2.MAY.2019 4 MIN READ | 4 MIN READ

Breast cancer is the most common form of cancer affecting women worldwide. Dr Esther Chuwa explains why breast reconstruction is an important option to consider following a mastectomy.

Breast cancer is something all women should be aware of and check for regularly. Despite busy lifestyles and demanding schedules, women need to prioritise their health. All women are at risk of breast cancer – a potentially fatal disease. However, early detection is the key to save your life. Early detection is only possible if you perform breast self-checks and go for screening tests like mammograms regularly.

Be proactive. Do not wait till you experience symptoms that limit your daily activities as that usually happens at the later stages. When it comes to treatment, consider your options carefully as scientific research and breakthroughs have resulted in more than one option.

Symptoms and signs of breast cancer

You should look out for:

  • A lump in the breast or underarm area, even if it is small
  • Changes to your breast tissue texture or shape
  • Dimpling or wrinkling
  • Persistent bloody or clear discharge from the nipple
  • Red, inflamed, or scaly areas on the nipple

If you notice any of these, especially if you are over 50 years old, or if you have a significant family history of breast cancer, visit your doctor for screening and a breast exam. As a rule of thumb, if you have 1 immediate relative or at least 2 second-degree relatives (eg. aunts) diagnosed with breast cancer, you should see a breast specialist for regular screening.

Do not panic if you notice any symptoms. Breast lumps are very common among women, and 80 – 90% are not cancerous. Your doctor may recommend a biopsy to extract some tissue from the lump if there is any doubt.

Surgery for breast cancer

Surgery is the mainstay of treatment for early stage breast cancers.  The radical removal of the entire breast or a mastectomy may be recommended in the following scenarios:

  • Women who wish to avoid radiotherapy after lumpectomy may choose mastectomy as a 'simpler' treatment
  • Cancer that is located in several different locations within the breast requiring total removal of the breast to ensure all cancer cells are removed with clear margins
  • Locally advanced breast cancers resulting in fungating growth out of the skin causing bleeding and infection
  • Women who are tested to have the mutated BRCA gene. These women have a much higher lifetime risk of breast cancer. They may choose double preventive mastectomies to reduce their risk.

The effect of a mastectomy on a woman

Breast cancer evokes a lot of emotions. Many women fear losing their breasts upon diagnosis, and they also fear losing their lives to cancer.

The breast is, for many women, a symbol of femininity and sexuality, as well as a source of bonding and nourishment for their children. A mastectomy may mean losing an important part of herself as well as her identity. For most early stage breast cancers, breast conservation or a lumpectomy results in similar survival outcomes as a mastectomy. This may be an option to consider if your doctor finds that you are a suitable candidate for the procedure.

Maintaining your dignity

Breast reconstruction or 'reshaping' a new breast following lumpectomy or mastectomy is proven to improve patients’ quality of life, body image and the psychosocial aspects of their recovery. There are several surgical options available for women who wish to consider some form of reconstruction:

  • Breast oncoplasty combines surgery to remove the cancer with plastic surgical techniques to restore the shape of the breast. Simply put, it involves performing better lumpectomies with partial reconstruction of the defect left by cancer removal. It is a day procedure with little down time.
  • Mastectomy with immediate reconstruction is a longer surgery and requires a longer recovery period. The breast may be reconstructed using your own 'spare' tissues and fat or implants. Your doctor will assess your cancer stage, physique and lifestyle and recommend the most suitable option that does not impact cancer recurrence or limit your current lifestyle.

Is it too late?

Many women believe that the decision to have reconstruction must be made at the point of mastectomy. This is not true. If your are unable to make a decision regarding reconstruction but would like to undergo mastectomy to rid of the cancer first, you may consider delayed reconstruction at a later stage once you have completed all medical treatments necessary for the breast cancer.

Reach out and receive

A breast cancer diagnosis is understandably scary. However, many women are becoming cancer survivors every day. Being proactive and responsible for your own health will give you the best chance of fighting the disease.

It’s important to seek help and support from friends and family too. Although statistics for survival have generally improved over the years due to screening and better drugs, it is still vital to have a good support network. Studies have found a 38% reduction in survival if women are socially isolated or withdrawn from any support. Lean on your friends and family or a breast cancer support group during your treatment and recovery. Do not be shy or afraid to reach out and receive help.

 

Article contributed by Dr Esther Chuwa, breast surgeon at Gleneagles Hospital

Reference

Breast Cancer: Prevention and Control. (ND) Retrieved 11/04/19 from https://www.who.int/cancer/detection/breastcancer/en/index1.html

Chang, L. (2018, Aug 5) Breast Cancer Surgery Overview. Retrieved 11/04/19 from https://www.webmd.com/breast-cancer/breast-cancer-surgery-overview

Gardner, S.S. (2017, Aug 11) Breast Reconstruction. Retrieved 11/04/19 from https://www.webmd.com/breast-cancer/breast-reconstruction-after-mastectomy#2

Martin, L.J. (2017, Jul 15) Breast Cancer Signs and Symptoms. Retrieved 11/04/19 from https://www.webmd.com/breast-cancer/overview-breast-cancer

2.MAY.2019
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Chuwa Wee Lee Esther
General Surgeon
Gleneagles Hospital

Dr Esther Chuwa is a breast surgeon practising at Gleneagles Hospital Singapore. She specialises in oncoplastic breast surgery as a surgical option for breast cancer treatment, minimally invasive breast biopsy techniques, and localisation and excision of non-palpable breast tumours.