Restoring Confidence Through Breast Reconstruction

Depending on the degree to which breast cancer has developed, a mastectomy (breast removal surgery) may be necessary to remove all traces of breast cancer. The result, however, is one many women would prefer to avoid. Dr Chan Ching Wan, our Senior Consultant and Breast Surgeon shares how breast reconstruction can help restore the cosmetic appearance of the breast and elaborates on the types of breast reconstruction and what to expect in the short and long term. Breast reconstruction surgery entails the use of tissue flaps taken from other parts of the body, such as the tummy and thighs, or the use of breast implants to restore the symmetry of the breasts. Generally, patients who have had a significant amount of tissue removed during breast surgery, are prime candidates for breast reconstruction. The best cosmetic results are achieved when breast reconstruction is conducted in the same sitting as cancer surgery. When done together with the cancer surgery, much, if not all, of the breast skin, including the nipple-areolar complex can be preserved, which enhances the appearance of the reconstructed breast. Immediate breast reconstruction is usually possible, however there are certain situations when it is not advisable and then a delayed procedure would have to be planned. Some patients do require radiotherapy which may cause the reconstructed breast to either lose volume, change colour, texture or appearance. If reconstruction needs to be delayed, it can still be scheduled months to years later. Types of Breast Reconstruction Modern advancements have spawned a variety of breast reconstruction techniques. The type employed will depend on personal preferences, the amount of breast tissue removed, and the shape and size of the breast. There are two main techniques used to reconstruct the breast: implant reconstruction and autologous or ‘flap’ reconstruction. Implant reconstruction involves the use of a breast implant filled with saline, silicon gel or a combination of the two inserted in the breast. Meanwhile, flap reconstructions involve the use of tissue taken from other parts of the body, such as the belly or thigh, to create a new breast. It’s also worth noting that in certain situations, implant and flap reconstruction are used together. Additionally, with both techniques, it is possible to reconstruct the nipple, especially in situations where immediate reconstruction is not an option. Nipple sparing mastectomy, where the nipple and the skin surrounding it is preserved, is performed only if there is immediate reconstruction. Depending on your condition, your breast specialist will provide you with all the information necessary to make the best decision. Breast Reconstruction Risks As with any surgery, breast reconstruction comes with certain risks. Infection may set in from having a foreign body (implants) introduced into the body. This can be treated with antibiotics; however, if the infection increases in severity, the implant may need to be removed. Furthermore, there’s always a risk (very small) of implants leaking or causing the surrounding tissues to harden (scarring also known as capsular contracture), making the reconstructed breast hard and/or lumpy to the touch. Stiffness and tightness around the chest and shoulder is common but can be addressed with early ambulation and physiotherapy. When reconstruction is done using a flap, the blood supply may sometimes not be sufficient to keep the flap alive resulting in flap failure. A re-operation may be necessary to replace the flap with another flap or implant. Fortunately, this does not happen very often at all. Oncoplastic Surgery Oncoplastic surgery differs slightly from breast reconstruction, in that plastic surgical techniques are used to restore the shape of the breast after a lumpectomy (partial breast removal). The removal of the cancer and the restoration of the breast shape is done in one operation. Occasionally, the unaffected breast will be surgically altered to be more uniform with recently treated breast. How Reconstructed Breasts Evolve with Time and Age Most implants can be used for 10 – 15 years before needing replacement. The general shape of the breasts will not change and evolve with time or with weight gain and weight loss as natural breasts would. In addition, there’s always a risk that implants will leak or rupture. Breasts reconstructed with autologous flaps, however, can change with weight loss, weight gain and ageing, and hence are the better option for longevity. Road to Recovery For several days after breast reconstruction surgery, you will experience some soreness and fatigue. You should expect 5 – 7 days in hospital recovering. In the next 6 – 8 weeks, sports and other similar intensive activities should be avoided. Generally, most patients will resume