Over the years, a lot of Singaporean women tend to shy away from breast reconstruction surgery due to various reasons.
More recently, however, more and more patients opt to get breast reconstruction surgery because of an increase in the number of women who are diagnosed with breast cancer - and most of these women lead a long and healthy life after treatment.
In Singapore, there are many credible surgeons that perform breast reconstruction but there is still a relatively large percentage of patients who have doubts about the procedure.
As a doctor, it is part of my duty to help patients understand everything about the medical procedure, the expected results as well as associated risks, especially when dealing with an invasive procedure such as breast reconstruction.
If you are still weighing your options on whether to get breast reconstruction or not, this article will help you have a better understanding of breast reconstruction surgery.
I have consolidated 15 truths about breast reconstruction in Singapore so you can have a more informed decision before committing to the procedure.
1. Breast reconstruction is an important step to manage and cope with the life-long effects of breast cancer surgery.
For some women with breast cancer, surgery (or mastectomy) is required for their treatment.
During a mastectomy, a woman’s breast is removed to treat cancer. After this procedure, the breast will not look the same as before as it will lose its shape and may have some deformity.
This is why breast reconstruction is often considered by women who have undergone surgery for breast cancer treatment.
Breast reconstruction is an additional surgical procedure (on top of what is required to treat cancer) that helps the patients regain their breast shape and eventually restore their breast’s natural form after a mastectomy.
2. In Singapore, plastic surgeons perform breast reconstruction surgeries.
Traditionally, qualified plastic surgeons perform breast reconstruction in Singapore. Plastic surgeons are equipped with the necessary skills to perform reconstructive surgery as well as tailoring the procedure with each patient’s needs and circumstances.
3. Breast reconstruction improves your physical appearance and overall outlook in life.
You might choose to have breast reconstruction because this procedure offers a lot of advantages which include:
- Improvement of physical appearance.
Breast reconstruction can make your breasts look balanced and regain its natural shape. With breast reconstruction, you do not have to use an external prosthesis to mimic the original form of the breasts. You can feel comfortable wearing any clothes you like without having to worry about your breasts having unequal sizes.
- Improvement of outlook in life.
Breast cancer treatment can leave an adverse mark on a woman’s overall outlook in life. Breast reconstruction can help renew your confidence by making you feel good about your body even after mastectomy.
4. The time when you get breast reconstruction surgery matters.
You can have breast reconstruction at the same as your mastectomy (immediate reconstruction) or you can to wait for another time to have your breast reconstruction surgery (delayed reconstruction).
As a personal recommendation, if you want to achieve the best aesthetic results, immediate reconstruction is the best choice for you because the breast skin and nipple can still be saved during a mastectomy. In addition, immediate reconstruction can leave lesser scars compared to delayed reconstruction.
While immediate reconstruction can be more beneficial than a delayed reconstruction, there are certain factors that make a patient not qualified for immediate reconstruction. These factors may include:
- The patient’s overall health and lifestyle
Patients who smoke, are obese, severely underweight and have a history of blood circulation issues may most likely be advised to wait for another time to get breast reconstruction. In some cases, your doctor may not permit you to have any breast reconstruction at all.
- Radiation as part of the treatment
Another factor that can cause you to wait for another time for breast reconstruction is radiation therapy. Breast reconstruction before radiation treatment can give rise to problems and can make the reconstructed breast more unnatural. If at the time of diagnosis, it is already determined that you will need radiation as part of your treatment, better discuss the best options with your surgeon first.
Cancer management can have a great toll on every patient’s life, and I understand that decision making can be very overwhelming. Some patients don’t want to make decisions about reconstruction until they are fully treated. Some may even not want to have any additional surgery after treatment.
If you are considering breast reconstruction surgery after mastectomy, I highly advise that you discuss this with your surgeon and plastic surgeon first so the surgical team can properly plan out the best surgery and breast reconstruction option for you.
5. In Singapore, there are different breast reconstruction options available.
There are different types of breast reconstruction procedures that a woman who has had a mastectomy can choose from. These are the two main types of breast reconstruction operations that are widely used in Singapore:
- Silicone or saline breast implants
- Tissue flap procedure (using the patient’s own tissues)
If you have not decided what to choose yet, I recommend that you discuss it with your doctor first. In some cases, breast reconstruction plastic surgeons may use both breast implant and flap procedures at the same time on one patient.
Also, nipple (areola) tattooing and fat grafting can be performed to help make the reconstructed breast look more natural. Fat grafting is usually recommended for breast reconstruction of smaller breasts.
6. Breast implant reconstructions are easier to perform but are more prone to future complications.
Implant reconstruction is performed by inserting an implant filled with saline (salt water), silicone gel, or a combination of both through an incision.
Breast reconstruction using implants is a procedure that is easier to perform and requires lesser recovery time compared to tissue flap procedure. In addition, the process and mechanism of implant-based reconstruction are easier to understand.
However, based on numerous studies and reports from previous patients, breast reconstruction using breast implants are more prone to complications over time. Because of these complications, extra procedures are required to address these issues.
Some of the most common complications with breast implants are:
- Capsular contracture: the breast implants may feel abnormally hard over time especially if radiation therapy is required for treatment
- Rupture: the liquid inside the implant may leak out of its casing
- Infection: if left undetected or untreated, ruptures can cause severe infections
- Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL): although rare, this condition can develop and is often associated with the scar tissue around the implant
Before choosing breast implants for your breast reconstruction, I strongly advise you to think about how comfortable you are dealing with implants and their associated risks for the rest of your life. Also, make sure first if there is a chance for you to have radiation therapy as part of your treatment to avoid complications in the future.
7. Tissue flap reconstructions are more complex but perform better over time.
Flap reconstruction is performed by using transplanted tissue from another part of the body (such as the tummy, thigh, back or shoulders) to form a new breast mound.
Oftentimes, one good option is to choose the tummy as the donor site (considering there is enough amount of tummy fat) because it can give the patient a smaller tummy at the same time.
The two most common procedures are:
- TRAM (Transverse Rectus Abdominis ) flap where a “flap” the underlying abdominal muscle as well as skin and fat are transplanted to reconstruct a new breast mound.
- DIEP (Deep Inferior Epigastric Perforator) flap by transplanting skin, fat and the connected blood vessels (DIEP) from the lower abdomen to reconstruct the new breast.
One major drawback of TRAM procedure is that it removes a part (or all of it) of the abdominal muscle causing it to weaken over time. This is why, most plastic surgeons would recommend to leave the abdominal muscle intact and therefore, use the DIEP flap procedure instead.
Because flaps are tissues, skin and fat from your own body, there is a reduced risk for flaps to cause complications as your body does not recognize them as “foreign materials”. Most patients also say that flaps are more comfortable and perform better compared to breast implants.
Unlike breast implants, however, flaps are more complex to perform and requires a longer time to fully recover and fully heal. Some of the most common issues with breast reconstruction using tissue flaps are:
- Weakened Tummy: after a DIEP flap breast reconstruction, the tummy can become weakened.
- Blood Vessel Blockage: although very rare case, the blood vessels that supply blood to the transplanted flap can develop some blockage and may cause the tissue to die
- Seroma: A condition where a collection of fluids start to settle on the thigh area where the flap was taken from. Seroma may require additional minor surgery to be fully resolved.
8. Recovery period depends on the type of breast reconstruction and your overall health, lifestyle and treatment plans.
Right after breast reconstruction surgery, expect to feel soreness and discomfort that may even last up to a week or two. Your doctor will give you after-care medications and tips to help you manage the discomfort and drains (used to collect fluid from the body) after the surgery.
In general, patients are able to fully recover within about 1-2 months post-operation. It may take about 8 weeks for all the swelling to heal. After this time, you can already return to doing normal activities such as exercising. However, it is important to understand that every individual is unique, and a recovery period can vary depending on different factor such as:
- The type of breast reconstruction surgery you had
Breast reconstruction with breast implants takes a shorter time to heal compared to tissue flap reconstruction because the areas where the flaps were taken from also requires time to recover and fully heal.
- Your overall health, lifestyle and treatment plans
Healing can also be influenced by your overall health and how your body responds to after-care treatments your doctor prescribes. Patients who practice smoking and unhealthy lifestyle may encounter more issues and may delay the healing process. In addition, past and future treatments such as past surgeries, chemotherapy and radiation therapy can influence the recovery process.
9. There are associated risks during and after breast reconstruction surgery.
As is the case of all medical procedures, there will always be some risks. In the case of breast reconstruction, some unique problems may occur although the chance of them happening is slim. Nevertheless, it is important that you are informed of these possible risks and side effects. These risks and side effects during and shortly after breast reconstruction include:
- Blood clotting
- Problems with the anaesthesia
- Build-up of fluid in the breast or the tissue donor site
- Complications in wound healing
In addition, breast reconstruction can also have some long-term effects such as:
Breast reconstruction and mastectomy will most likely leave scars in the treatment area. Patients with a history of excessive scarring and bleeding may have serious concerns compared to patients with the normal healing process. Some scars can be permanent, but I have had patients saying that their scars became lighter or faded away over time. With the advancement of technology, there are now newer techniques that can reduce the extent of scarring.
- Loss of sensation
It is important to note that the reconstructed breast is not a substitute for your natural breast - therefore it will not feel the same and the reconstructed breast may lose some sensation. Some patients say that over time, the new breast becomes sensitive and some pressure can be felt but does not feel exactly the same as the natural breast.
10. Breast Reconstruction is Permanent.
Thanks to the advancement of technology, breast reconstructions are often permanent and will last a lifetime.
There are some cases where a new operation may be needed to adjust or replace the implants, but these cases are not common. In fact, only a small number of these cases involve problems with the implant itself, but rather because of discomfort or adjustment.
