Choosing Your Breast Surgeon

What are the qualifications for a surgeon?

All surgeons must first qualify as doctors, so they all have a basic medical degree which includes the principles of medicine and surgery. The title of this degree varies according to the university attended. Examples such as at the University of Melbourne are MB (Bachelor of Medicine) and BS (Bachelor of Surgery) ie MBBS.

Surgeons then go on to do many years of further training in surgical specialities. On completion of the further training they acquire a specific surgical qualification ie FRACS (Fellowship of The Royal Australasian College of Surgeons).

Some surgeons then undergo further additional “super” specialist training in a particular discipline, known as a fellowship. Fellowship training programs are available in breast surgery such as the breast fellowship completed by Miss Jane O’Brien. A breast fellowship provides comprehensive and specific training in all aspects of screening, diagnosis and treatment of benign and malignant breast conditions.

How can I find out if my surgeon is appropriately qualified and registered?

• All doctors require current registration with the Australian Health Practitioner Regulation Agency (AHPRA) in order to practice. The AHPRA website has a Register of Practitioners on which you are able to confirm that your doctor has current registration, and is not suspended or deregistered.
• The Royal Australasian College of Surgeons (RACS) has an online Find a Surgeon Directory listing Fellows of the Royal Australasian College of Surgeons who meet the requirements of the College’s Continuing Professional Development (CPD) programme.  
• Breast Surgeons of Australia and New Zealand (BreastSurgANZ), the professional society of breast surgeons in Australia and New Zealand, is a membership based society, with differing eligibility criteria for the five levels of membership, reflecting differences in technical capability, breadth and depth of experience, structured and accredited post fellowship training. BreastSurgANZ has an online list of members- BreastSurgANZ Find a Surgeon

Why do many surgeons in Victoria use the titles, Mr or Miss, rather than Dr?

The tradition of addressing surgeons as “Mister” or “Miss” rather than “Doctor” is firmly entrenched in English surgical practice. Female surgeons in the United Kingdom have traditionally been addressed as “Miss”, regardless of marital status. The strong influence of the Royal College of Surgeons of England in the formative years of the Royal Australasian College of Surgeons (RACS) led to the persistence of the term in Australia. The tradition is generally thought to have had its origins in the days of the “barber-surgeons”. The blade-wielding skills of barbers had given them opportunities for surgical practice, and “surgeons” at that time seldom had formal qualifications. With the separation of the surgeons from the Great Company of Barbers and Surgeons in 1745 and the establishment of the Royal College of Surgeons of London, the title “Mr” was retained and began to be seen as a label of status, as it marked the completion of formal examinations.

In most other parts of the world all medical practitioners, physicians and surgeons alike, are referred to as ‘Dr’.  The Royal Australasian College of Surgeons is attempting to totally phase out the use of Mr and Miss, in favour of Doctor, and the college has adopted the title ‘Dr’ to refer to all surgeons, irrespective of the stated preference of the individual fellow, and strongly encourages its members to make this change in their private or personal practices. Click for further information.

In 2021, although the highest percentage of titles used by surgeons was ‘Dr’ (46.7 %), 43.9% of surgeons still nominated ‘Mr’ as their preferred title. The highest proportion of Fellows nominating ‘Mr’ as their preferred title were in Victoria (55% of all Victorian Fellows). The highest proportion of the use of female gendered titles is also in Victoria, but together with the other states and New Zealand, comprises only 1.2% of the total Fellow population.

The RACS put forward the disparate reasons listed below to justify the unilateral decision to remove the long used of the titles Mr and Miss in all RACS references to fellows and in RACS correspondence to fellows, labelling the titles as elitist and sexist, and their use an archaic and snobbish practice. The college maintain that:

• Gendered titles can be confusing for patients
• Gendered titles can contribute to implicit bias and perpetuate outmoded attitudes
• Gendered titles are not reflective of other RACS initiatives to increase gender equity amongst surgeons
• Risk assessment and mitigation strategies to reduce bullying, discrimination, and sexual harassment are necessary to ensure safe workplaces

See: Background on the Removal of Gendered Titles

What is a breast surgeon?

Breast Surgery is now regarded as a surgical subspecialty both internationally and in Australia.

Breast surgeons treat women and men with breast disease, and they also have an important role in the surveillance of women at increased risk of breast cancer, both for the purposes of early detection, and sometimes for consideration of prophylactic/risk-reduction surgery in this setting. In addition to technical skills, surgeons who treat women with breast disease should be good communicators and there is reliable evidence to show that good communication enhances a woman’s ability to deal with the crisis of breast cancer, and that it has a role in reducing post-treatment morbidity, including anxiety and depression. Breast surgeons must also be surgical oncologists, and breast specialisation requires a broad knowledge of cancer biology, molecular genetics and an understanding of non-surgical oncology fields including pathology, radiation oncology and medical oncology. Breast cancer is managed by a therapeutic consortium including breast surgeons, breast care nurses, radiation oncologists and medical oncologists all of whom work closely with their colleagues in pathology and diagnostic imaging. The Breast Cancer Multidisciplinary Meeting is more than a management team meeting − it is a forum for peer review in which opinions are frequently challenged and debated.