normal activity after 2 – 3 months. Bruising and swelling will take up to 8 weeks to go away, and the reconstructed breast will look and feel different from a normal breast. It will feel numb, but that feeling will gradually improve over time (this may take a few years). However, there will always be some loss of sensation for all patients. Depression and anxiety may happen during recovery. It helps to seek support from your doctor, friends and family, as well as support groups. It will take 1 – 2 years for the scars to fade and tissues to heal. But fade they will – although not completely – and in time, survivors can and will feel normal and whole again. With modern surgical techniques, the benefits of plastic surgery can alleviate the negative impact of a mastectomy. Reach out to us to learn what options exist for your present needs, our breast specialists stand ready to be there with you each step of the way. Article contributed and reviewed by Dr Chan Ching Wan, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery
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Getting To Know Dr Tang Siau-Wei

Get up close with our breast specialists and hear more from them on their philosophy for patient care and interesting personal anecdotes. “It is very rewarding as a doctor to journey with a patient, helping to treat and ‘cure’ these (breast cancer) patients, whilst getting to know them along the way.” Dr Tang is our Senior Consultant and Breast Surgeon who specialises in breast surgery. Prior to joining Solis, she was practicing in National University Hospital, where she is well versed in the care of benign and malignant breast conditions and provides comprehensive and holistic care for her patients. Q. Why did you choose to become a breast surgeon? I have always wanted to do surgery as I like the procedural aspect of it and being able to ‘work with my hands’. Back in the days whilst I was training in the UK, I had the opportunity to participate in research projects with the breast surgery team there and had the opportunities to learn more about diseases associated with breasts or breast cancer, and I found it interesting. As I progressed through my training, I was able to work with different specialties, and realised I enjoyed the work in the field of breast surgery the most.  I found the diagnosis and treatment of breast cancer interesting, and it usually involves a multidisciplinary team, where you get a chance to work with other doctors.  Also, the prognosis of the disease is quite good, where most patients recover from the disease and do well in the long run. Thus, it is very rewarding as a doctor to journey with a patient, helping to treat and ‘cure’ these patients, whilst getting to know them along the way. Also, with oncoplastic surgery – there is the element of ensuring the patient has a good cosmetic outcome for their body image and quality of life, whilst also ensuring they are treated for their cancer. Q. Share with us a patient’s story that left a deep impression on you A patient of mine, who had recently delivered her second baby, noticed swelling and hardening in one area of her breast for four months. Thinking that it was caused by blocked ducts, as she was weaning her infant from breastfeeding, she saw a breast masseuse to clear the blockage. However, the patient’s symptoms progressively worsened despite being administered antibiotics by a GP to treat what was thought to be a breast infection. Her GP subsequently referred her to me, and she was diagnosed with breast cancer. Fortunately, the cancer had not spread to any other organs, and she was treated and remains well now. Q. What is ONE myth or message that you would like women to know about breast cancer? A common misconception is that breast pain indicates there is a serious underlying problem in the breast, whilst painless breast lumps are harmless. In fact, it is very rare for breast pain to signify an underlying cancer. Breast pain is more likely caused by hormonal changes or muscle aches on the ribs and chest wall. Whilst painless lumps that are progressively growing may be a sign of an underlying tumour or cancer – we should never brush that aside and schedule for an appointment with a breast surgeon to get ourselves check. Q. What do you do during your free time? Outside of work, I mainly spend time with my family – husband and 2 kids. I would love to travel again once the borders are open. Q. What do you think you will be doing if you didn’t become a breast surgeon? I probably would have done another surgical specialty within medicine, or maybe be a dentist? As I would like to be within the healthcare field, as I enjoy the procedural work and would like to use these skills to help others. Article contributed and reviewed by Dr Tang Siau-Wei, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery Centre.
