Getting to Know Dr Lee Wai Peng

Get up close with our breast specialists and hear more from them on their philosophy for patient care and interesting personal anecdotes. “As a woman playing multiple roles in my life (whether a daughter, a sister, a wife or a mother), I feel that I can better understand and relate, and give them (patients) sound and professional advice.” Dr Lee Wai Peng is a Senior Consultant and Breast Surgeon and she specialises in treating benign and malignant breast conditions. Prior to joining Solis, she was a Senior Consultant and an Adjunct Assistant Professor at Changi General Hospital (CGH), a position she grew into following the completion of her advanced specialty training in general surgery in 2014. She strives to provide holistic and individualised care with a personal touch for ladies with breast conditions and is a strong advocate for encompassing cosmesis with surgical therapy. Q. Why did you choose to become a breast surgeon? My interest in surgery first started when I was in my teens and I had been watching dramas (imagine ER and other local or Hong Kong TVB dramas) of surgeons operating and patients getting better immediately after. This fascination continued during my medical student and internship days where I could see how surgery healed patients, and the immense gratitude that the patients have for their doctors. Being a woman, I feel that I could relate so much better with other women who were facing breast health issues, and hence, I decided to choose breast surgery. Patients’ symptoms and the reason to seek help and even their choice of treatment are greatly influenced by the people around them – it also depends on the stage of life they are at and problems that they might be facing at that time. As a woman playing multiple roles in my life (whether a daughter, a sister, a wife or a mother), I feel that I can better understand and relate, and give them sound and professional advice. Q. Share with us a patient’s story that left a deep impression on you I had a patient who came to me with a breast lump found in one of her breasts which eventually turned out to be breast cancer after further evaluation. During our consultation, she was extremely depressed and was facing many issues at home. She had to support her children, her husband had passed away from a heart attack, and she was estranged from her own family (i.e. her mother and siblings) during such difficult times. She almost didn’t want to have any treatment for her cancer. With encouragement from myself and my team of nurses, she came forward to seek treatment. We even managed to get her family to rally and support her during her treatment period and helped her to take care of her children. Their relationship improved eventually and they have been eternally grateful to us. They called it “blessing in disguise”. Q. What is ONE myth or message that you would like women to know about breast cancer? Breast cancer can happen to anyone and any woman. Every woman has a chance of developing breast cancer. You don’t have to be a smoker, drinker or leading an unhealthy lifestyle to get breast cancer. No family history does not mean that there is no chance of getting breast cancer. Q. What do you do during your free time? I used to love to do outdoor sports such as running and cycling. I also took up yoga. Travel has always been something I look forward to, especially for that mental break from work. However, with covid (pandemic turning to endemic), I have learnt to treasure my loved ones and now I look forward to spending my time with them. I recently found the interest to do more research work on breast cancer and have been spending quite a bit of time on it. Q. What do you think you will be doing if you didn’t become a breast surgeon? If I hadn’t been a breast surgeon, I think I would want to be an educator and work with pre-schoolers. After having two kids of my own, I have seen how innocent their minds can be and how much the world can amaze and “wow” them. Article contributed and reviewed by Dr Lee Wai Peng, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery
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No Correct Answer About Whether To Remove Breasts Because Of Cancer

For women, this can be the most difficult decision in their cancer journey since femininity and a fundamental sense of identity are tied up in it, says a breast cancer surgeon. “Will I need to remove my breast?” As a breast cancer surgeon, I get asked this question all the time. The diagnosis of breast cancer evokes anxiety in women, not just because it is a cancer, but also because of the possibility of surgical removal of the breast. Breast cancer is the most common cancer among women in Singapore with more than 2,000 women are newly diagnosed every year. Other than surgery, breast cancer may also require additional treatments such as chemotherapy and endocrine therapy, both of which can result in short- and long-term changes in a woman’s life. Research has shown that the psychosocial impact of breast cancer occurs not just at diagnosis, but also during treatment and survivorship. Women may experience distress associated with fatigue, mood, sexual and reproductive issues, self-image, spiritual challenges, relationships with others and fears of recurrence. Yet in clinical practice, how a woman copes with a breast cancer diagnosis may vary widely, depending on her age, family situation, attitude, and life priorities. WIFE, MOTHER, WOMAN *Anna was diagnosed with breast cancer five years ago at 41. She could have opted for a smaller surgery to keep the breast. Instead, she chose to have her breast removed. She also nonchalantly declined breast reconstruction to minimise surgery time and complications. She told me: “My mother had breast cancer too and I watched her suffer through the treatment. I want to come out of this better and stronger than she did.” Her priority was no-fuss surgery, swift recovery and quickly moving on to chemotherapy and radiotherapy, minimising long-term relapse risk. Then there is *Celine who was 77 years old when a breast biopsy confirmed cancer. As the changes were extensive, she required a