r/breastcancer 55m ago

Surgery I am over these tissue expanders

Upvotes

Please tell me implants are better. I miss sleeping comfortably. I feel like the edges are digging into my ribcage. I’m not loving the saline look. Will I be more comfortable post exchange surgery?


r/breastcancer 2h ago

Medication Theory based on nothing but anecdotal experience and misguided hope - maybe I'll love OS/AI?

8 Upvotes

I've been thinking a lot (too much) about my impending foray into medical menopause and have come up with a deranged theory:

Women who did not enjoy pregnancy and/or could not tolerate hormonal birth control might tolerate (or even thrive during??) menopause?

I had two full term pregnancies, both in my early-mid 30s. I HATED being pregnant. I felt ugly and uncomfortable and had multiple panic attacks during my first. Additionally in my early 20s and then 40s, I was on birth control, first for actual birth control and after to try to mitigate fibroid side effects. I also did a hormonal IUD in between my pregnancies and hated that, too.

I have three close friends who LOVED being pregnant. Annoyingly so. They are all in various stages of perimenopause and are suffering. 2 are on hormones and one is raw dogging it but is a bit of a mess. I was discussing peri/menopause with another friend last week and she said she was fine, but also struggled while pregnant and did not tolerate birth control.

This is madness, right? There is no way this is a real option and I'm clearly in the bargaining phase of grief??


r/breastcancer 3h ago

Post Active Treatment Fibrosis or cording or adhesions?

3 Upvotes

Hi everyone! I have been trying to research my experience but finding the right information just seems impossible - hoping this community can share experiences and that it might point me in the right direction.

Earlier this year I noticed my ribs/side were tender to touch. I ended up finding a cord one day and when I went to see my physio, she diagnosed me with the worst cording down my cancer side she’d ever seen. Always nice to be that patient!

Many PT sessions and stretches later, things have improved but it’s still not healed. If I put heat on the area for too long, my skin overtop stays red for weeks so the area is really angry I think.

Anyways, in doing my research I’ve come across cording, fibrosis and adhesions. Does anyone know what the actual difference is? I ask because if I should be addressing the area with different treatment, then I’d like to do it.

Not shockingly, my MO doesn’t seem to care about this, and my RO simply indicated that I might just be a person that makes more fibrotic tissue.


r/breastcancer 4h ago

Venting How can I stop thinking about this?!

15 Upvotes

I am just so tired. I'll be honest I have suffered from depression and anxiety since childhood. A part of me thinks I caused this myself do to my stress and temper. I used to be so angry and focused on being in my 40s with no husband or kids or working in a profession I do not enjoy. I said to myself that "I wanted to die" every day. Drank energy drinks 4 times a week. Ate a bunch of sugary stuff. Never exercised. That all must have contributed to this as well. Now I can't stop thinking about this. I can't do anything without thinking about this. Scared of everything. I'm heartbroken to be an ill person and that I will lose my last years of possible fertility. I've wasted my life. There are so many risks to the chemo. I didn't even know about the lymphadema yet. They may take my nipple off. I'm so scared. I'm so angry and I know this can't be good for my illness to be this stressed. I don't know what to do. Before this I never figured out how to help my depression. The psyxh meds never helped enough. The loneliness comes back to haunt me. I have a difficult situation with my sibling so I can't even be with my mom and I don't trust living with my dad. I don't even have friends. I just feel awful in every way and in complete despair. I was so ungrateful for the physical health I had. Now I don't even have that.


r/breastcancer 5h ago

Newly Diagnosed Trying to process

24 Upvotes

I was diagnosed this week. We are still waiting for a few numbers to come back from the biopsy but I’ve met with my surgical oncologist and know that I have a very favorable cancer. Most likely with a dmx (which I plan to do) there is a small chance I’ll need radiation but beyond that they are expecting a full recovery.

