Dr Janna Joethy, Consultant, Dept of Plastic, Reconstructive & Aesthetic Surgery explained the different breast construction procedures that can be tailor-made to suit each patient, as well as the pre- and post-surgery support available.
“Doctor, can you really recreate
my breast? How will it look?”
This was a question posed
by Mrs X, who is in her mid-30s.
She had been diagnosed with
breast cancer and wanted to
remove all cancerous tissue to
increase her chances of recovery
as her children were young.
Doctors had recommended
removing her affected right
breast– in a procedure known
as a mastectomy– but she was
worried about how her new
breast would look.
Implicit in her questions are a few
issues that have to be addressed.
Women who have breast cancer
may feel their femininity and
sexuality will be compromised
when they have a mastectomy.
Many of them want to know
how this will affect their role
as a wife, mother and daughter.
In the past, large amounts
of breast tissue are removed
during a mastectomy. Today,
less breast tissue is taken out
and plastic surgeons reconstruct
the breast at the same time.
I explained to Mrs X that I have
reconstructed breasts for younger
women. Most went home within a
week, happy with their new breast.
I assured her that care and support
would be provided to her during
all stages of her cancer journey.
Breast-care nurses will provide
additional support until she
is discharged from hospital.
To reduce her anxiety, I asked
if she would like to speak to a
breast cancer patient who had
undergone breast reconstruction.
Some patients are more
confident after talking to someone
who has already gone through
the same surgical experience.
As she was rather emotional
and overwhelmed, I suggested
seeing her three days later, so that
she could gather her thoughts.
FORM AND FUNCTION
At the next appointment,
Mrs X was more composed.
She had received information
from the nurses about the
operation and also learnt of women
who had positive results following
She wanted to know how her
reconstructed breast would look.
I reassured her that the aim was to
create a breast that looks natural
and mirrors her unaffected breast.
If the unaffected breast needs
aesthetic enhancement, it can
be done at the same time.
As plastic surgeons specialising
in breast surgery,we have to
combine form, function and
aesthetics to provide the
best result for patients.
There is no “one size fits all”
formula and the reconstruction
is tailor-made to suit each person.
Several reconstructive options
are usually available to patients
like Mrs X. One method is
to use implants, which come
in a variety of shapes and sizes.
After taking measurements,
an implant can be chosen
to match the unaffected breast.
Inserting breast implants
is a relatively quick process
but as implants are made of foreign
material, they may need to be
changed every few years.
Alternatively, tissue from the
patient’s back, abdomen or
buttocks can be used to fill the void
created by the mastectomy. This
procedure usually takes longer and
causes scarring to the area where
the tissue was harvested from.
After careful consideration,
Mrs X decided to use her own
abdominal tissue. Most women
prefer this procedure as it
gives them a tummy tuck
at the same time.
For women who need
radiotherapy after surgery, tissue
from the abdomen is typically more
robust and resilient than implants.
Mrs X was relieved to hear that
the reconstruction could be done at
the same time as the mastectomy.
She was concerned about the
tummy scars, but these could be
hidden by her undergarments.
Women who had a mastectomy
done years ago can also opt
for breast reconstruction.
They could have decided against
reconstruction or were unaware
that reconstruction could be done
at the same time as a mastectomy.
In these cases, the procedure will
be similar to the reconstructive
surgery that Mrs X opted for–
with tissue from either the
back, abdomen or buttocks.
These women can also opt for a
different procedure where fat from
the abdomen or thigh is removed
via liposuction and then used
to recreate a breast mound.
This typically requires repeat
procedures and the patient may
have to make a few hospital visits.
Of course, they can also consider
implants if they do not want to use
fat or tissue from their own body.
Mrs X’s surgery went smoothly.
She had some pain in the first few
days but this gradually faded.
Her children were happy to
see her recovering. Her husband
took leave from work to watch
over her every night.
Nurses taught Mrs X postsurgical
care and how best
to look after her reconstructed
breast to minimise the risk
Physiotherapists taught her
how to prevent the accumulation
of mucus and secretions, to reduce
the chances of a chest infection.
Mrs X made good progress and
was up and about by the third day.
Constant encouragement from
her husband kept her spirits up.
On the sixth day, she was
I saw her two weeks later
to remove her stitches and
she was happy with the appearance
of her reconstructed breast.
She was also pleased with
her flatter tummy.
Women typically need to wait six
months to a year for the swelling
in the new breast to subside before
undergoing a reconstruction
of the nipple and areola, which are
removed along with the cancerous
tissue during a mastectomy.
Mrs X is now back to her daily
routine and plans to have her
nipple and areola reconstructed
next year. For now, she is
contented to be able to fulfil
her role as a wife, mother