mastectomy. Despite the risks at her age, she insisted on breast reconstruction. “Doctor, I won’t feel complete without the breast. Please arrange for me to have reconstruction,” she told me. Fortunately, she was found to be surgically fit for her age and she successfully underwent mastectomy and implant reconstruction. These two cases show there is no one size fits all approach. Women play many roles in life – as a wife, a mother and a daughter. These roles strongly influence their attitudes towards breast cancer treatment. Some mothers of young children are driven to treat the breast cancer aggressively, to survive the cancer so they may continue their parenting role. Others fear the treatment will take them away from the family and in contrast may choose less intensive options. Some opt to relegate their caregiver role completely to other family members. Older women may decline treatment so avoid being a burden to their families. A SYMBOL OF FEMININITY The anatomical function of the breast is for lactation, allowing mothers to nurse their babies. Beyond this, the breast also symbolises femininity and is a major part of constituting a woman’s body image. This is why removal of the breast has a deep impact on a woman’s body image, taking a physical and psychological toll on patients. Ironically, reconstruction may not ease these feelings. Studies in the early 2000s showed younger women receiving mastectomy and reconstruction for breast cancer reported a more negative body image than those receiving breast conserving surgery, immediately following treatment, but this improved with longer duration from treatment. Other than surgery, other cancer treatments may also impact body image. Chemotherapy and endocrine treatment often result in hair loss, weight gain and the abrupt onset of menopausal symptoms such as hot flushes, vaginal dryness, decreased libido and reduced sexual functioning. These changes may cause psychological distress in both the breast cancer patient as well as her partner, potentially impacting on the emotional support that is critical in relationships. RECONSTRUCTION SURGERY Breast reconstruction plays a major role in contributing to the acceptance of mastectomy by women diagnosed with breast cancer. Immediate breast reconstruction is when the reconstruction surgery is performed at the same sitting as the mastectomy, hence the patient wakes up from surgery with minimal perception of losing the breast. This can be done using breast implants or autologous tissue from the patient’s own body tissue such as tissue from the tummy, thigh or back. In our Asian culture, women generally favour autologous tissue reconstruction over implant reconstruction, although other factors such as the patient’s physical make up may also come into play. Breast reconstruction is not without its risks, as the surgery will be longer and often more complex and with slightly higher risk of surgical complications. However, with proper patient selection and balance of risks and benefits, mastectomy with immediate breast reconstruction has been found to have fairly high levels of satisfaction in quality-of-life scores in the long term. THE ANGELINA JOLIE EFFECT I first met *Joan six months ago. She is 42 with a daughter in her early teens who is very attached to her. When she was diagnosed, she was adamant at removing both breasts even though the cancer was only confirmed on one side. In her own quiet but determined manner she told me: “I want to do everything to reduce my risk in the long run. I want to make sure I will always be there for my daughter.” In the last 20 years of clinical practice, I have witnessed a paradigm shift in women’s attitudes towards mastectomy. Conventionally, the breast is preserved whenever possible, especially if the cancer is localised. In recent years, more women are open to undergoing mastectomy even when breast conservation can be safely undertaken. I believe one of the most important reasons is due to the Angelina Jolie effect. Angelina Jolie was a well-known actress and celebrity, who in 2013 pronounced to the world that she had undergone bilateral mastectomy with implant reconstruction after discovering she possessed a BRCA gene mutation, which placed her at an inordinately high lifetime risk of breast cancer. It accelerated a movement in the USA where women made proactive decisions to be in control of their own destiny. In the last decade, there has been an increasing trend in women opting for bilateral mastectomy when the cancer is confined to only one breast. Reasons cited include fear of cancer recurrence, family history of cancer, stress surrounding follow up and improved breast reconstruction outcomes. Ironically, it has been suggested that in these women, bilateral mastectomy may even have psychological benefits. *Joan eventually did go ahead with bilateral mastectomy and reconstruction. Further laboratory testing subsequently discovered cancer in the other breast as well, which likely would have manifested some years later. So choosing bilateral mastectomy was the right choice for her and her family. For most women however, mastectomy can be a difficult decision as it still invokes an image of disfigurement and loss of femininity, despite significant advances in breast reconstruction techniques. Efforts in multi-disciplinary breast cancer care continue to focus on the psycho-social needs of this group of women. As a surgeon I hope every woman diagnosed with breast cancer will have access to adequate information and support in making the best decision for themselves, whether it is a mastectomy or breast conservation. We can’t make breast cancer go away, but we can make the treatment more acceptable and we can empower women to make the best choices suited to them. *Pseudonyms were used in this commentary. Article contributed and reviewed by Dr Tan Yah Yuen, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery Centre. Article first published on Channel News Asia: https://www.channelnewsasia.com/commentary/breast-cancer-women-health-breast-removal-reconstruction-2405711
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What Do Dense Breasts Have to Do with Breast Cancer?

