In some cases, a plastic surgeon may be “assigned” or strongly recommended to you as part of your treatment team. This is often the case if reconstruction is going to start at the time of mastectomy. In other cases, you may need to find a plastic surgeon on your own; this can sometimes happen if you are seeking reconstruction or a revision to a previous reconstruction several months or years after initial treatment. You can start by asking your breast surgeon or other patients or searching the websites of medical centers in your area. Whatever your situation, you’ll want to interview any surgeon who is recommended to make sure you’re comfortable with his or her surgical expertise and communication skills.
Be aware that plastic surgeons who offer breast reconstruction vary widely in their level of skill and the range of procedures they can perform. It is rare for any surgeon to offer — and excel at — every type of reconstruction procedure. Some really only do implants; others only do tissue flaps. Some surgeons only know how to do the flap procedures that have been around the longest, such as the TRAM and latissimus dorsi flaps. Newer flap procedures, such as the DIEP flap, require special skill and training in microsurgery, which involves reattaching tiny blood vessels from the flap tissue to the vessels in the chest area. If you’re seeking a revision to a previous reconstruction, you’ll want someone who is experienced with revision surgery.
So, be prepared to ask direct questions about which procedures a surgeon does most. If a surgeon only talks about certain procedures or downplays one approach in favor of another, he may be biased toward the types of surgery he knows how to do. You’ll probably have to talk to a few surgeons to get the full picture of what your options are. It’s also wise find someone who spends a great deal of time performing breast reconstructions versus someone who offers every type of plastic surgery under the sun, from facelifts to liposuction. You can ask for before-and-after photos and patient testimonials to assess his or her abilities, too.
Once you have the names of a few plastic surgeons, check to make sure they meet the following criteria:
- They are certified by the American Society of Plastic Surgeons, which offers a searchable directory online. Certification means they have completed specialized training and education in plastic surgery. You can further verify their certification through the American Board of Medical Specialties. There are many surgeons out there practicing plastic surgery who are not certified, so you’ll want to check on this.
- They accept your health insurance and are willing to work with your insurance provider as needed if any questions arise.
- They are available to meet your preferred time frame.
Schedule initial consultations with any surgeons you are considering. A consultation should be a fairly lengthy appointment — more than 30 minutes — in which you can talk through all of your questions. (See Questions to Ask Your Surgeon About Breast Reconstruction for a list of suggested questions.) This is also your best chance to make sure you are comfortable with this surgeon personally: you should be able to voice your thoughts, speak openly, feel like you are being heard, and receive honest and complete responses in return. Keep in mind that this is someone you will be working with over time on a very personal area of the body. Open communication is key.
If you live in an urban or suburban area, you should be able to find reconstructive surgeons with a range of expertise. This can be more challenging if you’re in a rural town or remote geographic area. For example, you may find plastic surgeons who perform implants and some of the earliest flap procedures, such as TRAM flaps, but not the newer ones. Some women in this situation choose to travel to another town or city to work with a particular surgeon or technique that they want. This involves more expense and inconvenience, such as travel and lodging, and you would need to make sure that any surgeons you’re considering would be covered by your health insurance plan. This extra effort may be worth it in the long run: getting the reconstruction done the way you want it in the first place can make a major difference. If you decide to do this, try to schedule two or three consultations on the same day, or consecutive days, so you only have to make one trip. Once you arrive at a decision, the surgeon’s office often can help you figure out the logistics of your hospital stay and recovery, insurance coverage, and lodging for any family members or friends accompanying you.
On the other hand, if travel and/or extra expense are just not possible, you may need to make the best choice among the options available close to home. You’ll need to think about your particular situation and do what’s right for you.
“Some surgeons are good technicians, some are good artists. You want one who is both.”
– Kathy Steligo, The Breast Reconstruction Guidebook (2017)