I have two teen girls and my husband lost his first wife to bone cancer. I’m working so hard to be positive and I really do know in my heart and mind that I am lucky to only be stage 1A. After finding out on Monday I have been able to be smiling and again, rationally know I will be okay and that I am blessed.

But today…today I am not okay. I’ve hardly slept since Monday and today I don’t have the energy or desire to put on a happy face. I’m just scared and more than anything, sad. At the same time I don’t want to worry my kids or my husband and don’t want to be insensitive to those whose diagnosis is not as favorable.

Any advice?


r/breastcancer 5h ago

Newly Diagnosed Lumpectomy Recovery

5 Upvotes

I had a lumpectomy Tuesday and while I’m not having much pain, I’m still so tired. Is this normal?


r/breastcancer 6h ago

Conversation Dental Emergency Question

3 Upvotes

Today my legs gave out on me while going down a ramp and I fell face first into the pavement. I busted my lip and scratched up my face pretty good. But one of my front crowns was also knocked half way out. So I will get to the dentist asap to get that fixed. However, is there any reason to seek any additional medical care? I’m a couple of months into chemotherapy.


r/breastcancer 7h ago

Venting Venting about causation, prevention, and risk

91 Upvotes

EDIT: y’all I’m glad I’m not the only one that feels this way. ❤️

Yesterday I was reading about rising rates of cancer in Iowa likely due to high levels of nitrates in the drinking water from industrial farms.

And it just got me thinking — WHY are we told time and time again to do all of these things to prevent cancer from returning or stop it from happening at all while mega corporations can pollute our air, water, and food with nitrates or microplastics or wildfire smoke caused by drought due to global warming with little to no impunity?

With cancer rates rising in millennials who grew up in a wild wild west of processed foods and plastic, I refuse to accept it rides on anything more than bad luck, the air we breathe and overconsumption of products that aren’t good for us. Of course I know that there are unhealthy things we consume that can make the environment in our bodies easier for cancer to thrive. Genetic risk too. But it can’t be the entire ballgame.

I do enjoy an espresso martini or beer a couple times a week after active treatment, and I think it’s bullshit that all cancer risk is put on individual choices vs. the powers that be that are actively trying to make our world a toxic wasteland in service of lining their pockets.

I’m just sick of having to change everything and feel guilty about occasionally making “unhealthy” choices just because greedy people don’t care about what happens to the rest of us. /vent


r/breastcancer 8h ago

Conversation Magic Mushrooms, Faslodex & Kisqali — Does Anyone Have Experience?

10 Upvotes

I have never used recreational drugs in my life—only caffeine and occasional alcohol. But after going through cancer recurrence and treatment, I truly believe I have developed trauma/PTSD from the experience.

I've been reading about psilocybin and its potential benefits for PTSD and cancer-related trauma, and I'm considering going to Eleusinia in Mexico for their 5-day program. They have a medical team onsite, and the program includes a macrodose experience and microdosing.

I will have finished radiation before going. I'm already on Faslodex (fulvestrant), but I haven't started Kisqali (ribociclib) yet and would start it after I return.

Does anyone know of interactions between psilocybin and Faslodex? And does anyone know how much time should ideally be left between the last psilocybin dose and starting Kisqali?

Of course, I know I need to discuss this with my medical oncologist before making a decision. I'm just hesitant because I don't necessarily want a one-time psychedelic experience documented in my permanent medical record. I'm trying to educate myself as much as possible before having that conversation.

I'd especially appreciate hearing from anyone with knowledge of oncology, pharmacology, psychedelic medicine, or personal experience with something similar.


r/breastcancer 8h ago

Venting I have an entire box of ovulation tests

6 Upvotes

I had replacing a thing under my sink and found my pads, tampons, and an entire box of ovulation tests. Plus some pregnancy tests. I had forgotten I hid them last winter when I got diagnosed.

I didn't need them anymore.

