More women in Singapore are opting for breast reconstruction after having a mastectomy to remove cancer tumours in their breasts.
This comes amid two trends that underline the need for this option.
First, many more women - almost 1,900 a year - are being diagnosed with breast cancer here than in the past. Second, most of them survive for longer periods after a mastectomy and some then turn to breast reconstruction after surgery.
Dr Chan Ching Wan, a senior breast cancer surgeon at the National University Cancer Institute, Singapore (NCIS), said that in 2010, 44 per cent of its patients who had undergone a mastectomy had their breasts reconstructed. In 2001, only 8 per cent had taken this option.
Breast reconstruction is considered part of the medical treatment and is covered by insurance such as MediShield Life. People may also draw on Medisave to pay for it.
Breast cancer usually occurs in one breast. If the tumour is large, removing it and some of the surrounding tissues would leave the woman flat on one side of her chest. Reconstruction rebuilds this breast to match the healthy one.
Breast reconstruction can be done with silicone implants, with tissue taken from the abdomen and back, or less commonly with tissue from the buttocks and thighs.
The advantage of a silicone implant is faster recovery as there is surgery at just one site. Also, removing tissue from the tummy could weaken it and this would be a concern for more physically active women.
However, implants are supposed to be changed after 15 years. Dr Yap Yan Lin, a plastic surgeon at NCIS, said she has known women to keep the same implant for 30 years. It does not go bad or rupture, but she said that over time, it can lose shape.
Dr Chan said if the cancer is likely to recur, she would recommend implants, as this leaves the option of using one's own tissue the next time.
Doctors say most women opt for tissue transplant because the reconstructed breast looks more natural.
Dr Ong Wei Chen, a senior reconstructive and aesthetic plastic surgeon at National University Hospital, said she would discourage women with sagging breasts from choosing implants, as their breasts would look unbalanced. When a woman's own tissue is used, the reconstructed breast will sag at about the same rate as the real breast, she said.
About a third of women who have had a mastectomy can choose a newer technique that preserves their nipples. Dr Chan said she tries to preserve the nipple if the tumour site is distant. She sends a bit of tissue from the area to the laboratory to check for any cancerous cells, while the surgery is going on.
The nipple is removed only if there are cancerous cells.
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