Many choices have to be made in the process of breast reconstruction. Perhaps the most important question is: “Is breast reconstruction right for you?”. For tens of thousands of breast cancer patients in Singapore, the answer has been ” Yes!”. Today, most patients who have undergone breast cancer surgery are suitable candidates for breast reconstruction. Women in Singapore choose breast reconstruction for many different reasons. Some of them no longer feel full or feel feminine. Others, do not want to deal with the daily care of wearing external breast prostheses. For many women in Singapore, breast reconstruction is a good way to feel better and start a new beginning in life.

There is a lot to know when planning breast reconstructive and aesthetic surgery. We will try to give you some information about this process. However, this article does not provide medical advice and does not replace consultation with a qualified plastic surgeon. If you consider breast reconstruction you must see specialists in Singapore such as breast surgeons or plastic surgeons who can give you detailed and accurate information about this procedure.

How do doctors diagnose and treat breast cancer?

Doctor looking at a mammography

Breast cancer is a group of diseases. It is abnormal breast cells that can go on and spread to other parts of the body and can harm a patient. Some of the symptoms of the breast include a lump in the breast, a change in the size and shape of the breast or discharge from a nipple. Men can have breast cancer too but the number of cases is small.

Doctors in Singapore use various methods to diagnose cancer. Usually, the first thing that they do is breast cancer screening to see if the patient has something in the breast. If there is an abnormality there may be other imaging test or if necessary a biopsy will be performed. There are many different breast biopsy techniques that can be done to diagnose breast tumours. Sometimes the surgeon has to do the biopsy and that’s called an excisional or wide local excision. If the patient is diagnosed with breast cancer she/he is referred to a breast surgeon who schedules the appropriate operation.

When it comes to breast cancer treatments there are different methods that doctors may use and these include different types of mastectomy and lumpectomy (breast-conserving surgery) as well as radiation therapy. For some types of cancer, such as anaplastic large cell lymphoma the main treatment can be chemotherapy. In this article will focus on mastectomy and how the breast can be reconstructed after such a surgery.

What is a mastectomy?

Mastectomy is a surgical procedure that removes tissue from the breast due to the presence of cancer or precancerous lesions. The amount of tissue removed during a mastectomy is not always the same. It varies according to the size and stage of cancer, the patient’s body type and personal preferences. Both procedures, mastectomy breast surgery and breast reconstruction surgery, normally work together.

Types of mastectomy

There are different types of mastectomy – partial, radical or complete mastectomy and preventive mastectomy.

  • Partial mastectomy. Doctors can perform a partial mastectomy for women with a first or second stage of breast cancer. This procedure is usually followed by radiation therapy to the rest of the breast tissue. In some patients, another surgery is required after a partial mastectomy. Sometimes, if cancer cells are found in the residual glandular tissue, it may be necessary to remove the entire breast.
  • Radical mastectomy. It is the complete removal of the breast, including the nipple. The surgeon removes the skin and the muscles under the breasts. This surgery is rare today. A less traumatic and more widely used procedure is a modified radical mastectomy where the entire breast is removed without the chest muscles. The procedure can be followed by breast reconstruction.
  • Preventive mastectomy. Women who have a high genetic or familial risk of breast cancer may choose preventive breast cancer treatment. It can be a general mastectomy with removal of the entire breast and nipple or a subcutaneous mastectomy where the breast is removed but the nipple is saved. Studies show that the chance of breast cancer can be reduced by 90% after performing a preventive mastectomy in women at high risk of developing cancer. Breast reconstruction can be done during a preventive mastectomy (immediate reconstruction) or can be scheduled for a later time (delayed reconstruction).

The type of mastectomy and treatment for breast cancer depends on several key factors, including age, general health, family history, the size of the tumour, the stage of the cancer (how far it has spread) and whether the lymph nodes are involved. What type of surgery will be done usually depends on the discretion of the breast surgeon.

