BREAST RECONSTRUCTION IN SINGAPORE AFTER MASTECTOMY
There are almost 1,900 cases of breast cancer in Singapore. It is said that 1 out of 14 Singaporean will develop the condition in their lifetime. Thus, many women are undergoing mastectomy or breast removal surgery to avoid further development of cancer. However, it is only one part of your breast cancer management. Once you have undergone a mastectomy, you may also opt to have breast reconstruction surgery.
Although it eliminates the risk of breast cancer, a mastectomy can leave an impact on a woman emotionally and psychologically. Because they are losing a part of them, breast cancer survivors are more conscious about their self-image, lowering their self-esteem. As a result, within the last decade, there has been a significant increase in women who are opting to go under breast reconstruction in Singapore.
What is breast reconstruction?
Breast reconstruction surgery is the process of reconstructing the breast shape after a mastectomy (removal of a whole breast) or lumpectomy (removal of a part of the breast). This treatment helps breast cancer survivors regain their confidence -lost after a mastectomy- by bringing back the body they once had.
The goal of breast reconstruction is to recreate the shape and look of a natural breast and match it to the other breast as much as possible. However, there is still a possibility of the two breasts looking different even after the surgery. So, some women opt to have breast enhancement done to the other side for a more uniform look.
If you underwent a double mastectomy, the process of reconstruction would be about creating matching, natural-looking breasts that are in proportion with your body frame.
Options for breast reconstruction in Singapore
There are two standard options for breast reconstruction in Singapore. It can be done either using breast implants or using your tissue (a tissue flap). However, do note that one way of surgery may not be suitable for everyone. The type of operation you need will depend on the shape and build of your body, your general health, your expectations, and whether you are going or underwent radiotherapy.
Reconstruction using breast implants
Using breast implants is one way of reconstructing your breasts. It is an ideal option for surgery because it requires less operation than other options. The procedure can be done at the same time as your mastectomy or after further treatments.
The implants are placed either behind or in front of the chest muscle (pectoral muscle). For breast cancer survivors, breast reconstruction might be difficult since the skin around the breast is removed during mastectomy. Though if you choose to reconstruct your breast through implants, plastic surgeons can use tissue expanders to stretch the skin on your chest.
This method is ideal for thin women with small breasts, who don’t have enough extra fat or tissue on the bellies, back, thighs, or buttocks, required for the other forms of surgery. It is also ideal if you do not want further incisions in other parts of your body, thus a shorter recovery time.
A common concern with this type of surgery is the results will not look natural. Implant reconstructed breasts are also firmer and move less naturally. However, with the latest innovations, there are breast implant brands like Motiva® , where you do not need to worry about your breasts looking “fake”.
Motiva® Ergonomix™ uses ProgressiveGel Ultima™, an elastic silicone gel designed to give a more anatomical shape and softer feel. It has the ideal balance of viscosity (how it flows along with movement), cohesivity (how well the gel stays intact without breaking up), elasticity (how well is returns to its original state after being stretched), and viscoelasticity (how flexible and adaptable it is), allowing the implant to mimic the natural movement of breasts. So, it looks round when lying down, and moves to the shape of natural breasts when standing up.
Reconstruction using your tissue (tissue flap)
A tissue flap procedure, also known as autologous reconstruction, is another way of breast reconstruction in Singapore. A tissue, referred to as a “flap”, is taken, commonly, from the belly, the back, buttocks, or inner thighs, and then it is made into a newly reconstructed breast.
The tissue can either be a “free flap” or a “pedicled flap”. A “free flap” is a tissue that is completely separated from its original blood vessel, while a “pedicled flap” is still attached to its original blood vessels. Both types are shaped into a breast and stitched in the chest. Although a “pedicled flap” is more widely used because the method has been around longer and is easier to do.
Reconstruction using your tissue results in a natural-looking and behaving breasts. As you lose or gain weight, your newly constructed breast will get bigger or smaller.