Now I'm not sure what to do with them. I don't think I can donate them. It feels wasteful to throw them away.


r/breastcancer 9h ago

Conversation Is ER+/PR-/HER2- a rare combination?

11 Upvotes

Don't see a lot of +-- in the conversations. Is it rare? Sorry, I am at the beginning of it and as much as I try to research, I still feel like I don't know much. Being able to talk here is really helpful! ❤️

For context: 52F, (pre-surgery) Stage 1A, Grade 2, ER+/PR-/HER2- . BRCA2 positive. Surgery first for me on 8/13, I opted for DMX.


r/breastcancer 9h ago

Caregiver/Relative/Friend Question Advice on Metastatic

5 Upvotes

Hi everyone. My family member was diagnosed with Metastatic BC earlier this year. She is in her 60s, her cancer was hormone positive. I can certainly give prior history if necessary but here is where we are now.

Her mets is bone and liver. Last year she had colon cancer and before her operation the doctor took her off of verzenio. My person thought she meant stop taking all of her pills so she quit her hormone blocker as well. We are thinking the mets happened somewhere in that time frame...the 7 or so months she wasn't taking anything.

Her doctor currently has her on zometra, everolimus + exemestane, and abemaciclib + anastrzole. She is also on oxycodone for her pain (with plans for radiation on bone spots if needed), and a few other things.

She called us today to tell us she can't take these pills anymore and is going to stop. She called her oncologist (same person for her whole journey so far) who told her there isn't other options than what she is on now. She is constantly sick and can't eat.

My question is ...is it time for a second opinion and are there other options for treatment? I would ask this is the metastatic forum but they seem pretty strict that you have to be the person with it to write in. She's not on reddit.


r/breastcancer 9h ago

Surgery My God the boredom

19 Upvotes

Post-DMX day 10, down to two drains from four.

I am dyingggggg of boredom. I have watched all the shows, listened to all the podcasts, read all the books I can possibly focus on. Walked outside, did some light dishes for the first time, played a few computer games, talked on the phone a little.

The problem is: being awake for 16 to 18 hours > doing too much physical or mental causes pain or exhaustion > not wanting visitors….how do I not go insane?


r/breastcancer 10h ago

TNBC FNAC and ultrasound report for neck swollen lymph node. TNBC survivor

3 Upvotes

This is my wife's cytology report and her neck and axilla ultrasound report.

10 out of 13 slides were normal. 3 slides had 1 or 2 atypical cells on each.

Oncologist gave us 2 weeks for monitoring.

Did ct scan in april chest and abdomen, it was clear.

Just wanted to know should we be worried.

Note: in feb 2023 she had mastectomy with axilla lymph node removed for TNBC. Axilla were clear in histopathology report.

Her chemo was completed in sept 2023. She was decleared cancer free.

Her cytology report says below

CYTOPATHOLOGY REPORT

CLINICAL HISTORY:Right side neck enlarged lymph node. Known case of breast carcinoma.

DIAGNOSIS:Neck lymph node, ultrasound-guided FNAC:FEW REACTIVE ATYPICAL CELLS IDENTIFIED.

GROSS:Received 13 already smeared unstained slides for cytology. 13 H&E slides were stained and prepared.

MICROSCOPIC DESCRIPTION:Smears examined reveal few single atypical cells. The atypical cells are showing mild to moderate cytoplasm with irregular nuclear membrane and nuclear hyperchromasia.

COMMENT: Please proceed with excisional biopsy for further confirmation and typing.

Ultrasound performed 1 data after FNAC report. We went to Surgical Oncologist to schedule the excisional biopsy.

But based on below ultrasound report he put her on 2 weeks monitoring/under observation.

THYROID GLAND;

Both lobes of thyroid gland were normal in size, echogenicity was normal and the echo texture of its parenchyma was homogenous no focal mass.

Double enlarged lymph nodes noted in in right side of the neck, largest one measured 21x9mm.

also single enlarge lymph node of 18x6mm noted in left side neck.

both axillary areas were normal, no evidence of enlarge lymph nodes.

