What is Breast Reconstruction?
Having breast cancer can be one of the most difficult challenges for a woman. Having a new breast reconstructed after mastectomy can help restore the body image of a woman. Almost anyone who had or undergoes mastectomy for breast cancer can opt for reconstruction.
Breast reconstruction is a surgery that restores the shape, appearance, and size of one or both breasts. Women often choose to undergo this procedure following a mastectomy or lumpectomy. This procedure goes beyond just physical rebuilding.
Many women who undergo breast reconstruction report feeling more confident after the surgery, improving their quality of life and supporting their recovery after breast cancer. Breast reconstruction can also have practical benefits; making it easier to purchase items like bras and swimwear.
Breast reconstructive procedures have been shown in many clinical studies to be oncologically safe. There are also more surgical options available, not only for the breast that needs to be removed, but also the opposite breast to improve symmetry of both breasts.
How does a woman manage after mastectomy if reconstruction is not performed?
Women who do not have a reconstructed breast can use a silicone breast prosthesis which they can insert into their brassiere. A prosthesis can help to create the shape of a breast underneath clothing. However, the woman may still feel the loss of her breast once clothing is removed.
Some have complained about the tightness of skin over their mastectomy scars, or the uneven weight felt on the chest from the loss of a breast. Others have felt that a prosthesis cannot give the “cleavage” a breast mound created from reconstructive surgery can give them, hence the inconvenience with choice of design and type of clothing.
Understanding Breast Reconstruction Surgery: When & How It's Performed?
How Soon After Mastectomy Should Reconstruction Take Place?
Breast reconstruction surgery can be performed at any time after a mastectomy. Some women may choose to have immediate reconstruction on the same day as their mastectomy, while others may choose to delay it, preferring to make decisions about breast reconstruction after completing their breast cancer treatment.
At the same time as the mastectomy or lumpectomy (Immediate reconstruction):
In this procedure, the surgeon reconstructs the breast mound in the same operation as the mastectomy. A patient who undergoes immediate reconstruction does not need to go through the psychological impact of waking up from surgery and living without a breast and does not need to undergo a separate surgery at a later date.
Other benefits of immediate reconstruction can include reduced scarring and a better cosmetic appearance of the reconstructed breast as surgeons are usually able to preserve more of the skin and in some cases, the nipple of the breast.
However, not all women can undergo immediate reconstruction. Women with late-stage breast cancer may be less likely to undergo immediate reconstruction. Women who require radiation therapy after mastectomy may need to undergo two stage reconstruction as radiation therapy can change the shape of the reconstructed breast mound.
After the mastectomy (Delayed reconstruction):
Some women may choose to delay reconstruction surgery till after they complete their breast cancer treatment. The reconstruction procedure can take place months, or even years later, giving patients ample time to consider their options for reconstruction.
How Is Breast Reconstruction Performed in Singapore?
Breast reconstruction generally falls into two categories: implant-based and autologous (flap) reconstruction, which uses one’s body tissue to form new breasts. Sometimes, a combination of these two is used. The goal is to create a breast mound symmetrical to the opposite breast.
Implant-based reconstruction: This involves the use of silicone breast implants to recreate the desired shape and size of your breast. Sometimes an expander implant is used in a two staged reconstruction. This method is often quicker and involves less recovery time compared to flap (autologous) reconstruction. This is a popular option for women who do not have enough body fat or tissue available for flap reconstruction. It is also popular with women who prefer a quick recovery.
Autologous or “flap” reconstruction: This method uses your tissues (skin, fat, and sometimes muscle) from another part of your body — such as the abdomen, back, or thighs — to create a new breast mound. This type of reconstruction involves more complex surgery but can produce a more natural look and feel compared to using implants. Three types of flap reconstruction are usually done in Singapore: DIEP flap, TRAM flap and LD flap
A TRAM (transverse rectus abdominis myocutaneous) flap transfers tissue (including skin, fat, and blood vessels) from the abdomen to the breast but leaves it attached to the abdominal muscle, and tunnelling under the skin to bring the flap to the chest area. A DIEP (deep inferior epigastric perforator) flap transfers tissue from the abdomen to the breast without requiring to move the abdominal muscle. In this surgery, microanastomoses of the blood vessels is required.
The LD (latissimus dorsi) flap transfers tissue from the back on the same side of the breast, moving the skin, fat, muscle and blood vessels.
Surgical Options for Breast Reconstruction
- Implant-based breast reconstruction after complete mastectomy
- Tissue transfer (autologous) breast reconstruction after complete mastectomy
- Sensory innervation of tissue transfer (autologous) breast reconstruction
- Partial breast reconstruction
- Delayed breast reconstruction
- Fat grafting / fat transfer
- Nipple reconstruction
- Contralateral breast surgery to improve symmetry after mastectomy
How do I know which option is suitable for me?
