A general surgeon is a jack of all trades in the operating room. A general surgeon has a minimum of 5 years of training in 9 areas of surgery. Common conditions that call for a general surgeon include hernias, gallstones, appendicitis, and breast tumors. General surgeons can pursue additional training in, for example, surgical oncology. The vast majority of breast cancer surgery in the United States is performed by general surgeons who do fewer than 20 breast cancer cases a year.
A breast surgeon is a general surgeon who has a strong interest in caring for patients with breast cancer. Unlike, say, plastic surgery, there is no board certification specific to breast surgery. All breast surgeons in the United States have done a surgical residency, which makes them general surgeons. A small percentage have gone on to complete an extra training, called a fellowship. A fellowship-trained breast surgeon has spent an extra 1 to 2 years studying breast surgery or oncology through either the Society of Surgical Oncology accredited breast fellowship or surgical oncology fellowship programs. However, many excellent breast surgeons began practicing before breast-fellowship training became available in 2004, so don’t discount a highly experienced surgeon who doesn’t have this credential. But the credential is something to look for as a marker of a general surgeon with expertise in breast care.
An oncoplastic surgeon combines plastic surgery techniques with breast surgical oncology, meaning they are trained to both remove the cancer and create a good cosmetic outcome. Oncoplastic surgeons are potentially ideal for flatties because they are more highly trained than the average general surgeon but they aren’t hyper-focused on reconstruction like plastic surgeons.
Plastic surgery is a surgical specialty focused on restoring, reconstructing, or altering the body. To become a plastic surgeon, a medical school graduate completes an additional 5 to 6 years of surgical training. The pro of going to a plastic surgeon is they often have a great deal of breast experience. The con is that they are typically focused on reconstruction so getting them to do a flat closure may not be easy. Some may not accept a patient who wants a flat closure because the surgery doesn’t reimburse as well as reconstructive surgeries.
Plastic surgery is a broad field with several sub-specialties. Microvascular surgery is the sub-specialty of plastic surgery that handles reconstructive surgeries that involve “free flaps,” meaning taking tissue from one part of the body and moving it to the chest to create a breast-shaped mound.