Nobody hands you a roadmap when you get a BRCA1 diagnosis. You get your result, you get off the phone, and then you’re just supposed to figure out what comes next. Finding the right team of doctors was one of the most overwhelming parts of this whole process and nobody really talks about how to actually do it.

So here’s how I did it.

Start with what matters most to you

This might be controversial but I’m going to say it anyway. I found my plastic surgeon first.

I know. I know. You’re supposed to start with the surgical oncologist. That’s the medically logical order. But I already knew I was having the mastectomy. My priority, if I’m being honest, was making sure I came out the other side looking like myself. I’m young. I wanted to feel attractive. I wanted to look in the mirror after and still recognize my own body. That mattered to me and I’m not going to pretend it didn’t.

So I researched plastic surgeons. I looked at before and after photos obsessively. This was harder than I expected for a reason I didn’t anticipate going in. Most of the photos out there are from therapeutic mastectomies, meaning women who had cancer. A preventive mastectomy is different. Because there’s no tumor to remove, surgeons can conserve more tissue, which means the reconstruction results can look quite different. I wasn’t finding the right comparison and I didn’t even fully realize it at first.

If you’re in the same position, look specifically for before and afters from prophylactic or preventive mastectomies. It takes more digging but it matters. What you find otherwise may not be an accurate picture of what your outcome could look like.

When I found a plastic surgeon whose work I felt good about, something interesting happened. He told me which surgical oncologist he worked with. And that’s how I found the rest of my team.

It worked backwards from the conventional approach and I’d do it exactly the same way again.

Who you actually need

Here’s a quick breakdown of the key players and what they each do.

Your genetic counselor is usually the first person you talk to after a positive result. They help you understand what your mutation means, what your options are, and what your family members should know. If you haven’t seen one yet, start there.

Your surgical oncologist is the surgeon who performs the mastectomy itself. They’re focused on removing the breast tissue safely and completely. This is your cancer prevention specialist.

Your plastic surgeon handles the reconstruction. If you’re planning on reconstruction, which not everyone does and that’s completely valid, this person matters enormously. They’re the one shaping what you look like after. Choose carefully.

Depending on your situation you may also see a medical oncologist, particularly if there’s any concern about existing cancer, and your OB-GYN will likely be involved given that BRCA1 also significantly raises ovarian cancer risk.

Shop around. Seriously.

I consulted with multiple surgeons before making any decisions. This is not disloyal or indecisive. This is smart. You are making a permanent decision about your body and you are allowed to sit in multiple offices and ask hard questions until you find people you actually trust.

My clinical research background helped me here. I wasn’t intimidated walking into a surgeon’s office. I knew how to read a room, ask specific questions, and push back if something didn’t sit right. I knew what I was looking for and I wasn’t going to apologize for that.

If you don’t have that background, write your questions down before you go. Bring someone with you if you can. You are the patient and this is your body and no good surgeon will make you feel bad for being thorough.

What to look for

Beyond credentials and experience, here’s what actually mattered to me. Did they listen? Did they take my concerns seriously, including the ones about how I would look and feel after surgery? Did they show me enough before and after photos that I felt genuinely informed? Did I leave the appointment feeling more confident or more anxious?

Trust your gut. You’re going to have a long relationship with these people. You need to actually feel good about them.

One thing I wish someone had told me

The plastic surgeon and surgical oncologist work together. They’re in the operating room at the same time. Which means their relationship with each other matters almost as much as your relationship with each of them individually. Ask about that. Ask how often they work together. A well coordinated team makes a real difference.

Finding your team takes time and it can feel overwhelming on top of everything else you’re already processing. But it’s worth doing carefully. These are the people you’re trusting with your body.

Take your time. Ask your questions. Look at all the before and after photos. And make sure you’re looking at the right ones.

You’ll know when you’ve found the right people.