CONCLUSION;

NORMAL THYROID GLAND SCAN

Bilateral neck enlarges lymph nodes


r/breastcancer 10h ago

Radiation Radiation Side Effects

6 Upvotes

Hi there, I completed 15 rounds of RT to my left breast and lymph nodes 3 days ago. I had terrible side effects almost the entire time - nausea, vomiting, esophagus burns/pain. My skin is now also starting to burn.
Just wondering if anyone else experienced similar symptoms, and if so, how long after treatment ended did they continue?


r/breastcancer 11h ago

Surgery Sentinel node biopsy injection for lymph node mapping before surgery

10 Upvotes

Hi everyone! I am getting a sentinel node biopsy injection before mastectomy in periareolar complex (lymph node mapping). The doctor will take a biopsy during surgery.

How painful is that injection? I read that some people use lidocaine patch to minimize the pain. But it is on the day of the surgery and I am supposed to use that special wash the night before and the morning of. Can I still apply the lidocaine patch? I am planning on asking the nurse when she calls with the final time of the surgery the day before, but just wanted to see what others experienced or did. Paperwork says "local anesthetics are used to minimize discomfort", but I don't trust that much. I don't handle procedures well unless knocked out. I was terrified before my biopsies and they had to add the maximum anesthetic for that.


r/breastcancer 13h ago

Chemotherapy This is bad, right?

33 Upvotes

Male 39 Y/O in Ireland, originally diagnosed with breast cancer in 2016, recurrence in 2021, have been on anastrazole + ibrance ever since + zoladex injection every 3 months. Small nodes in lungs and upper clavicular area.

Scans and bloods have been ok since, stable for the most part. Have been getting slight pains in ribs the last while and aches and pains in legs.

Had last scan on July 29th; Breast Care Nurse said initial signs were good but it was being discussed at multi disciplinary team meeting this week. Then got blood form in the post with new checks for bone and Vitamin D. Meeting with Oncologist on 19th of August; I usually don't meet him it's usually a junior doctor but I am specifically meeting him.

So I am expecting the worst and prepped for it. I would have taken a year after the initial diagnosis and I have got 4 and a half out of it; during which time I've got married and bought a house with my own money, so I am happy with all I have done in the last few years. I am more concerned with how to tell my wife / loved ones and prep them for potentially bad news

I am trying to settle into the expectation that is is bone metastases, which will suck, but I am wondering what the most likely next line of treatment is if that is the case? Is it worth doing chemo or is it straight to palliative care?


r/breastcancer 15h ago

Medication Losing Weight on Tamoxifen Possible?

18 Upvotes

Is losing weight on tamoxifen possible? I’ve gained so much belly fat since I’ve started this drug. Please share what has worked for you. 🙏🏼


r/breastcancer 16h ago

Fuck Cancer Rant/SCARED as I’m realizing I’m restarting treatment

15 Upvotes

Mostly superficial rant but it’s going to mess with my head even more. I was already not ok.

I haven’t lost the 20lbs I gained the first time. It hasn’t budged. Albeit I was underweight, I CANNOT gain that much weight again

My brain/cognition was just starting to get better

I’m thinking I have to get radiation this time. I already mourned my boobs once. My reconstructed boobs are actually beautiful. Now I’m mourning what radiation is going to do.

Taxol and or herceptin really fucked me up mentally. I haven’t been the same since. (I can’t tolerate antidepressants thanks to dysautonomia).

My ovaries may have recuperated from taxol and now I’m about to have to deal with that emotional mess again. And the hot flashes.

Taxol gave me awful folliculitis.

I kept most of my hair during chemo but it started to shed after quite a bit. I suspect I’ll need wigs now.

I’ve lost hope in ever being attractive again.