As in all branches of specialist surgical training, breast surgeons should continue to be strongly encouraged to travel and work overseas as part of their training. The facilities for training in Australia and New Zealand are now amongst the best in the world, but there is still an opportunity to develop enhanced surgical skills by spending an extended period of time overseas at centres of excellence. Jane O’Brien spent nine years working as a specialist breast surgeon in the United Kingdom and feels strongly that the acquisition of new and advanced techniques, such as oncoplastic breast surgery, and the experience of different medical systems broadens the overall vision of breast surgical practice.

Historically, breast surgery in Australia and the UK was a component of general surgery, but the responsibility of the surgeon in the diagnosis and management of early breast cancer, together with the rapid increase in information and technology relating to the disease, have driven the need for increased specialisation. General surgeons frequently encountered breast problems in their practices in the past, prior to the emergence of breast surgery as a specialty, and for geographical and logistic reasons, surgical treatment of breast disease in some parts of Australia, especially in regional and remote areas, is still undertaken by general surgeons, who retain a broad range of general surgical interests. There is no reason why this practice should not continue, and women should be free to make the choice themselves, between the convenience of having their breast surgery performed locally, closer to home, compared to the advantage of being treated by a specialist breast surgeon, working within a specialised multidisciplinary team. In Australian capital cities, most breast surgery is now performed by specialist breast surgeons, such as Jane O’Brien, whose practice is confined exclusively to breast work, and much less commonly by general surgeons who have a breast interest.

There is evidence that clinical outcomes are better when treatment is provided by a specialist breast surgeon working within a multidisciplinary team, and available data demonstrates that breast subspecialisation results in the improved overall survival of breast cancer patients. (see Benefits of Breast Surgical Specialisation) In addition, a US study found that patients treated by specialist breast surgeons (defined as high-volume surgeons) were more satisfied with the treatment decision process and with the surgeon -patient relationship, than patients treated by low volume surgeons. You should therefore check prior to referral that you are being referred to see a specialist breast surgeon if possible.

If I have breast cancer diagnosed, how do I choose a breast surgeon?

One of the most important decisions women face when diagnosed with breast cancer is in choosing a breast surgeon. In discussing this matter with your general practitioner, it is important that you make a decision that best meets your needs. You can always review the decision at a later date, or seek a second opinion. As with many decisions in life, the decision involved in choosing a breast surgeon may involve weighing up multiple factors. With the crisis of a newly diagnosed breast cancer, or sometimes with even just the knowledge of a suspicious finding on a mammogram, women can experience a tremendous urgency to undergo immediate surgical removal of the lesion. The very act of doing something, anything, often alleviates the sensation of escalating anxiety. It is extremely important however to appreciate that you don’t need to rush into a surgical procedure or immediate commencement of cancer treatment. Going through the process of choosing a breast surgeon can take time, and women may be tempted to rush through it, in the hope of commencing treatment sooner. Keep in mind, though, that most people with breast cancer have ample time to allow them to make well considered decisions, and carefully choosing the doctor you need now, can ultimately pay off for years to come.

Is the surgeon a full member of BreastSurgANZ?

Breast Surgeons of Australia and New Zealand (BreastSurgANZ) is the peak professional body representing breast surgeons treating patients with breast disease in Australia and New Zealand, and the society advocates for ongoing recognition of breast surgery as a sub-speciality area of surgical expertise. BreastSurgANZ supports a patient-centred approach to high quality breast cancer care across the entire patient journey from screening to diagnosis to treatment, prevention and identification of genetic risk.

BreastSurgANZ is committed to setting post-Fellowship education and training standards for the surgical management of breast disease and to ensuring ongoing improvements in patient care through quality audit, research and the development of evidence-based practice.

The more than 400 BreastSurgANZ members manage the health care needs of most patients with early and locally advanced breast cancer and are the trusted experts in the management of breast cancer, providing coordinated care within a multi-disciplinary team. They are Fellows of the Royal Australasian College of Surgeons and are committed to establishing best practice standards and benchmarks for the treatment of breast disease.

BreastSurgANZ is a membership based society, with the differing eligibility criteria for the five levels of membership reflecting differences in technical capability, breadth and depth of experience, structured and accredited post fellowship training, together with a demonstrated commitment to ongoing professional development. To attain the top level of membership, and be a ‘full’ member of BreastSurgANZ, certain criteria need to be satisfied, which include ongoing commitment to CPD activities in breast disease, and full participation in the BreastSurgANZ Quality Audit, which is a keystone of the Society and has been collecting data continuously for over 20 years.

Decide what you want and need in a breast surgeon

Before you start looking for a doctor, think about the qualities you want your doctor to have. A few ideas are listed below, but you may want to consider others.

