Hand Slapped by my surgical oncologist 😡

[eva9310]

I have a medical oncologist and surgical oncologist on my team at MD Anderson. I'm doing ac x 4 every three weeks almost done with that then perjeta, taxol, & herceptin for 12 weeks then surgery then herceptin for 9 months every three weeks.

I'm almost done with my AC and went to a consultation with a plastic surgeon that has come highly recommended.

My surgical oncologist pretty much called me and chewed me out. I guess she doesn't think I need to be interviewing or picking my own plastic surgeon and that I would just fall in line and see who she told me too.

Then she said (without even seeing my response to chemo) that her plan is to take at least 10 lymph nodes, mastectomy, expanders and radiation for 6 weeks then 6 months to a year later reconstruction.

MDA is aggressive. That's both good and bad but what the heck, you can rail road me and make these decisions for me not to mention while they are fantastic at curing cancer (because of a lot of over treatment) they are not known for gracefully putting you back together. Plastics is not their specialty so I don't expect that, thus I looked for a surgeon that I feel comfortable with and deciding what type of reconstruction is MY choice.

I'm not even leaning towards RADs or taking more than the 2 positive lymph nodes.

Does everyone have a surgical oncologist and plastic surgeon? My plastic guy said he would work with her but she said NO. He works with another breast surgeon who also comes recommended and does a lot of breast cancer but she's not a surgical oncologist.

Any thoughts?

Eva
Er/pr negative, her 2 positive
Right breast clear
Left breast, 2 tumors, 4mm & 1mm
2 + lymph nodes (the 1st pathologist said negative MDA said positive)
Apparently there is a grey area I don't understand.
Treatment

[sarah]

Hmm, well she may feel the radiation will be better to do before reconstruction, hopefully someone can answer the delay with reconstruction question. I hope you're right handed. taking out so many lymph nodes means you'll have to be very careful with that arm and if you ever prick it or get a bite on it, you will have to quickly clean it and put an anti-bacterial liquid on it. You should definitely have lymph massages after the surgery and learn to do exercises yourself.
You're at the top HER2 hospital so you are in good hands.
take care,
health and happiness
sarah

[snolan]

I had a general surgeon and plastic surgeon who have worked together and it went very smoothly. I was told by the general surgeon that he didn't know what was going to have to come out until he got in there. I would question why the surgical oncologist is predetermining what he is going to do and who he will work with. You need to have control of what is going to happen to you on some level. You always have a choice of who you work with so don't be bullied into something that doesn't feel right.

[Nurse4u2day]

I have a surgical oncologist ( specialist in IBC) and 2 plastic surgeons along with my medical oncologist. They all work very well together .
I listen to my medical oncologist for chemo tx
I defer to my surgical oncologist for the bmx ( IBC is actually in the surface of my skin along with in the skin tissues)
My first PS placed my expanders . My second PS out of Stanford specializes in the type of recon I'm going to have done DIEP ( my other ps does not , one is local oneis not hence. The two PS.
My surgical oncologist referred me to both my medical oncologist and plastic surgeon. My first plastic surgeon referred me to my Standford surgeon.

[LizzElliot]

You should be able to have the docs you want. However, if you have two who won't play nice together, I suppose that's worth considering. Is your Surgeon's preferred PS OK? Or should your Surg be given the boot for one who can play nice with your chosen PS? Honestly, when you are facing chemo, cancer, surgery, recovery, your Surg should be ashamed of herself. Quite unprofessional to have these deal-or-no-deal alliances and hold you captive to them.

[Shirley]

Eva,

Your medical team should work together. I wonder if the surgical oncologist said "no" because you'd be going to a different hospital, or maybe your plastic surgeon doesn't have privileges at MD Anderson? My PS was present for the mastectomy so that he could place the expanders.

I've never been told what to do; recommendations were made and I usually had some choice. I am going to providers that are all in the same hospital system and they all work together regularly. I did at one time consider a PS in another town for DIEP and they were all fine with that. Nobody ever said "no".