Factors to consider when choosing the right option includes overall health, breast size and shape, amount of tissue available, lifestyle requirements, as well as personal desires.
Implant based reconstruction is suitable for women who do not have droopy breasts, or who do not have enough donor tissue or prefer not to have another surgery at the donor tissue site. Use of implants is also ideal in bilateral breast reconstructions.
Using one’s own tissue can allow the reconstructed breast to behave more like a real breast over time. The results tend to improve over time. Nerves have also been reported to grow into the tissue, leading to better sensation over time.
Additional procedures to improve symmetry and shape of the breasts may also be performed.
Is Breast Reconstruction Safe For Cancer?
Historically, breast reconstruction was delayed for years after mastectomy, because it was believed that it would compromise treatment and recurrence.
We now know that reconstruction does not affect recurrence or survival. Women who undergo immediate reconstruction have similar survival rates as patients who do not have reconstruction.
Breast reconstruction is a medical procedure that is part of the treatment for breast cancer.
What To Expect Before, During, and After Breast Reconstructive Surgery
Before Breast Reconstruction Surgery
- Consultation: You will have detailed discussions with our surgeon about your medical history, aesthetic goals, and the different options available to you. This will help you make an informed decision to choose the most suitable type of surgery for you.
- Medical Evaluation: Depending on your overall health, you might need to undergo various medical tests, or cease taking certain medications.
- Preoperative Preparation: You will be advised on changes to your medication routine, diet, and physical activities. Before surgery, your doctor will likely also mark incision sites and determine the placement for the reconstructed breast mound.
- Emotional Preparation: The emotional aspect is as important as the physical. Feeling anxious or scared is common, but be sure to express your emotions to your healthcare provider. They can offer resources and support to help you manage your feelings.
During Breast Reconstruction Surgery
- Anaesthesia: Breast reconstruction is performed under general anaesthesia, which means you will be asleep and pain-free throughout and immediately after the operation.
- Procedure: The time taken for surgery will differ depending on your chosen method. The surgeon will either place the implant or use your tissue to recreate the breast mound.
After Breast Reconstructive Surgery
- Recovery Room: Post-surgery, you will be moved to a recovery room where the medical team will monitor you as you wake up from the anaesthesia.
- Pain Management: You will likely experience some discomfort, but this can be managed effectively with medication.
- Supportive Garments: You may be provided with a surgical bra or compression garments to provide support and reduce swelling in the affected areas.
- Home Care: Once discharged, you will be given specific instructions about wound care, drain management, and signs of complications to watch out for.
Post-Surgery Follow-up Care
Proper follow-up care is essential after surgery to ensure a successful recovery and to monitor your progress. Here’s what you can expect as part of your post-operative journey:
1. Regular Check-ups
Regular follow-up visits will be scheduled so your doctor can assess your recovery and address any concerns. These appointments are crucial for tracking healing, managing discomfort, and planning further treatments if required, such as nipple and areola reconstruction.
2. Wound Care
You will be given clear instructions on how to care for your surgical wounds/dressings. Keeping these areas clean can prevent infections and aid in your healing process.
3. Managing Drains
If surgical drains are used, you’ll be guided on how to record the output from these drains. They are usually removed at one of your follow-up visits when the output decreases.
4. Pain Management
Pain and discomfort are typical after surgery. You will be prescribed pain relief medication to manage this. It is important to take these as instructed and communicate with our doctor if the pain persists or worsens.
5. Activity Restrictions
You will be guided on what activities to avoid and when you can resume regular activities, including work, exercise, and heavy lifting. Initially, it is essential to avoid strenuous activities for about 4-6 weeks to prevent complications and allow your body time to heal. You should also discuss with your doctor what kind of bras you can wear and what you should avoid.
It can take up to 6 weeks for bruising and swelling around the breast area to subside, and up to 1-2 years for scars to fade. Remember, everyone’s recovery journey is unique. It is crucial to listen to your body and not rush the healing process. The most important goal of your post-operative care is to support you in achieving the best possible outcome and returning to your normal routine at a comfortable pace.
Potential Risks & Concerns
Like all surgeries, breast reconstruction surgery carries a degree of risk and potential complications. Here are some of the potential issues that could arise, but it is important to note that not every patient will experience these.
1. Surgical risks
- Bleeding and Hematoma
- Anaesthesia Risks
2. Surgery-specific risks
- If you are undergoing flap reconstruction, there are rare cases in which the transferred tissue might not receive enough blood supply and may require additional surgery. Though uncommon, there may be problems with the donor tissue site.
- If you are undergoing implant-based reconstruction, scar tissue (capsular contracture) may form around the implant but this usually happens after some time and the effects may be differ for different individuals.
3. Aesthetic concerns
- Asymmetry: The reconstructed breast may not perfectly match the size or shape of the natural breast, and further procedures may be required for symmetry.
- Scarring: Scars are inevitable in any surgery, although techniques to minimize scarring are used whenever possible.
