SINGAPORE - At Sengkang General Hospital (SKH), breast cancer patients undergoing mastectomy need not fear their nipple would be removed along with the rest of the breast. 

Its surgeons perform a minimally invasive mastectomy that spares not only the skin but also the nipple. The removed breast is also immediately reconstructed by a plastic surgeon using the patient’s own skin, fat, and blood vessels. 

This two-in-one procedure is spearheaded by SKH surgeons as part of the SingHealth Duke-NUS Breast Centre, comprising five key SingHealth institutions. Annually, the centre handles about 70,000 outpatient visits and manages over 1,300 breast cancer patients. 

Minimal scar technique at other public hospitals, such as KK Women’s and Children’s Hospital (KKH) to remove the breast, is different and does not include a breast reconstruction procedure at the same time as the mastectomy. 

Speaking at a press conference on Tuesday, breast surgeon Sabrina Ngaserin said: “The incision, about 4cm, is made under the arm pit or the bra line where it is inconspicuous, allowing for close-to-ideal breast restoration. 

“We remove the cancerous breast tissue as a whole through the single port placed at the incision site. We do not break up the tissue, as this will possibly reintroduce cancer back into the breast area.” 

She added that the “free flap” – which is using the patient’s skin, fat, and blood vessels for reconstruction – is carried out concurrently. 

In the free flap surgery, a tissue flap – including blood vessels, skin, fat, and sometimes muscle – is removed from one area of the body, such as the back or abdomen, and reattached to the chest to form a new breast mound. 

“The reconstructed breast looks and feels more natural as well as contoured, akin to natural breast tissues and is a lifelong solution over implants,” Dr Ngaserin said. 

“We hope to offer this as a standard procedure and first line of treatment over conventional approaches,” said SKH’s chairman of the division of surgery Benita Tan. 

Associate Professor Tan, who is also a senior consultant with the hospital’s breast service, said: “This allows the team to plan implant-based reconstruction, fat grafting, and other variations of flap reconstruction even for patients with challenging clinical conditions.” 

This minimally invasive breast cancer surgery that spares both the skin and nipple was first used in Japan in the 1990s. It is still not commonly performed in the world as technical expertise is required, said Dr Ngaserin. 

Since 2019, the team at SKH has used the technique in operations on over 30 breast cancer patients, more than half of which were carried out with immediate breast reconstruction using tissue from the abdomen. The youngest patient was 36 years old and the oldest was 65. 

One patient who went through the endoscopic breast conserving surgery is accountant A. Tan, 40. 

Ms Tan, who declined to give her full name, discovered a lump in her left breast in early 2022 and was referred to Dr Ngaserin by the polyclinic she visited. 

After she went through ultrasound scan and MRI, she was told she had first stage breast cancer. Ms Tan, who did not have any family history of breast cancer, said she was worried enough to seek a second opinion. “But after learning that the conventional technique used by the second doctor would leave a visible scar, I returned to Dr Ngaserin,” she added. 

After the surgery, four rounds of chemotherapy and eight rounds of radiation, Ms Tan said her life has returned to “almost normal”. She did not need the reconstruction. 

“The operation scar is small and faint. No one can see it unless I raise my arm. My breast looks and feels almost exactly as it was before, except for the darkened skin because of radiation. I feel confident once again,” the mother of two girls said. 

A spokesman for the National Cancer Centre Singapore said that the division of surgery and surgical oncology at Singapore General Hospital and NCCS have also been performing endoscopic assisted mastectomies for breast cancer patients since 2019. This technique is different from the one performed by SKH surgeons. 

The spokesman said the choice of scar incision on the breast depends on various factors including the location of the tumour and breast size, and can also be done in discreet locations such as bra line or by the nipple. 

A National University Hospital spokesman said that NUH will have its own programme by 2024. 

Breast cancer is the most common cancer among Singapore women and the most common cause of cancer deaths in women here. The incidence here has more than tripled over the past 50 years, to 74 cases per 100,000 women now – one of the highest in Asia.