Even though both methods can bring back the shape of your breasts, it is essential to know that it doesn’t restore sensation to the breast or the nipple. The skin over the reconstructed breast can become more sensitive to touch over time, but it won’t be the same as it was before surgery. Breast reconstruction surgery also does not restore the look of your nipple and areola. So, women also undergo nipple and areola reconstruction, usually, through micropigmentation .
When to have breast reconstruction?
So, is there a right time to have a breast reconstruction surgery? Undergoing this procedure will be based on your overall health, physical, mental, and emotional condition. It is vital to make sure that your body can handle the operation, and that you are mentally ready to have such a change.
Breast reconstruction can be done at the same time as a mastectomy (immediate reconstruction), after a mastectomy and other treatments (delayed reconstruction), or a staged process (delayed-immediate reconstruction).
Here, as soon as the cancer surgeon removes the breast, a plastic surgeon comes in and immediately starts reconstructing a new one. It can be done either by implants or tissue from other parts of the body.
However, if you are required to undergo further treatment for breast cancer, your surgeon may not recommend this option, as the reconstructed breast may be affected by other operations. If you are undergoing a prophylactic mastectomy — mastectomy to reduce a high risk of breast cancer — then reconstruction can be done immediately.
For cases where cancer cells are larger than 5 centimeters and have spread to the lymph nodes, it usually needs further treatment. The reconstruction process can also be done after all other cancer-related therapies, such as radiation therapy and chemotherapy, are done. The newly constructed breast can hinder the treatment from reaching the area affected by cancer, though it is a case-to-case basis.
Surgeons may advise you to undergo breast reconstruction after 6 to 12 months after your mastectomy. It can also be done years later if you are still undecided, or you suddenly had a change of heart about your decision.
A newer approach breast reconstruction is a staged approach. Here, a tissue expander is inserted under the chest muscle after the surgery to maintain the shape of the breast and breast skin.
The expander has a port where the surgeon can add or remove fluid over time. During radiation therapy, your doctor can deflate the expander to allow the radiation to target the area affected by cancer. After your radiation therapy is done and the tissues have recovered (around 4 to 6 months), breast reconstruction can be completed. The expander is removed and then replaced by a flap from a different part of your body.
Preparation for breast reconstruction
Just like any other operation, there are things that you need to do to prepare yourself for breast reconstruction:
- Get lab testing or medical evaluation to make sure your body is healthy to undergo the operation.
- Avoid any strenuous activity that can injure or sprain your body. Though regular exercise, walking, jogging, or swimming can help reduce stress and improve metabolism, which can help the healing process.
- Increase protein intake and take multivitamins to help tissue repair and wound healing.
- Avoid or stop smoking as it can reduce the body’s ability to heal.
- Avoid medications such as aspirin, anti-inflammatory drugs, and herbal supplements because it can lead to bleeding problems during and after surgery.
Recovery from breast reconstruction
After the operation, you can expect soreness and swelling for 2 to 3 weeks. Your doctor will give medication to ease the pain. During that time, drains will also be in place to remove extra fluid from the surgery. The doctor will then decide when the drains can be removed, depending on how much fluid is collected each day. He will also instruct you in terms of wound care, bathing, and garments to wear.
Instead of pain, you might feel numbness or tightness in the reconstructed area. Over time, some feeling may return to your breast, and the scars will fade as well. Around 6 to 8 weeks, you can resume regular activity, though avoid strenuous activities that involve the chest area.
Also, make sure to continue going to your doctor for regular check-ups. Keep doing self-exams and annual mammograms to monitor any signs of breast cancer coming back. No need to worry as breast reconstruction surgery does not increase the chance of cancer coming back. If ever the condition does come back, surgery, radiation, chemotherapy, and targeted therapy can still be options for treatment.
Undergoing breast reconstruction is a big decision that can impact you not only physically but emotionally. Consult with your doctor and plastic surgeon on which method will best suit your body and the current state of your health. Making a decision does not happen with one consultation; you need to think about what is best for you. Research and consult several surgeons about the different options available to you to make a smart and informed decision.