a comprehensive list and we are not medical professionals. Please add additional questions in the comments so we can further build this list!
Note: You want to be sure surgeons have had experience performing the type/s of reconstruction procedures that interest you, then consult several doctors who perform them. Your breast surgeon should be known for their excellent ability in taking all those pesky cells that can turn in to cancer (and I’m sure there are more qualifications than this, but this is the main point after all). Your plastic surgeon should not be the same as your breast surgeon and has performed the kind of recon you are interested in, a lot. For anyone not clear about this, this is not augmentation. There are a number of different types of recon and we’ll get into that perhaps in another post.
- How many of the specific procedure have they performed?
- What are the complications that other patients have experienced?
- What percentage of their patients have experienced complications?
- Ask to see photos of their work
- Ask for patients who would be willing to talk about their experience
- Ask if a resident, intern or fellow will be performing any part of the surgery or will be involved in your care. In my opinion, and many others, you only want the surgeon doing any and all of the procedure. Make sure they can tell you with confidence that only the surgeon you are interviewing will be performing the surgery. I have talked to some women who changed doctors and hospitals as they did not want to be associated with a teaching hospital.
- How long do they expect the surgery to be?
- I tend to get very nauseas from anesthesia and pain killers, is there anything they can do about this? Meds they can provide me into my recovery?
- What are the expectations when you wake up (ie your mobility, how soon will they get you up to walk around, pain)?
- How long do they expect you to be in hospital?
- Will I have a private room so my husband/partner/family can stay over night?
- What physical restrictions are part of the recovery and for how long? (ie restrictions on what you can lift, when you can drive/that your reactions and use of shoulders will be safe, when can you exercise and what kind, when can you do more “normal” things?)
- How long do they expect you to have drains?
- Are they available for questions during recovery?
- What happens if there are complications?
- When do they expect you can return to work? (depends on the type of work you do and your own body―I’m reading that many women need 6 weeks. At 3 weeks they’re really not ready but some don’t have much choice.)
- Get diagnostic codes for the procedures so you can share with your insurance to get a guess at what your out of pocket expenses will be
Nipple Sparing vs Skin Sparing Mastectomy
These are the procedures I am most interested in and these are the questions I’ve put together thus far in preparation for my consultations.
- Am I a candidate for a nipple sparing mastectomy?
- Is there anything we can do prior to surgery to ensure the nipple doesn’t contain pre-cancerous cells?
- Is there anything we can do prior to surgery to ensure the nipple will be able to continue getting blood flow after surgery, to prevent necrosis (when the skin dies due to lack of blood flow)?
- How do you reconstruct a nipple?
- How do I care for a reconstructed nipple through recovery?
- Is there a need to perform a sentinel node biopsy? Will you be removing any lymph nodes? If yes, what are the risks of lymphedema (fluid retention and tissue swelling in that can occur in the arms)?
- Based on my size/shape, if can keep nipple or not, where will the scar/s be? I prefer not to have a side scar. Are either lollipop or anchor scars performed? Other?
- How do I best take care of the scar so it heals nicely? I’m so pale that everything looks more dramatic on me…
- Assuming we will be going straight to expanders, what is your recommendation on how often to get filled and how much based on my size?
- Any concerns with reactions to the material of the expanders, saline fills or eventually implants?
- How many months do you expect me to be in expanders?
- What is the pain management protocol through the expansion process? I hate taking meds!
- What kind of exercising should I not be doing during the expansion process?
- When you do the implant transfer, if need nipple recon or other cosmetic improvements, are these done at the same time or do you have to wait for the implants to settle?
- What kind of implants do you use?
- What do you think of the Gummy Bear or Tear Drop implants?
- If I need nipple or areola tattoos, what is the best process? Seeing some women with very faded/uneven tattoos.
- What causes rippling with the implant? How is that corrected?
- In what cases would you use AlloDerm, fat injections, other materials to give the breast the most natural look possible?
- What if I have issues of insomnia, anxiety or depression? I’ve heard some women go through a variety of emotional issues pending how their bodies/minds handle this type of major surgery.
- What type of bras and athletic bras are appropriate during recovery?
- What kind of breast cancer surveillance do we do once I’m fully healed?
Necessities & Resources
Check out what we’ve begun compiling for useful information about preparing for surgeries and helpful resources: