Madam May Wongc arrying her 10-month-old son Tok Yuan Yi, with husband Sam Tok Hoe Tooi, 46, and Dr Lim Geok Hoon. Madam Wong underwent the minimal-scar mastectomy 10 days after giving birth to Yuan Yi. ST PHOTO: KUA CHEE SIONG

Procedure for suitable patients with breast cancer preserves areolas and nipples

In a conventional mastectomy, a breast cancer patient ends up with a long scar across the chest and loses her nipples and areolas in the procedure.

The KK Women’s and Children’s Hospital (KKH) has come up with a surgical technique for suitable patients which produces a less visible scar around the areolas, preserving them and the nipples.

The minimal-scar mastectomy technique was developed by Dr Lim Geok Hoon, a senior consultant at the hospital’s breast department.

“It’s actually a combination of two techniques – the nipple-sparing mastectomy and oncoplastic breast surgery, both of which have been established since the 1990s,” said Dr Lim.

“Studies have shown that if you keep the nipples, it’s better because it improves the patient’s overall psychological well-being,” she added.

For some women, the technique may even preserve the sensation in their nipples. Dr Lim said a patient’s breast skin envelope will also be preserved, making future breast reconstruction easier.

Breast cancer is the leading cancer in women here, with the incidence rate more than doubling from 25 to 65 per 100,000 women over the past 40 years.

Minimal-scar mastectomies work only for women with small breasts, those who do not have cancer in the nipples or areolas and those who do not have cancer on large areas of the breast skin, said Dr Lim.

The technique does not allow for a breast reconstruction procedure at the time of the mastectomy.

Dr Lim said the technique cannot be applied on smokers and patients with connective tissue disease or diabetes because the blood supply to the nipples may be compromised.

Even so, a sizeable proportion of patients here may be suitable candidates for the procedure.

Up to 74 per cent of breast cancer patients here had a mastectomy and about 75 to 88 per cent of these patients did not opt for a breast reconstruction from 2001 to 2010.

Based on 12 years of data from more than 3,000 patients, KKH’s mastectomy rate was about 65 per cent. More than 70 per cent did not opt for reconstruction.

Since March last year, the new technique has been used on three patients, with no complications, said Dr Lim.

The cost of the new technique is comparable to that of a conventional mastectomy procedure without breast reconstruction, and the length of stay in the hospital remains between one and two days.

Subsidised patients pay about $5,000 to $7,000, while private patients pay about $12,000 for either procedure, which are also Medisave- claimable.

Potential complications for the minimal-scar mastectomy, such as the widening of the areolas and death of cells in the nipples and areolas, are uncommon and may occur in less than 5 per cent of cases.

Madam May Wong, 38, who had the minimal-scar mastectomy procedure for both breasts in August last year, is encouraged by the results.

She was 31 weeks pregnant when she was diagnosed with third-stage breast cancer in both breasts, and went for the surgery just 10 days after she gave birth to her youngest son at 34 weeks.

“It took me a long time to decide on a conventional mastectomy but less time to decide on the new technique because I considered the appearance and that I could preserve something,” said Madam Wong, who has two other boys aged six and 10.

She has since recovered from the surgery and completed chemotherapy and radiation therapy.

Madam Wong, who does parttime administrative work, is now undergoing immunotherapy and hormonal therapy.