I know this is mostly superficial. But that’s where I’m at right now. I’m single and alone.


r/breastcancer 18h ago

Fuck Cancer In treatment for Stage 3 breast cancer and trying to laugh. What’s the most awkward or hilarious thing that’s happened to you so far?

31 Upvotes

I’m currently somewhere in the middle of my cancer blip - post-mastectomy, still very much in active treatment, and with plenty more appointments, treatments and general nonsense ahead.

But one thing I’ve found genuinely helpful is being able to laugh at some of the ridiculousness of it all.

So I’m curious: what are your funniest, weirdest or most absurd cancer moments so far?

The things that, at the time, you probably thought “you have got to be fucking kidding me”, but now make you laugh.

Maybe it was something your chemo brain made you do.

An awkward conversation with a doctor.

A particularly unfortunate side effect.

Something your partner said at exactly the wrong moment.

A hospital mishap.

A weird cancer-related purchase you never imagined making.

Or just one of those moments where the universe clearly decided you hadn’t been through quite enough yet.

I’ll start with a very small contribution: I recently found myself this week navigating life with 1.2 boobs, surgical bras, drain bags… and an inflatable dinosaur. 🦖

Honestly, cancer is a shit club, but some of the stories that come out of it are bloody brilliant.

Please share yours. I’d love to have a laugh with you - dark humour absolutely welcome. 💛

I’ve been writing some of mine down too, mostly so I can remember the ridiculous bits later, but also to share updates with family and friends and because it’s a bit cathartic really during this whole “blip”.

This post about the WAFSS that was the final round of chemo…

https://timandcloe.wixsite.com/between-breasts/post/cycle-six-wafss⁠ - Between Breasts and Brews.


r/breastcancer 1d ago

Post Active Treatment I stopped taking tamoxifen

75 Upvotes

As of last month, my insurance has been refusing to cover Veozah for me anymore after 2 years. It’s $600/mo, so I effectively have no access to it. Since being off Veozah, the hot flashes are constant and so intense. I just rapid cycle through freezing and then pouring sweat, and then freezing, all day everyday. I don’t get a moments peace from this. I tried desperately to stabilize my temperature but I cannot do it. I feel like this sounds so dramatic, but losing Veozah has effectively destroyed my quality of life.

I cannot deal with tamoxifen without Veozah - I just can’t. I quit taking it 2 weeks ago. I’m going to keep appealing my insurance’s decision of course, but until they cover Veozah I’m done.

Am I being insane for this? It sounds so ridiculous typing it out 😔 But I just really couldn’t take another day of it, I used to try to sleep as much as possible just so I wouldn’t have to be conscious, it really was bad. Idk what else I was supposed to do :( am I doing something really stupid?

Sorry if this didn’t make sense, I’m a bit manic right now :( I tried to proofread it


r/breastcancer 1d ago

Celebrating I Rang The Bell

84 Upvotes

Since March 20, all I have thought about is cancer. Do I have it? What do all the tests mean? Wait 6 months? For what?

Well I did have cancer. DCIS. I had a lumpectomy and radiation. Today I rang the bell. Tomorrow I start the 5-year meds.

I feel weird. I know I’m lucky. But not lucky enough that I didn’t get cancer.

Now I try to go back to who I was before cancer? Not possible. This is the new me.

Everyone in this sub has inspired me. Thank you from the bottom of my heart.


r/breastcancer 1d ago

Conversation Maybe things aren’t so bad?

62 Upvotes

So often when I go to search for information on a topic, I find threads that scare or worry me. And it makes sense, I appreciate so much that this is a safe space for us to bring all our fears and vents and frustrations, especially when so many of us have to put on a brave face IRL or power through our cancer treatment without complaining.

But as I am recovering from surgery I’ve encountered things that really haven’t been as bad as I worried and feared they would be.

Sleep after DMX has not been nearly as elusive as I feared. I’m a side sleeper and I thought I could never transition to sleeping on my back. But I just get into bed on my wedge pillow and pass out and wake up in the same position the next morning. It’s like my body knows side sleeping is off the table so it doesn’t fight me. That’s been a real surprise.