Ultimately it's your choice. Does MDA assign you with a nurse navigator? I went to this person on a few occassions for assistance (needed desperately to switch to a different radiation oncologist)--they are usually very good at helping you untangle and resolve these issues.

One comment about the nodes. What you've described sounds standard. If you have 2 positive nodes I think it is common to take more than that. I only had micromets in one node and my surgeon took 5 or 6 (and I know some of the other docs in that hospital routinely took out more than that).

I hope things get cleared up soon for you.

Shirley

[BonnieR]

I notice your profile mentions a "grey area" regarding lymph nodes that's pretty important to clear up!
And I personally would have to step back and reconsider a surgeon who is so domineering and touchy. Unless she is fabulous and just has bad bedside manners. But these decisions are yours to make, not hers. You chose the doctors who you're comfortable with
I like someone's suggestion of speaking to a patient advocate to sort this out
But don't take any crap either!
Keep the faith

[jaykay]

My breast surgeon has a "preferred" plastic surgeon she works with. I met with the ps to make sure I liked her and agreed with what she wanted to do. I think all the breast surgeons have preferred partners but you still have the right to choose who you want. If I didn't like mine, I would have chosen someone else.

They do work in tandem - breast surgeon does the mx and the ps is right behind him/her with the reconstruction.

Were the 2 positive nodes from a sentinel node biopsy? They are tricky; you have to be careful. That's probably why they are recommending rads.

I had a bmx first with expanders, chemo, radiation and did end up waiting about 6 months for the final exchange surgery with silicone implants. Only reason I waited so long was some business travel that was planned. Had my expanders in for a year. The radiated breast is a bit tighter than the other one, but basically, they look fine to me.

No bullying allowed here - you make your own choices and get all the opinions you want.

Best
Janis

[KeriK]

I too am a MDA patient. My onc surgeon was dr Kelly Hunt and plastics is Dr Jessie Selber
I love them both and they worked great together. My recon was done months after radiation. Your skin needs time to heal and I highly recommend having those "gray" nodes removed!!
Hope this helps
PS. My breast look so great and so natural Dr Selber listened to my concerns and wishes and was able to come up w a plan that didn't involve tram flap.

Keri

[Adriana Mangus]

Eva,

I have to agree with Kerik. I did not have breast reconstruction but it's important for the body to heal.

Nice post Kerik.

Take care,

Adriana

[agness]

Wow. That is a lot of audacity. No, you get to decide who does your reconstruction.

If I hadn't don't my research the standard of care for me would have been left mastectomy and full ALND. But I had been breastfeeding at the time of my diagnosis and I knew where the tissue was damaged as it was no longer producing milk there.

Based on a study that had been done looking at neoadjuvant chemo and SND as a predictor of response in the axilla we were able to get my surgeon on board with less invasive surgery, given my HER2 diagnosis they easily offered me lumpectomy instead of mastectomy.

My sense after 6 rounds of TCHP and an MRI and ultrasound showed the tumor had dissolved was that surgery wasn't needed, that if anything was left if was microscopic and rads could take care of it. Still, there is little to no data available on forgoing surgery and none about doing this after neoadjuvant TCHP. I resigned myself to having the lumpectomy and SND which I had this week. My pathology report came back quickly - no cancer was found anywhere and my lymph node showed scarring.

TCHP is working and the doctors can't even keep up with the results.

[norkdo]

gosh, you have to be Canadian.

[CoolBreeze]

I selected a different PS than my surgeon typically works with. He didn't complain but iI found t is just a bit more difficult to schedule sometimes. My PS had a homebase of one hospital and my BS had a different hospital. They had privileges in both hospitals but the schedules meant that certain surgeons got preferences and it was harder to manage.

It's weird stuff that we never know about. But why your doctor wouldn't just explain that is beyond me.

I agree with everybody. You pick who YOU want and they have to make the rest of the stuff work.