07 Oct 2010
This month is Breast Cancer Awareness Month. For many women, getting rid of breast cancer is but the beginning of rebuilding their lives.
At 49 and the mother of two grown-up sons, Madam Christina Chua has lost all shyness about going without a bra.
In fact, the nurse started to do so after losing her left breast to cancer two years ago.
One could not guess, thanks to reconstructive surgery, which gave Madam Chua a new breast that “looks natural, just like the other breast”.
“I feel a sense of confidence that I’m still like other women. The reconstructed breast is even slightly bigger,” she said sheepishly.
The only difference is that it does not have a nipple. Although Madam Chua can opt for an operation to craft a new nipple, she doesn’t mind its absence for now. There is the convenience of simply sticking on a nipple tape and going bra-less altogether, she said.
Breast reconstruction surgery has given many women like Madam Chua a fresh lease of life after the trauma of cancer.
“Having a new breast improves the woman’s body image and her psychological well-being,” said Dr Ong Wei Chen of the division of plastic reconstructive and aesthetic surgery at National University Hospital.
About 1,400 women in Singapore are diagnosed with breast cancer yearly.
In the past, women who had mastectomies could disguise the surgery only with silicone breast protheses inserted into bras.
Now, one’s own tissue – namely the skin, fat and muscle from the lower abdomen or the back – can be used to build the new breast.
Alternatively, silicone implants can be used to create the breast mound, but using one’s own tissue gives the breast a more natural appearance, said Dr Ong.
Advances in surgery can preserve even more of the breast now.
Skin-sparing or nipple-sparing mastectomy techniques – in place of the standard mastectomy – can also be used to achieve a more natural-looking breast, said Dr Georgette Chan, a breast surgeon at The Breast Surgery Centre. These specialised mastectomies aim to preserve the skin of the breast and the nipple if possible.
Dr Tan Bien Keem, a plastic, reconstruction and aesthetic surgeon at Singapore General Hospital, noted that breast reconstruction surgery has picked up in the last 15 years.
“When surgeons first came up with the procedure 10 to 15 years ago, patients were more reluctuant as they were worried about its safety,” said Dr Tan. “As we become more experienced, these worries are no longer a major concern.”
About 15 per cent of breast cancer patients opt for reconstruction.
Others either choose the simple mastectomy or breast-conserving surgery, where the bulk of one’s breast tissue is retained.
The latter is for tumours that are confined to one area of the breast and are small compared to the size of the breast such that removal will not cause much disfigurement.
Breast reconstruction can be done immediately after a total or partial mastectomy in the same operation, or at a later date.
Last year, about a third of breast cancer patients here who had a mastectomy also underwent immediate breast reconstruction.
And it is not just younger women who want it. Most of her patients are in their 50s, said Dr Chan.
“This goes to show how important breasts are to every woman, no matter how old they are,” she said.
An example is 54-year-old Madam Stella Tan, who opted for reconstruction surgery after a mastectomy of her right breast last October.
The regional sales manager – whose tumour was discovered during a massage in China, where she goes monthly for work – did not have any regrets about her decision.
“If I were to give reconstruction a pass but end up changing my mind two or three years later, having another operation may be risky as I would be older,” she said.
The mother of two, who is married to a 55-year-old regional sales manager, feels like her old self again and the reconstructive surgery had a great part to play in that.
“I was surprised by how good the results were – I almost forgot that I had cancer,” said Madam Tan, whose sons are aged 27 and 23. “I eat, work, play and relax just like before.”
However, breast reconstruction has its limitations. For example, the removal of breast tissue means that functions such as milk production are lost.
The most unsettling change, perhaps, is that the rebuilt breast will not feel the same as before.
“The breast will feel soft but sensation in the transplanted skin may take some time to return,” said Dr Ong.
This loss of sensitivity in fact perturbed Madam Chua so much that she took three months to accept the new breast.
“After the surgery, I would cry every time I went to see the doctor,” she recalled. “The doctor would ask me why I am crying when the breast is so beautifully done.
“I think it was because it will never be what it was before.”
Madam Chua – who is married to a 49-year-old oil refinery technician – added that two years on, the new breast is still somewhat insensitive. “It feels weird sometimes, as if it’s not my own skin,” she said.
However, this is a small price to pay, she added. It’s better to have a reconstructed breast than a cancerous one.
Said Dr Chan: “Cancer patients understand that surviving the cancer is the top priority, so their goals are realistic – most of them simply want to minimise the impact to their body image.”
What is important is to look forward and adopt a positive mindset, said Madam Tan.
“If you keep thinking that you are abnormal because your breast has been operated on, then you will never feel beautiful or confident about yourself again.
“For me, I simply believe that beauty comes from the heart,” she said.
Look out for more features on breast cancer in the coming issues of MYB during Breast Cancer Awareness month
Breast cancer affects about 1,400 women in Singapore yearly
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Dept of O&G
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