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Hear From A Breast Cancer Survivor: Listen To Your Body

Learn how a breast cancer survivor stayed positive and survived her first health scare with courage, determination, and an effective treatment plan When Lay Peng felt a lump on her right breast in mid-2019, she brushed it off, thinking that it was due to hormonal changes and would soon go away. However, she became worried when the lump remained after six months. After completing an ultrasound scan and mammogram at her next annual health screening, she was advised to seek medical attention. “I was concerned about the lump but I did not think it was breast cancer,” Lay Peng related. “I have no family history of cancer and I also have been healthy all along.” Lay Peng came to know of her breast cancer diagnosis through a biopsy and consultations with a Breast Surgeon. When the news of her breast cancer broke, her mind immediately went blank. “I was worried for my family – my daughters, my husband and my elderly folk,” Lay Peng recalled. “I came to realise the fragility of life.” Understanding breast cancer and undergoing treatment Breast cancer is a type of cancer arising from the milk glands of the breast, described Dr Tan Yah Yuen, Breast Surgeon at Solis Breast Care & Surgery Centre. There are a wide variety of symptoms for breast cancer, she explained, with the most common symptom being a painless breast lump. However, some patients manifest no signs nor symptoms at all. Hence, in the very early stages of breast cancer, findings can only be discovered via mammography. Ultrasound scans are also useful in complementing these screenings, while 3D mammography is recommended for a more thorough examination of dense breast tissues. Dr Wong Chiung Ing, Senior Consultant, Medical Oncologist at Parkway Cancer Centre, observed that the chance of cure is more than 95% for early-stage breast cancers that are confined in the breast. However, breast cancer is generally not curable if there is spread to other organs such as the liver, lungs, bones, or brain. Nonetheless, treatment options such as chemotherapy, radiation therapy, hormonal therapy, targeted therapy, and immunotherapy are available to improve survival rates and the quality of life. “In determining the treatment regimen for each patient, we perform tests on cancer cells before tailoring the type of treatment,” Dr Wong said, adding that the patient’s general health and condition would also be taken into consideration. The treatment of breast cancer thus involves a multi-disciplinary team of doctors and specialists which includes surgeons, medical oncologists, radiation oncologists, and pathologists. Strong support is also needed from nurses and other health professionals such as physiotherapists, dieticians, and psychologists. “With so many treatment options available, it is therefore very important for us to come together as a team to derive the most effective treatment plan for patients,” Dr Wong shared. In Lay Peng’s case, her doctors had advised for her to receive neoadjuvant chemotherapy, or chemotherapy before surgery, as initial treatment for her cancer. The primary objective of neoadjuvant chemotherapy is to downstage the tumour which may allow less extensive surgery on the breast/axilla, and to reduce the risk of distant recurrence. Despite her initial concerns, Lay Peng mustered the courage and determination to undergo treatment and get well. “I only have one life,” she reflected. “Instead of asking why, I accepted reality and embarked on the recovery journey. While there were tough moments along the way, I think the focus on getting well is important for you to get going.” Feeling well and cancer-free Lay Peng and her doctors’ efforts paid off post-surgery in September 2020. The treatment had resulted in a complete pathological response at surgery, meaning that no cancer cells were detected from tissue samples after surgery. Besides surviving breast cancer, Lay Peng was also able to conserve her breast, and did not require mastectomy. While treatment was manageable on the whole, Lay Peng revealed challenging moments such as hair loss, loss of appetite, nausea, and diarrhoea. Nonetheless, she remained grateful for the time and space to recover, as well as for the strong support from her doctors and nurses in Allied Health, as well as her family, friends and colleagues. It is never too late to seek medical help, Dr Tan assured, though there is a lower risk of relapse if breast cancer is detected earlier. Today, just slightly more than 50% of women in Singapore undergo regular breast cancer screening. Yearly screenings are recommended for women who are 40 years of age and older, or earlier for women with a family history of breast or ovarian cancers. For postmenopausal women, screenings should be done at one- or two-yearly intervals, depending on their individual risk factors. Most importantly, women should not put off their breast cancer screenings and should remain alert to bodily changes. “Listen to your body and trust your instincts,” Lay Peng encouraged. “If you sense something wrong, it is best to get it verified.” Article contributed and reviewed by Dr Tan Yah Yuen, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery and jointly produced with Parkway Cancer Centre
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