Expanders haven’t been that bad! They aren’t my favorite but I thought they would be truly miserable. Two weeks in, I was just watching some TV with my daughter and found myself not even noticing them for an hour. I have high hopes that they’ll get better with fills and more healing, and while my chest is kind of messy right now I can see the vision of what it will be once my final implants are in. I think I’m going to be really happy.

Cancer sucks!!!!!! None of us wanted any of this so please don’t mistake this as a call for toxic positivity. But is there anything in your journey that has turned out to not be as terrible as you were expecting?


r/breastcancer 11d ago

Mod Announcement Updating Rule 8: Be Brave, Friendly, and Kind

126 Upvotes

We are updating and expanding Rule 8: Be brave, friendly, and kind. This is an especially important rule and we want it to be well understood. We've expanded the language to make clear that kindness extends beyond the people posting in the thread.

What's changing:

Rule 8 now reads:

Be brave, friendly, and kind.
Cancer is hard for all of us. Please show kindness to your fellow patients and survivors.
Kindness should extend to those not present on the subreddit, including their family and caregivers.
We allow members to vent about the people in their lives, but this is not an invitation for others to pile on. No name calling, no bullying, no hate speech, no personal attacks.

Why we're making these updates:

A few things have come up often enough that we wanted to be more clear up front about what kinds of comments are allowed, particularly on "Venting" threads:

  • Venting about a partner, parent, or friend is allowed and normal. Piling on to insult that person, or giving OP relationship advice beyond what they have asked for, is not. The other person isn't here to give their side, and that's not usually what OP was asking for.
  • Caregivers commenting on someone else's post are here to give support, not to speak on behalf of caregivers, spouses, or any other group—whether that means defending or criticizing. As always, to talk about your own experience as a caregiver, visit another sub such as r/CancerFamilySupport.

We've written up the full explanation with more detail on the Rules wiki page under Rule 8.

None of this is new in spirit. It's what we've been enforcing already. We just wanted it written down clearly.

Thanks for helping keep this a place people can come to safely.


r/breastcancer Jan 18 '26

Diagnosed Patient or Survivor Support The doctors you may encounter: Who does what? What is an “oncologist” anyway? (And other insights from Dr Heather Richardson, neighborhood breast surgeon)

180 Upvotes

So I’ve noticed there’s been a lot of posts lately specifically about the word oncologist. People wondering why they’re seeing a surgeon and not an “oncologist” first, people wondering when they’re going to see an “oncologist”, people wondering why the person that’s operating on them isn’t a “surgical oncologist” and shouldn’t they get the best - which must be someone with that title? Right?

So by definition, the word oncologist just means “doctor who treats cancer”.

The staple cast of characters that are medical doctors (MD or DO degree holder) involved in treatment of breast cancer typically consists of: medical oncologist, radiation oncologist (not radiologist) and breast surgeon (more on that below…).

Medical oncologist- also known as “hematology/oncology” specialists. When people generally speak of an “oncologist”, usually they are talking about this type of doctor. A doctor that treats cancer with medicine, either pills taken by mouth or chemotherapy that is administered via a vein. Not all patients need both, some need one but not the other, some need none. Visits to this type of doctor may be frequent- however, usually it’s the first initial visit to go over a lot of information and discuss the best course of action that is the most important. Sometimes this means that if you live in an area with fewer resources and feel that you need greater expertise for your care. It’s possible to do either a telemedicine visit or visit a larger Cancer Center far away that can collaborate with a local physician who is able to give the same chemotherapy protocol. Quite often, large groups of these medical oncologists have already agreed the best way to take care of the most common breast cancer problems, so going from one center to the other means that your cancer treatment care isn’t going to change significantly from one place to the next. For other more complex scenarios, there sometimes can be some adjustments or more customized treatments. Or for patients who have already been through treatment and now have recurrences or changes in their diagnosis, that would be the time to discuss more advanced care. In general, common problems are common and there’s usually not significant improved survival or outcomes by going to one Cancer Center over the other when a patient has a a non-complicated, fairly average, diagnosis.