11. Breast reconstruction will not hide cancer or increase the risk of it coming back.
Based on research, breast reconstruction surgery has no influence whatsoever on breast cancer recurrence. This means that undergoing breast reconstruction does not increase or decrease the chances of your breast cancer returning.
In the case where breast cancer does come back, reconstructed breasts should not hinder any effort of finding and treating cancer. Thus, undergoing breast reconstruction will not increase the risks encountered in breast cancer treatment.
In addition, routine mammograms are no longer needed on the reconstructed breast, as there is very little breast tissue remaining. Cancer may show up on the skin around it, but these can be detected in a physical exam. If an area of concern is found, a mammogram may be done to diagnose the situation. In this case, have your mammogram done in a clinic or health facility that have trained technologists with experience in dealing with implants. Tell your technologist about your implant before he/she starts the mammogram. Images may be covered by implants and it is important that the mammogram is done so that the implants are avoided, and the best possible images are taken.
It is recommended for women with silicone implants that a breast MRI be done 3 years after they receive their implants, and every two years after that, to search for signs of ruptures.
12. In Singapore, breast reconstruction can cost from $25,000 up to $75,000.
Breast reconstruction costs in Singapore can range from $25,000 up to $75,000 or more for each procedure. The wide variance in the costs is due to the various reasons such as:
- The techniques used and the length of time it takes to finish the procedure
Depending on the situation, the surgery can be done in one go or it can be divided into two stages. Two-staged procedures are done via the insertion of a tissue expander which is gradually inflated throughout a period of a few months. When it is sufficiently expanded, the final implant is then inserted to replace the expander.
In some cases, a more complex breast reconstruction procedure is done that requires the extraction of tissue from back, abdomen, thighs and other parts of the body. This procedure requires a much more refined process and generally takes longer to perform. Due to these reasons, the procedure will be more expensive.
- Doctor’s fee and the type of hospital where the procedure was performed
Another thing to take note with regards to the cost id the doctor’s fee and the type of hospital where the procedure was performed. In general, private hospitals charge more for breast reconstruction compared to restructured hospitals.
13. Breast reconstruction in Singapore is covered by insurance and is Medisave claimable.
In Singapore, breast reconstruction procedures are usually covered by your insurance. They are also Medisave claimable, as these procedures are often done to treat patients who have breast cancer. Although it might seem at first that breast reconstruction is a cosmetic procedure, it is not considered one as its primary aim is to alleviate the effects of breast cancer and restore what it took away.
14. The success of your breast reconstruction will depend on your doctor’s expertise.
These flowing tips will help you find the best plastic surgeons in Singapore for breast reconstruction:
- Find a surgeon who listens to your needs and explains the risks and benefits of each option.
Deciding on which option to take for breast reconstruction is hard, and it is vital that you have adequate knowledge of the advantages and disadvantages of each. Make sure that you voice out your concerns and needs for the reconstruction and that the surgeon make you feel at ease and comfortable.
- Go see the plastic surgeon recommended by the doctor that performed your mastectomy. Usually, after a mastectomy, the doctor will recommend a plastic surgeon that can perform the breast reconstruction. This is a good place to start because it means that he/she has a good reputation among his/her peers and will be able to assist and answer your questions.
- Get a second opinion.
There’s no need to rush into breast reconstruction surgery. It is good practice to get a second opinion before continuing with the procedure to ensure that all bases are covered and there is little room for error during the procedure.
- Decide on a type of procedure and choose a doctor that does it well.
Not all plastic surgeons are experienced when it comes to all breast reconstruction options. A lot of them specialize in a specific type, which is why it is important that you decide on which option you want before you ultimately decided on a plastic surgeon. Once you have decided, find a doctor that specializes in that specific option.
15. Breast reconstruction is a lifetime commitment.
Committing to breast reconstruction is an important decision as it will last for the rest of your life.
Take note that not all cases of breast reconstruction are successful, and the results may not be what you had hoped. If you decide to commit to it, it is very important that you follow the tips I’ve outlined in the previous section to find the right plastic surgeon for you.
Losing a breast is emotional, and it will take some time before a woman gets used to her situation. Similarly, when a woman gets used to the sensation of a missing breast, it will also take time to adjust emotionally to a reconstructed breast.
Several physical and emotional changes occur after breast reconstruction surgery. You will need a period of adjustment in accepting your new breast and you may experience some strong emotions after the procedure. During this time, it is important to keep these things in mind:
- Talk to your doctor.
Knowing what to expect can help you take control of your emotions and make the road to recovery much easier. If you have any concerns, call your doctor and talk about it. Talking to a mental health therapist can also go a long way in sorting out your feelings.
- Find a support group.
Whether or not you go through with breast reconstruction, remember that there is support out there when it comes to dealing with breast cancer and breast reconstruction. Several women who have undergone breast reconstruction form support groups to help each other cope with their situations.
Your doctor and support groups can help you in coping with your situation. You may never be the same, but it is reassuring to know that you are not alone.