What does reconstructive breast surgery mean?

Women who have lost one or both breasts due to cancer may desire to have their breasts reconstructed. This procedure can restore the breast mound to its natural form and size. Breast reconstruction is a combination of plastic surgery techniques that not only create a new breast but significantly improve a woman’s appearance, self-esteem and help you achieve the best possible quality of life.

When is breast reconstruction done?

Plastic reconstructive breast surgery can be done during a mastectomy which is called immediate reconstruction or it can be done after the breast cancer surgery which is known as delayed reconstruction. Depending on your personal preferences, you and your surgeon will decide which method is best for you.

One of the biggest advantages of immediate breast reconstruction is that the breast is restored during a mastectomy. It means you have only one operation and one recovery period. With immediate reconstruction, you avoid the experience of being left with only one breast or no breasts.

The advantage of late reconstruction is that it allows you to focus first on your recovery process from breast cancer surgery as well as to regain your strength. It also gives you more time to consider alternatives and make a well-informed decision about breast reconstruction.

Breast reconstruction options

There are different types of breast reconstruction surgeries. The method that you and your doctor will choose will be based on several factors such as your health and lifestyle, your body type, and breast size. How to increase breast size after this? Breast reconstruction can be done using tissue from your body, also called flap reconstruction or using breast implants.

woman choosing between two types of breast implants

Flap (Autologous) breast reconstruction

Autologous reconstruction uses your own body tissue, muscles and fat to restore the breast to its natural shape. During autologous breast reconstruction, the tissue can be transplanted from different parts of the body such as abdomen, buttocks, back, inner tight, etc.

  • DIEP Flap reconstruction (uses tummy fat). It stands for Deep Inferior Epigastric Artery Perforator Flap. This is a technical term which refers to the blood vessels which supply the tissue from the lower abdomen. Essentially, the procedure involves taking the lower abdomen skin and abdominal fat and transferring that to the chest to make a breast(aka fat transfer breast augmentation). It has the advantage of producing a natural-looking breast shape and natural feeling reconstruction. It also has the added bonus of removing some of the excess tissue from the lower abdomen and essentially performing an abdominoplasty or tummy tuck procedure at the same time. The DIEP reconstruction can be performed as an immediate procedure at the time of mastectomy or can also be done as a delayed procedure once you’ve complete your cancer treatment. A similar procedure that also uses abdominal tissue is TRAM flap. The difference between the DIEP flap and TRAM flap is that the DIEP uses only soft fat tissue while the TRAM flap uses tissue from the abdominal muscles.
  • SGAP flap reconstruction (uses buttocks tissue). This technique uses tissue from the upper buttocks to create a breast. The tissue is taken from the side of the buttock and transplanted into the breast pocket. SGAP flap leaves scars on the reconstructed breast as well as on the upper buttocks. This method is normally used if you don’t have adequate skin and tissue in your abdomen.
  • TDAP flap reconstruction (uses back tissue). During this procedure, a piece of skin and muscle is taken from the back or armpit and placed in the area of the breast where it is used for its reconstruction. This method is sometimes used to give a more natural look and shape to the new breast.
  • TUG flap reconstruction (uses inner tight tissue). TUG stands for Transverse Upper Gracilis flap. This is another option of breast reconstruction. It is a free flap meaning it involves microsurgery. The transverse part is the direction of the skin paddle. The upper gracilis means that the surgeon is going to take a little piece of muscle together with flap so it is not a true perforator flap which is what a DIEP flap is. The inner tight drains are placed that stays a little bit longer than the breast rates- at least two weeks. TUG flap reconstruction is rare and just a few plastic surgeons in Singapore perform it.

Breast reconstruction using implants

This method involves less surgery than flap reconstruction as it doesn’t require a donor site. Basically, the surgeon reconstructs the breast by using a saline or silicone implant. There are two main forms of implant-based reconstruction after mastectomy.