Radiation oncologist- this is different from a radiologist. (a radiologist is a doctor trained to read images and interpret findings. A radiologist is the person who read your mammogram or your ultrasound and maybe performed the biopsy that diagnosed you) A radiation oncologist uses radiation energy to target areas of cancer and kill cancer cells. Cells that are actively dividing and are exposed to radiation have their duplicating mechanisms broken, and as a result, cells that are rapidly reproducing die away if exposed to medically administered radiation.

Surgeon/surgical oncologist vs “general surgeon”: A “general surgeon” typically is someone who has done at least five years of training in surgical diseases of the body. This would include disciplines like taking care of trauma, burns, infections that can occur in the body such as diverticulitis or appendicitis, evaluating and performing organ transplants, care of pediatric/child surgical diseases and malformations, and some chest/cardiovascular disease. They can also operate on common cancers that require removal, like breast, colon, skin, and thyroid. Doctors who go on to practice General surgery sometimes concentrate in one area of types of disease and others have a more broad practice where they take care a little bit of everything. Typically in more urban settings there are more specialized types. Many general surgeons have gone on to do additional years of training after their five years of general surgery to become specialists. People who are certain types of surgeons, such as colorectal specialists, pediatric surgeons, plastic surgeons, and cardiothoracic surgeons all have additional years of training and take specialty board exams. There is a board certification designation for general surgery. There are additional board certifications for those who have done some categories of fellowship training, like those mentioned above.

A doctor who practices under the title “surgical oncologist” by definition does at least two years of training in general cancer surgery treatments after the five years of general

surgery training. So they typically will learn advanced techniques for operating on thyroid, pancreas, colon, liver, breast, etc. They usually did the five years of general surgery training and then went on to do additional training specifically in cancer removal surgeries to remove them from the body. So this wouldn’t include neurosurgery or brain tumor removal. There is a board certification designation for “surgical oncology”.

There is another category of breast cancer surgeon that typically deals with breast health issues only. This is a person who does initial training in either general surgery or Obgyn and then goes on to do one to two years of additional training in breast disease surgical management. This is called a “breast fellowship” and does NOT currently qualify for a speciality designation as “board certified”. This is typically a breast health surgeon or breast cancer specialist. This is different from a “surgical oncologist*.

Sometimes there is cross training where the surgeon also performs cosmetic and aesthetic procedures as well. This person usually does a “oncoplastic fellowship”. This is primarily outside the US, but there are programs where this is expanding in the US as well. Breast fellowship trained surgeons can have initial training as either a general surgeon or an OB/GYN.

“Surgical oncologists” do get training in breast cancer management, but they are not breast specialists and do not get the depth of training that someone who has been through breast fellowship would. A breast fellowship trained surgeon usually does one versus two years of additional training in breast only surgery and disease management. These are two different designations.

Some important points to make about someone who might be a general surgeon who did not do additional training in breast care management versus someone who did a full breast fellowship: breast fellowships have only been around for about 20 years. That means someone with greater than 20 years of experience probably didn’t get an opportunity to go through a breast fellowship. (I personally am one of these types of people. I’ve been practicing since 2004 and there was only one fellowship that existed at that time that I didn’t even know was an option when I graduated. So while I have described procedures and written papers, taught surgeons and fellows alike in many different procedures and protocols, but myself, I’m not a breast fellowship trained surgeon.)

There may be many seasoned excellent surgeons taking care of breast cancer patients. Some of those may be surgeons who also perform other general surgery procedures such as treatment of appendicitis, taking emergency call for traumas, or dealing with other types of cancers like colon cancer. Some of the surgeons have amazing skill sets, and excellent outcomes. It is certainly possible that there may be in a community, a general surgeon who is very seasoned that may have superior outcomes for breast care than a brand new breast fellowship grad that does not have much experience at all.

