25 Aug 2011
By: NG WAN CHING
Times were when a woman having a breast removed due to cancer would have little else on her mind but getting the cancer out of her body.
These days, however, more women are thinking ahead and opting to have the breast reconstructed once it is removed.
Two out of every 10 women undergoing mastectomies at KK Breast Centre in KK Women’s and Children’s Hospital agree to a breast reconstruction now, twice the number from four years ago.
All choose to have the reconstruction carried out at the same time as the mastectomy, said Dr Esther Chuwa, a consultant at KK Breast Centre.
Studies have shown that breast reconstruction does not interfere with the patient’s recovery or affect the recurrence of the cancer – good news for women devastated by not just a life-threatening disease but also a disfiguring one.
Madam Carol Lim, 39, was glad to hear that she could have her left breast remade after the cancerous tissue was excised while she was still on the operating table.
She wanted to look good and feel confident after her cancer surgery in April this year.
“I was not even 40 years old,” she told Mind Your Body.
This same desire to look and feel normal is also pushing up the numbers at other cancer centres, at National University Hospital (NUH) and Singapore General Hospital.
At NUH’s division of plastic, reconstructive and aesthetic surgery, 30 per cent of women who had breast cancer surgery last year underwent breast reconstruction too, up from 15 per cent in 2001.
Of all the patients who had breast reconstruction at NUH, 99 per cent chose to have it done immediately.
SGH has seen an increase of such cases from 10 per cent in 2007 to 15 per cent last year.
One of the reasons could be the increasing number of young women coming in with breast cancer, usually because it is diagnosed earlier now, said DrJane Lim, a senior consultant at NUH’s division of plastic, reconstructive and aesthetic surgery.
“Younger women affected by cancer seek complete restoration of form for better integration back to society, family, work and married life,” she said.
What holds most patients back is whether reconstructive surgery is safe or if it would affect their odds of recovery, said Professor Colin Song, the head and senior consultant at SGH’s department of plastic, reconstructive and aesthetic surgery.
“Many studies show that reconstructive surgery does not worsen prognosis or survival,” he said.
Some studies have shown that younger patients may even do better with such a morale booster.
The psychological well-being could boost the body’s immune response, which is known to have some association with mental well-being, said Prof Song.
It has also been found that older women, who were previously not given the choice of reconstruction, benefit more with reconstruction than with an external prosthesis, Dr Lim said.
“This is especially if they are very active. External prostheses are hot, hard to retain and may occasionally drop out,” she said.
Dr Evan Woo, an associate consultant at KKH’s department of plastic, reconstructive and aesthetic surgery, said: “Breast reconstruction can help women overcome their body-image issues, enhance emotional wellness and complement overall recovery.”
So a discussion of mastectomy procedures these days would also typically include the patient’s options for reconstruction, said Dr Lim.
Doctors also prefer to rebuild the breast immediately. It is aesthetically better as tissue is pristine and scarring has not occurred.
Doctors would also be able to save more of the native breast skin. This gives better shape, contours and sensitivity, said Dr Lim.
In the last year, NUH has been carrying out breast reconstruction where the nerves, blood vessels and muscles are joined. This has allowed some patients to be able to feel a light touch on their new breasts.
Despite the advances, fewer women here choose reconstruction than elsewhere, say, in Britain.
There, an average of 40 per cent of patients choose to have breast reconstruction, said Dr Woo.
Increasing public awareness may bring about an increase in the numbers here, he said. But they are not rising as quickly because of certain barriers.
Culturally, women here seem more open to living without breasts compared to their counterparts in the West, said Dr Woo.
There is also some lack of knowledge about breast reconstruction, and not just among patients, said KK Breast Centre’s Dr Chuwa.
Some breast cancer surgeons are unfamiliar with breast reconstruction.
“A surgeon’s lack of complete understanding of the outcomes and implications of breast reconstruction can restrict referrals for reconstruction,” she said.
In KKH, all breast cancer patients younger than 60 years old and who are suitable for reconstruction, are offered the choice to meet a plastic surgeon for an opinion.
There is also a misconception that breast reconstruction is considered cosmetic surgery and will not be covered by hospitalisation insurance or Medisave, said doctors.
Ms Sally Oh, manager of KKH’s Business Office, said breast cancer patients can claim from their Medisave for breast reconstruction.
Hospitalisation insurance may also be used, depending on the patient’s plan and its terms.
GLAD SHE DID IT
Madam Carol Lim’s first thought when she was diagnosed with breast cancer was that it could not be happening to her.
She calmed down when she was counselled by KKH senior nurse clinician Teresa Ng.
It was then she found out she could have breast reconstruction immediately following her mastectomy and it would not increase her chances of cancer recurrence.
“It helped that the surgeon, DrWoo, who spoke to me after Teresa, gave me a detailed explanation and told me he was very good at his job,” said Madam Lim, a secretary and mother of three, aged 21, 14 and 41/2.
A check on the Internet confirmed what Dr Woo had told her and she knew it was what she wanted, as long as she could afford it.
“I wanted to look good. I wanted to be confident,” she said.
Depending on a patient’s eligibility for subsidy, the estimated bill for a mastectomy followed by an immediate breast reconstruction ranges between $6,000 and $30,000.
Breast cancer patients who undergo this procedure may use up to $7,550 from Medisave for it and $450 per day for daily hospitalisation charges. Madam Lim’s bill is still being calculated.
She was diagnosed with stage zero, or very early stage, breast cancer in early April and had her mastectomy and breast reconstruction done in late April.
Even though her cancer was caught very early, she still needed a mastectomy as doctors told her the tumour was “on the bigger side”.
Blood vessels along with excess skin and fat connected to them were transferred from her lower abdomen to her chest. None of the abdominal muscles were affected.
“The two operations, one to remove my cancer and the other to rebuild my breast took 12 hours,” said Madam Lim, who did not need chemotherapy or radiotherapy after her surgery.
At first, her left breast was a little bigger than her right breast. But it has since shrunk and her breasts look more balanced now.
Initially, the breast was “rock hard and sore”.
“Now my husband says they feel natural and normal,” said Madam Lim, who added that her scars are very neat and not that obvious.
Her husband is 42 and a manager in a construction company.
However, she does not have the sensation she had in her left breast before the surgery.
“I was aware that blood vessels and muscles were connected and the nerves were not. I’m okay with that. I just need to look and feel good and not put my husband off when we are being intimate,” she said.
“I’m so glad I had it done. I still feel like a woman.”
Email: wanching@sph.com.sg
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