Briefly:
I want a prophylactic mastectomy.  I am 52 years old and have had both
breast cancer and ovarian cancer.  I have not been tested for a BRCA gene
mutation because I am adopted and have no known genetic relatives.  I am
currently healthy and have finished treatment for the ovarian cancer.  The
general surgeon my gynecologic surgeon referred me to does not wish to do
the mastectomy.  I am looking for comments on whether my desire for the
mastectomy is resonable as well as suggestions on how to find a surgeon
willing to do the operation.  I live in the Seattle, WA area but am
somewhat limited by my insurance (ChoiceCare) as to which medical
facilities I can use.

More detail:
I was treated for ductal breast cancer in 1997, lumpectomy, full node
disection, chemotherapy (CAF), and radiation.  The original breast
tumor was fast growing, I had a mammogram in February and the lump was
2 cm in diameter when removed in November.  There was no spread to my
nodes.  Since then, providers have sometimes felt a lump during a
breast exam and a mammogram was suspicious but no further biopsies
have been done.  I am very nervous about a new tumor arising that is
not caught early, given my history above.  I realize that mastectomy
does not completely remove the danger of breast cancer but it does
greatly reduce the chances.

I had surgery for stage III ovarian cancer in January 2004 and have
had 12 sessions of chemotherapy, the last in October.  The first 6
sessions were IV paclitaxel and the last 6 interperitoneal topotecan.
My CA-125 values are low and have been since after the surgery and
first chemotherapy.  I am now feeling well, have fully returned to
usual activities, and my blood counts are normal.  Of course I am
anxious about the return of the ovarian cancer but I've done all
that I know to do at this point to reduce my risk.

I first discussed the mastectomy with my gynecologic surgeon.  He
was supportive and gave me a referral to a general surgeon.  He did make
the point that my ovarian cancer was a greater risk to me than breast
cancer.

I also discussed the mastectomy with my medicial oncologist.  He was
less supportive, but did say it was my choice to make.  He also made
the point that the ovarian cancer was a greater risk at this time.

The general surgeon does not want to do the operation.  Her stated
reasons are that the risk of ovarian cancer re-occurring are too high
and it is too soon after treatment.  She did not give a time frame
when she would be comfortable doing the mastectomy.  She did give
me the names of a couple of surgeons who might do the operation but
neither of them are on my insurance list.

I would like the surgery now because of insurance and employment
issues and because my vascular port is ready to come out.  While this
isn't a big procedure, it could be combined with a mastectomy.  I also
don't see a major rationale for waiting.  I do want to be optimistic
and believe I will be one of the long term survivors.

Commnents?  Should I wait for some period of time (how long?) before
approaching a surgeon?  Should I look now for another surgeon and if
so, what is a good way to find a surgeon other than looking at a
list approved by my insurance company?

Thank you for any help.
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jhaviland@bigfoot.com