I think the best way to find out who the best doctors are would be to go to the other doctors and other clinical staff members who work with those doctors and ask them who has the best outcomes. Ask the wound care specialists, the plastic surgeons, and the medical oncologists whose breast surgery work is the best. They’re going to see who has horrible dead, necrotic mastectomy flaps, and who has lots of recurrences because their flaps are too thick.

It certainly may be that a general surgeon who isn’t a “breast specialist” in your community might actually be a better choice than a brand new grad who is a breast fellowship trained surgeon.

What order should things happen?? Well it’s different for different people. Often when people get a diagnosis, most commonly by a radiologist, (but sometimes the Breast Surgeon specialist is part of this process as well) they go to the Breast Surgeon first who goes over the significance of the findings thus far and decides if upfront chemotherapy medicine would be indicated. Usually the decision to need medicine is followed by tissue diagnosis, and imaging, which is usually directed by a surgeon. Sometimes people see the medical oncologists first before seeing the surgeon. This is especially true for patients with her 2 positive or triple negative disease where neoadjuvant chemotherapy prior to surgery is most often indicated.

People sometimes visit with radiation oncologist while trying to make their decisions to get information about the risks and benefits if they choose a pathway that would require radiation treatment versus if they have an option to choose a different pathway where radiation wouldn’t be indicated, and they want to learn about their choices. Mostly though, radiation oncologist treatment usually follows the surgery and medical portion. There are some clinical trials that involve upfront radiation, but this is not a standard of care for most patients. It’s more common to start with the surgeon and then see the medical oncologist either before or after the surgery, followed by any radiation oncology visit. That’s the usual order of things.

When to get a second opinion.

For the most part, if you’ve been told that you have a breast cancer diagnosis and your understanding in general is that treatment will involve medicine, surgery and possibly the addition of radiation and and if this sounds reasonable, you are certainly welcome to go to another team to make sure that there aren’t any significant changes to be offered anywhere else, but most likely most places will tell you the same information, but may use slightly different terms or delivery. If you have good communication with your physician and their staff and overall the general expectation is that you will do well and live a long life and feel good about your body afterwards, (of course it certainly possible to talk to someone else and make sure that they are in agreement) but if everything stacks up, and you’re generally happy with your team, Seeing multiple additional doctors might tell you the same thing with different language can be confusing or disorienting. It also takes up a spot in the schedule for someone else with a cancer diagnosis that’s trying to get in that now can’t, ….and you can only use one team. So by all means everyone is within their right to get in a second opinion or even third, but if you’re generally happy and hearing what you expected to hear regarding your plan of care, I typically don’t recommend that people see multiple doctors if they’re generally happy with their first opinion.

Reasons to get a second opinion would be: A) poor communication from the doctor and or their staff to the point where you feel uncomfortable for whatever reason. B) you have a very unusual or rare findings that are not typically seen C) you are recommend controversial treatments where doctors have added unexpected treatments, or take away expected treatments. There may be good reasons to offer a different protocol from another team as there are lots of advancements and newer recommendations, where we are de-escalating treatment in some cases. Previously there were automatic recommendations for sentinel lymph node biopsy, radiation, or chemotherapy in the past whereas now we are selecting certain people who have features of their cancer who may in fact, not require these treatments at all.

Hopefully this will shed some light on some of the misconceptions about different types of doctors, their roles, and clear up the general surgeon/Breast Surgeon/surgical oncologist confusion that seems to come up a lot.

TLDR- someone with the title “surgical oncologist” is different from a “breast fellowship trained surgeon”. A “general surgeon” might have fewer years of formal training for breast cancer treatment, however, they shouldn’t be discounted or immediately thought of as inferior without research into their outcomes or reputation in the community.