Once diagnosed with breast cancer, post-mastectomy can be distressing for many. However, breakthroughs in modern medicine have discovered that women can continue to feel normal through various treatments, including breast reconstruction surgery.
Allowing one to feel ‘normal’ again
Each year, Breast Cancer Awareness month is celebrated in October. The annually held campaign is aimed at raising the understanding of the impact of breast cancer on individuals.
Many times we have heard of breast cancer, leading towards lumpectomy — removal of the lump only. In the worst-case scenario, a mastectomy will be performed, which means women who undergo this procedure will lose one or both breasts. The idea of this can affect the aesthetics, physiological and psychological well-being of an individual.
Hence, breast reconstruction is one of the ways to restore hope and physical confidence in women walking through a cancer diagnosis. Typically, breast reconstruction takes place during or soon after mastectomy, and in some cases, lumpectomy. Breast reconstruction can also be done many months or even years after a mastectomy or lumpectomy.
Breast reconstruction surgery aims to restore the breast to its natural form. Over the last decade, it has become an increasingly popular option driven by greater awareness and better success rates. Sharing further insight on the procedure, general and breast surgeon Dr Ho Pey Woei, together with plastic and cosmetic surgeon Dr Leung Chin Meng, talk about the insight of breast cancer post-surgery and how breast reconstruction helps boost confidence.
General and breast Surgeon Dr Ho Pey Woei. 
Plastic and cosmetic surgeon Dr Leung Chin Meng.
An adverse effect on women
Depending on each individual, Dr Ho said that the treatment options varied. However, the main treatment for this cancer would be the removal of the tumour, or the whole breast (mastectomy). For the latter, Dr Ho said this would leave the patient flat-chested, with no nipple on the operated side, and a transverse scar across the chest.
Aside from that, losing one side of the breast also changes the body posture and balance of an individual. To add to that, post-surgery usually sees patients referred to a physiotherapist for arm exercises to avoid stiff shoulder joints.
As the removal affects the woman physically, it can cause psychological and social stress. But there are options for women to feel a sort of normality post-mastectomy. According to Dr Ho, among the options are to wear an external prosthesis.
“Breast form is a prosthesis worn either inside a bra or attached to the body to simulate the weight, bounce, feel, movement and especially the shape of the natural female breast. Depending on the material or shape used, these qualities can be achieved to different degrees,” said the surgeon.
Explaining further, Dr Ho disclosed that a more expensive breast form used silicone gel-filled inside a very thin, slick plastic shell with tapered edges. “Other materials such as foam and fibre are also used, especially for immediate post-mastectomy breast forms,” though only silicone breast forms can provide the weight, feel and move like a natural breast.
Breast reconstruction post-mastectomy
Aside from the temporary measures provided for breast cancer patients post-mastectomy, a treatment surgery known as breast reconstruction is another alternative. The surgery is to re-create a new breast for the patients, thus a more permanent solution for them.
Plastic and cosmetic surgeon Dr Leung said the surgery enabled women who had lost their breasts to feel whole again. “By providing a mound, a well-reconstructed breast will obviate the need for breast prosthesis and help to boost confidence.”
However, Dr Leung emphasised that breast reconstruction surgery was not cosmetic surgery. “It is considered part of the overall treatment for breast cancer. Breast reconstruction can either be implant-based using a breast implant or by using the body’s own tissues transferred from the back or lower tummy.“
Side effects of post-breast reconstruction
Through his experience in the field of cosmetic and plastic surgery, Dr Leung said certainly, side effects would arise depending on the type of surgery.
“The potential complications of implant-based reconstruction include infection, implant extrusion, deflation or rupture and firmness due to capsular contracture (implant covering becoming hard).”
“In instances where the skin is needed to be transferred from the back to provide additional skin cover for the implant, there will be scars on the back,” he added.
Sharing further on tissue flap reconstruction to assist in breast reconstruction — a procedure that used tissue from other parts of the body, such as the tummy, back, thighs, or buttocks, to rebuild the breast shape — Dr Leung said there was a risk of poor wound healing with loss of flap if blood supplies were compromised.
“There may also be abdominal wall weakness or hernia if the flap has been taken from the lower abdomen. Patients ought to bear in mind that some complications may prolong recovery and cause a delay in the commencement of adjuvant treatment, such as radiotherapy and chemotherapy, “ he said.
Back to normal
Breast reconstruction may allow a woman to feel ‘normal’ again despite the distressing experience of losing their breast due to cancer. Dr Leung, however, emphasised that results might vary depending on the used technique and the size, and shape of the normal breast.
“Some breasts, especially large, droopy breasts, are more difficult to match. As a result, the doctor stated that expectations for breast reconstruction must be realistic. “The reconstructed breast will look most natural when it is performed immediately after skin-sparing mastectomy, using tissue from the back.”
Nonetheless, once the wounds are healed, there is no specific care needed. Dr Ho also added that breast reconstruction would not affect the detection of cancer recurrence. Overall, the treatment for post-mastectomy breast reconstruction can optimise and boost the confidence of women diagnosed with this cancer.
