After Your Mammogram : Referral to a Surgeon

After your mammogram results are in, you may receive a call that you will be referred to a surgeon for further treatment.  This doesn’t necessarily mean that you have breast cancer, but it does mean that more examination and information is necessary before a diagnosis can be made.

Please Note: I am not a medical provider, and I highly advise you to make sure to follow up with your doctors and medical team for any specific medical advice.

My Story: The Call I Didn’t Want to Get…

The referral call isn’t a fun call to receive.  I remember sitting down at my breakfast table when I got the call from my primary care doctor.  She was very kind as she told me that my mammogram and ultrasound results indicated that I needed to be referred to a surgeon for a potential biopsy.  This wasn’t totally unexpected, because I have lumpy breasts, but I wasn’t thrilled about this call.

Since I had her on the phone, I decided to take a few moments to ask some questions.  I wanted to make sure to take advantage of her perspective while my case was still fresh in her mind. 

I asked her which surgeon I would be referred to.  I then asked if this person was a breast cancer specialist.  When I found out that this doctor was a general surgeon, I decided to ask some followup questions.  I asked her if she was aware of any breast cancer specialists in the area.  She thought about her previous patients and was able to give me the name of another doctor in the area who her patients seemed to like working with.  I thanked her for the time, and then let the news sit after I hung up the phone.

I wasn’t surprised that I was being called back in.  I had already been back to the office for a followup mammogram and ultrasound.  I was pretty sure that a biopsy was in my future. It was now time to think about which surgeon I would see.

My Decision Making Process

I was familiar with the surgeon that I was being referred to, and I was aware that he was not a specialist in breast surgery.  The more I thought about my history with lumpy breasts and now with this new calcification that had shown up, I was really convicted that I needed to find a surgeon who would specialize in my breasts. 

I already have a dentist, an eye doctor, a hand doctor, a shoulder doctor, and now I think I needed one for my breasts!  What was important to me was that I received personalized care based on the unique issues that I have with my breasts. 

I have dense breasts with benign lumps in them that had already been biopsied a few years ago.  I wanted to make sure that I was being followed closely and that any changes would be found as quickly as possible.  Additionally, I wanted to build a relationship with the surgeon who would be operating on me, if necessary.

I am a big believer is building long term relationships with medical professionals, whenever possible.  When I find someone I can trust, my anxiety goes down when I need to see that provider.  I like the ability to build a medical relationship over many years so that my care can be personalized to my needs.  When I realized that the surgeon I was being referred to was a general surgeon, and was the same one I had seen a few years ago,  I felt my anxiety growing. 

It took a few weeks for me to realize why.  I was on a walk with Dave when the light finally went on for me.  My anxiety was high, not because of the possibility of cancer,  (weird, right?), but because I didn’t fully trust the medical care team that I was being referred to.  They were not low quality, and there is no definitive reason why I was feeling that way.  But I just didn’t like it.  Here I was, facing a scary time in my life, and I wanted a supportive, individualized, specialized  team around me.  I needed a care team that I could trust completely.  I knew that I needed to look elsewhere.

So, I made some calls and managed to get an appointment with another doctor.  I needed to wait several weeks to keep that appointment, but I am so glad I did.

Choosing a Different Surgeon

It turns out the first specialist I saw in this new medical group was actually an oncologist.  Usually these professionals only see patients with a definitive cancer diagnosis.  But, when I was on the phone with the scheduling team I shared my story of previous biopsies and abnormal imaging, and the doctor agreed to see me even without a cancer diagnosis.

When I saw him in the office he reviewed my imaging and also took the time to look at my most recent bloodwork.  He spent time listening to me, and answering my questions.  He was so patient with me.  Then, he said that who I really needed to see was a breast surgeon.  There was one who worked in the office with him that he highly recommended.  

Her went out of the room to get the referral information, then quickly popped back in to see if it would be ok if the surgeon saw me right then!  The surgeon was doing paperwork in the office and was available to see me!

The oncologist and the breast surgeon came in together, and the surgeon quickly greeted me and then looked over my imaging results.  He wanted to get my imaging redone at this facility as soon as possible and then have an appointment with me to discuss the results.  

After seeing both of those doctors and getting the new imaging scheduled, I suddenly felt a relief flow over me.  The level of care, confidence, and attention I was getting helped me trust my new care team.

Have Confidence in Your Breast Surgeon!

The breast surgeon I met that day was the one who oversaw my diagnosis process and also was the one who did my surgery.  He was faithful to call me back when I wrote him questions through the patient portal.  He respected my desire to receive results in person rather than over the phone.  

Your breast surgeon will be the one who is ordering the additional imaging, and also the one who will be ordering any biopsies.  The only way that a cancer diagnosis can be confirmed is with a biopsy.  Throughout my diagnosis process I had a total of 5 of them!  I’ll write more about those in other posts.  

The breast surgeon will also be the one recommending the surgical treatment for your breast cancer, if appropriate. He will likely work with a reconstructive or plastic surgeon if a mastectomy and reconstruction is performed.  

Please, take time to research your surgeon and choose one who you feel comfortable with. I was more comfortable with a breast surgeon because I was convinced that the cosmetic results after surgery would be better with a specialist.  

While I won’t show you my surgical results, I will say that I am quite pleased with how things look now after my lumpectomy.  My surgeon used a technique called flap rearrangement to make sure that my breast didn’t dimple after he removed one of my lumps.  I have 2 small scars, one on my right from the cancer removal, and one on the left from a benign lump removal.  

When we were discussing my treatment options, I asked him about mastectomy plus reconstruction for my particular case, and he said that he would much rather see me have a lumpectomy because the recovery time was so much quicker.  He would have performed the mastectomy, if I had chosen that path.  He told me his patients were happy with their reconstructive results after that surgery, but he was also very honest about how major that surgery was and the difference in recovery time.  What I really liked was that I was able to ask him lots of questions, in the office, and through my patient portal, and he was ready and willing to answer them for me.  

Your breast surgeon will be the one orchestrating your diagnosis process, ordering biopsies, and overseeing your surgery choices and recovery.  Take the time now, after imaging and before diagnosis to make a choice of a provider you are comfortable with. 

Here are a few links that I have which I hope will be helpful to you as you research a surgeon for your care.

• Breast 360 is a patient facing website written by breast surgeons.
• National Breast Cancer Foundation has a guide for patients to understand the care team and the specific roles of each doctor in your care.
• I sought information from Breastcancer.org on many of my questions.  They are a great resource for patients.

A referral to a surgeon doesn’t always mean that you will be diagnosed with breast cancer. In fact, there are many things that can come up on imaging that require more information. If you do get that referral call, I highly recommend that you do research on who you are being referred to. The surgeon is a very important part of your care!