4. Emotional & Psychological issues
Adjustment issues: Even with successful physical results, some women may find it emotionally challenging to adjust to their reconstructed breasts. It is important to discuss all your concerns with your surgeon during the consultation before the surgery.
Frequently Asked Questions
Yes, breast reconstruction is considered a major surgery. It involves the use of general anaesthesia and can take several hours, depending on the type of reconstruction. The procedure also requires a hospital stay and a significant recovery period.
Yes, it is possible to reconstruct both breasts during the same surgery, known as bilateral breast reconstruction. This may be chosen in cases of double mastectomy or if a woman wishes to achieve symmetrical breasts after a single mastectomy.
The longevity of breast reconstruction results depends on the method used. Autologous or “flap” reconstruction generally has lifelong results as the new breast mound is made from your own tissue. Implants used in implant-based reconstructions may need replacement after 10-15 years.
Breast reconstruction aims to create a breast mound that appears as natural as possible. However, the result may not be identical to your original breast(s). Autologous reconstruction often offers a more natural look and feel than implant-based reconstruction. Factors like surgical technique, your body’s healing response, and any additional treatments you may need can also impact the final result.
While most women who have had a mastectomy are candidates for reconstruction, it may not be suitable for those with certain medical conditions, like uncontrolled diabetes or heart disease, or those who smoke heavily. It’s essential to discuss this with your healthcare provider.
The timing of breast reconstruction is a personal decision and can also depend on your medical condition. Many women opt for immediate reconstruction, done at the same time as the mastectomy. Others may choose delayed reconstruction, performed months, or even years after the mastectomy.
Yes, breast reconstruction can be performed years after a mastectomy. This is known as delayed breast reconstruction. It can be a suitable choice for those who were not ready for immediate reconstruction or needed to complete other treatments first.
The cost of breast reconstruction typically includes surgeon’s fees, anaesthesia fees, hospital or surgical facility costs, medical tests, post-surgery garments, and medications. The exact cost will depend on the specific procedure and other individual factors.
In Singapore, Medisave, Medishield Life, and most private insurance plans can be used to cover the costs of breast reconstruction, subject to certain limits and conditions. However, coverage can vary based on your specific plan. We recommend checking with your healthcare provider and insurance company to understand what is covered.
It may be possible for some patients to have a nipple-conserving mastectomy. This depends on the size and location of the tumour. You may choose to have the nipple and areola surgically reconstructed or tattooed if the nipple needs to be removed during surgery.
Both older and younger women have been shown to benefit from breast reconstruction, and complication rates for older women are not significantly higher than in younger women.
After the operation, you may experience some pain and swelling in the affected area, but this can be managed using medication. Generally, the post-operative pain subsides within 3-5 days.
It can take about 4-6 weeks after surgery for patients to resume normal activities, but all recovery processes are different and the time it takes to recover varies from person to person, as well as the reconstructive procedure carried out.
Depending on the kind of reconstruction surgery, your reconstructed breast may feel close to the original breast. You may only regain sensation in your breast after some time.
No, patients who undergo breast reconstruction do not suffer a higher rate of cancer recurrence.
Why Choose Our Female Plastic Surgeon For Breast Reconstruction in Singapore?
Discover why so many patients entrust their breast reconstruction journey to Dr. Ong Wei Chen:
Specialized Expertise: As an accredited plastic surgeon specializing in breast reconstruction, Dr. Ong has mastered the intricacies of this complex surgery. She combines her technical prowess with an innate ability to understand and support her female patients, providing comprehensive care every step of the way.
Over Two Decades of Experience: Dr. Ong’s surgical career spans over 20 years, with a significant focus on reconstructive procedures including breast reconstruction. She is well-versed in various techniques such as autologous tissue and implant reconstruction, tailoring each procedure to the individual needs of her patients.
Empathetic Communication: Dr. Ong believes in empowering her patients through information. She patiently explains each aspect of the procedure, including potential risks and the recovery process, addressing all questions with thoroughness and empathy. Her approach ensures every patient feels heard, understood, and comfortable.
A Woman’s Touch: As a female surgeon, Dr. Ong shares a unique perspective with her patients. She understands the aesthetic aspirations of women on a deeply personal level. This understanding, coupled with her professional expertise, helps foster an open dialogue, leading to better surgical outcomes and patient satisfaction.
Breast reconstruction is a significant procedure requiring an experienced, skilled surgeon. We encourage you to take the time to research, ask questions, and even seek second opinions. Your goal should be to find a surgeon who aligns with your personal goals, understands your needs, and can deliver the results you envision. Dr. Ong Wei Chen could be that surgeon for you.
As a female plastic surgeon with a sub-specialty training in breast reconstruction, Dr Ong not only carries out the demanding technical requirements of breast reconstructive surgery well, she can relate to her female patients, giving comprehensive care and support her patients need.