  • The first technique is to it in two stages. That means that in the first stage a tissue expander (partially inflated breast implant) is placed into the breast (underneath the chest or pectoral muscle). Over time this will stretch out the muscle and the breast skin and at a later date, an implant can be placed as a second stage.
  • The second form of breast reconstruction with implants is what’s called a direct to implant or immediate implant reconstruction. It is rather than place the tissues expander in the first stage and then place the implant in the second stage, the surgeon simply places the implant in the first stage. One of the big advantages is that with direct implant reconstruction you can save one operation and you just get this done in one phase. The disadvantage of breast reconstruction with implants is that there is a risk of capsular contracture – a hardening of the scar tissue around the implant, which can occur years later.

Reconstructing the nipple and areola after breast surgery

Nipple and areola reconstruction is really important to the final phase of breast reconstruction. They are often removed during breast cancer surgery. Breast reconstruction returns the volume of the breast and makes it symmetrical to the other side. But the problem is that there is no nipple on the top.

There are different plastic surgical techniques that are used to restore the nipple and areola. Most of them are based on the use of local breast tissue, creating a small height approximately the same size as the opposite nipples. The areola is reproduced through a tattoo.

Is breast reconstruction a major surgery?

It is major surgery. You can expect to stay several days in the hospital whether you’ve had flap reconstruction or implant reconstruction.

Recovery time can vary gradely depending on both the timing of when your reconstruction is and the type of reconstruction that you have. If you use your own body tissue you probably will have to stay in the hospital for at least five to seven days and to allow six weeks for recovery.

If you use implant or expander based reconstruction surgery you will most likely to have much shorter recovery. Generally, the hospital stay is one or two days and you can go back to activity after about two weeks.

What are the advantages of having breast reconstruction after mastectomy?

  • The surgery improves body image, emotional quality of life and sexuality.
  • Breast reconstruction may help reduce anxiety and depression as well as the fear of cancer diagnosis.
  • The operation gives more confidence about prognosis.
  • Majority of women are satisfied with their breast reconstruction and would recommend it to others.

How much does breast reconstruction surgery cost in Singapore?

The cost of breast reconstruction surgeries in Singapore may range from $20,000 to more than $60,000. There are many factors that affect the price such as the complexity of the operation, the surgeon’s fee, the medical tests that need to be done and so on. Breast reconstruction surgery is usually done to treat patients with breast cancer and it is normally covered by the insurance and is Medisave claimable. If you are considering such operation contact your health insurance provider and aks for information about what’s covered. Private Medical Insurance plans that usually cover such intervention are Integrated Shield Plan, Critical Illness Policies, Cancer Insurance Plans.

Breast reconstruction rate and profile in Singapore patient population

Breast reconstruction is an important part of breast cancer management. More and more women in Singapore are undergoing breast reconstruction surgery to restore their natural shape.

According to researches done for patients who underwent breast reconstruction at the National University Hospital in Singapore, between the years 2001 and 2010, 993 patients underwent a breast cancer surgery and 241 of them underwent breast reconstruction. The patient group that showed the largest preference for breast reconstruction procedures pertains to Malaysian women. Chinese are the other large ethnic group who went this surgery. The youngest woman diagnosed with cancer was 20 years old. The study assessed factors such as ethnicity, age, breast cancer demographics, time and type of implant.

To conclude

Breast reconstructive surgery is a very popular topic. You can find a lot of online articles about breast cancer, treatments and different methods for breast reconstruction. Among all cancers, women around the world are more likely to get breast cancer, and this is a serious social problem. In the last 20-30 years, doctors have learned very well how to detect and treat this disease. With vast advancements in cancer treatments, survival rates for patients with cancer have significantly improved over the years. When breast cancer is diagnosed at an early stage it can be cured in most patients. And these patients need to have a normal life which is possible thanks to breast reconstruction surgery.

We hope you’ve found this article helpful!