• Choose a doctor who has extensive experience with breast cancer (see Benefits of Breast Surgical Specialisation) Surgeons will differ in the amount of breast surgery they perform and in their levels of experience and expertise. Satisfy yourself that the surgeon treats breast cancer cases frequently, and is a member of BreastSurgANZ, which is the professional society of breast surgeons in Australia and New Zealand, and has eligibility criteria for membership.
• Confirm that the surgeon offers a full range of breast cancer operations. All surgeons are not equal in terms of their surgical skills, and the range of breast procedures they offer, especially with respect to oncoplastic breast techniques.
• Pick a doctor who has privileges at a hospital that is acceptable to you. Doctors can only treat patients within facilities at which they have admitting privileges/rights.
• Consider the surgeon’s professional contacts. Breast surgery is often only one part of breast cancer treatment, and it is important to know that there is a good working relationship between your surgeon and other health professionals who may be involved in your care and that your surgeon practices in a multidisciplinary team setting (see Multidisciplinary Breast Cancer Care) It is also beneficial to you if your surgeon keeps in regular contact with your GP. This helps your GP to answer questions you may have and to assist with your general health care. Check that the breast surgeons works with other cancer specialists and breast care nurses (see Breast Care Nurses) to address all of a woman’s needs at the time of her diagnosis and treatment.
• Choose a doctor you feel comfortable with. Languages spoken, gender (see Female Breast Surgeons), ethnicity, age and educational background may be important factors for you. You and your doctor don’t need to be best friends, but if you don’t get along, your care may suffer.
• You may have strong feelings about personality and bedside manner. Some people prefer their doctors to have a clinical, business-like manner, while others value a doctor with a strong focus on emotional health as well as their medical needs. Most women find it helpful if they feel relaxed with their surgeon and find him or her easy to talk with and willing to answer any questions. It is also important that the surgeon gives you as much information as you require. Overall, while it’s crucial to be able to communicate well with your doctor, there may be limits to the amounts of information you can absorb, and being able to trust your surgeon, and to know that your wishes and decisions will be respected is vital.

Access and Convenience

The choice of surgeon may for some women be influenced by convenience, and availability. It is important for some patients that the availability of a surgeon to see you, and the timing of the surgery fits in with other aspects of your life. If the surgeon who has been recommended to you cannot see you for a few days, this does not have an adverse impact on your overall longterm outcome. The most specialised breast surgeons, who perform only breast surgery and no general surgery, do not have urgent general surgical referrals competing for their time, and most are therefore able to keep aside sufficient urgent appointment slots for breast cancer referrals. The surgeon’s rooms may also be important to you, as especially when you are anxious and stressed, it can be reassuring to visit surroundings which are pleasant and relaxing.

The location of the surgeon’s rooms in relation to the hospital may also be factor, and if you are travelling to the city from the country for your care, it may be easier learning to negotiate a single location.

The costs involved and whether you choose to be treated within the private or public health system may also be relevant. Public patients in public hospitals do not have a choice of doctor (see Private vs Public)

How do I go about choosing a breast surgeon?

Many people with breast cancer say the most difficult part, after dealing with the shock of the diagnosis, is working out where to go for treatment and care. Your decision may be guided by a number of influences, including word of mouth, advertising, internet and your general practitioner. Often the most reliable of these is your GP, and also word of mouth from a reliable source. Advertising is the least reliable. The internet can vary from being extremely useful to very poor.

• Ask your GP
• Ask family, friends and friends of friends, and ideally aim to find someone who has been through the experience.
• Ask people you meet along the way, for example the radiographer who does your mammogram. What other staff say about doctors is often significant, and can be quite telling.
• Do your own research. A US study found that women who chose their own surgeon were twice as likely to see a highly experienced surgeon. Women who were more actively involved in selecting their surgeon were more likely to be treated by a high-volume surgeon in a more comprehensive treatment setting.
• The Cancer Councilin each state and territory has an Information and Support Helpline, which provides a free, confidential telephone information and support service. Specially trained staff are available to answer your questions about cancer and offer emotional or practical support. They can provide support and information on general issues to consider when choosing a surgeon. The Cancer Council Helpline can be reached on 13 11 20.
• Breast Care Network Australia(BCNA) is a national organisation for Australians personally affected by breast cancer, working to ensure that Australians diagnosed with breast cancer and their families receive the very best information, treatment, care and support possible, no matter who they are or where they live. BCNA have a free and confidential helpline providing information, support and referral to relevant services and resources, which can be reached on 1800 500 258.
• The Cancer Councils and BCNA will not make specific personal recommendations regarding particular surgeons but will suggest you should confirm that your surgeon
  1. Is a member of BreastSurgANZ
  2. Works as part of a multidisciplinary team, which holds regular multidisciplinary meetings at which your case (with your prior consent) will be reviewed and discussed
  3. Works with a Breast Care Nurse as part of their team