Upon learning that breast density is linked to an increased risk of breast cancer, many women will be quick to check by touch or appearance if their breasts are dense. Unfortunately, breast density can only be confirmed with an imaging examination. Dr Lim Siew Kuan, our Senior Consultant and Breast Surgeon, shares more about some of the characteristics of dense breasts and how they relate to breast cancer. What are the Characteristics of Dense Breasts? A breast contains varying amounts of fibrous, glandular and fatty tissue. To be considered dense, a breast should have less fat and more glandular and fibrous tissue than is expected. It is also worth noting that dense breasts are more commonly found in young women (premenopausal) as well as older women (postmenopausal) taking hormone therapy to address symptoms of menopause. The four main categories of breast density include: Category A: Breast is composed almost entirely of fatty tissue Category B: Breast has scattered areas of fibroglandular density Category C: Breast has a mix of fibroglandular and fatty tissue, also known as heterogeneous density Category D: Breast has extremely dense tissue with little to no fat Understanding the Link Between Breast Density and Breast Cancer To this day, the reason for why dense breasts increase the risk of breast cancer is undetermined. However, certain metrics reveal why breast density is cause for concern. For some context: Oral contraceptives increase breast cancer risks for women 40 – 49 years old by 1.3 times. Heterogeneously dense breasts increase the risk by 1.2 times. Extremely dense breasts increase the risk by 2.1 times. And having a first-degree relative diagnosed with breast cancer before the age of 40 increases the risk by 3.0 times. Taken as a whole, breast density is a risk factor, but it is certainly not the biggest.A family history of breast cancer, a previous personal history of breast cancer or high-risk breast lesions, as well as hereditary mutations in the Breast Cancer (BRCA) genes are more important risk factors than breast density. Challenges in Mammogram Diagnosis Dense breasts pose a significant challenge when looking for traces of cancer. On a mammogram, dense tissue is presented as a white area, but so too is breast cancer. The challenge for doctors exists in interpreting the mammogram, as cancer may be hidden under the guise of dense breast tissue. Nonetheless, mammograms are still the ideal choice for women with dense breasts; anecdotal evidence reveals that mammograms are more accurate than other diagnostic tests and can detect most types of breast cancer. Alternative Diagnostics A combination of mammography and breast ultrasound is frequently used to increase the detection of breast cancer for women with dense breasts. The addition of ultrasound allows the visualisation of small breast lesions, which may be obscured by dense tissue on mammograms. Digital breast tomosynthesis (3D mammogram) is now widely available and is preferable to 2D mammography in screening women with dense breasts. It gives improved sensitivity for cancer detection, while decreasing the false-positive rates. Breast Magnetic Resonance Image (MRI) has also emerged as another excellent imaging modality, and may be used for further assessment when both mammography and ultrasound are non-conclusive. The benefit of using MRI is that, unlike mammograms, dense breast tissue does not affect imaging results. However, the downside is an increased likelihood of false positives. Due to its high sensitivity, MRI screening is also recommended in women with a high lifetime risk of developing breast cancer. Recommendations If tests conclude you have dense breasts, try not to worry too much, a discussion with a breast specialist will reveal what options are available to you based on your medical history and any other relevant factors. Yearly mammogram screening is advised, but for a more conclusive result, an ultrasound, breast MRI or even genetic testing may be recommended by your doctor. If you have discovered some signs and symptoms of concern, schedule an appointment with our breast specialists for medical advice on what are the best steps to take. Article contributed and reviewed by Dr Lim Siew Kuan, Senior Consultant and Breast Surgeon at Solis Breast Care and Surgery Centre.
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