What is Breast Reconstruction?
Q U I C K A N S W E R:Breast reconstruction is surgery that rebuilds the shape, size and appearance of one or both breasts after a mastectomy or lumpectomy. In Singapore it is either implant-based or uses your own tissue (flap reconstruction), and can be performed immediately with the mastectomy or delayed. Dr Ong Wei Chen provides breast reconstruction at WC Ong Plastic Reconstructive Surgery, Gleneagles Medical Centre.Breast reconstruction is a surgery that restores the shape, appearance and size of one or both breasts, usually after a mastectomy or lumpectomy for breast cancer. Almost anyone who has undergone, or is undergoing, mastectomy for breast cancer can consider reconstruction. Breast cancer is one of the most difficult things a woman can face, and reconstruction goes beyond physical rebuilding. Many women who undergo breast reconstruction report feeling more confident afterwards, which supports quality of life and recovery after breast cancer treatment. There are practical benefits too — everyday items such as bras and swimwear become easier to buy and wear. Breast reconstructive procedures have been shown in many clinical studies to be oncologically safe. Surgical options exist not only for the breast being removed, but also for the opposite breast, to improve symmetry between the two sides. At WC Ong Plastic Reconstructive Surgery, Dr Ong Wei Chen provides breast reconstruction in Singapore at Gleneagles Medical Centre.
Is breast reconstruction safe after breast cancer?
“Many people assume plastic surgery is only cosmetic. A large part of the work is reconstructive — restoring form and function after cancer, injury or congenital conditions.” — Dr Ong Wei Chen, Senior Consultant Plastic Surgeon
Breast reconstruction does not affect breast-cancer recurrence or survival. Historically, reconstruction was delayed for years after mastectomy because it was believed to compromise treatment and increase the risk of recurrence.
It is now known that women who undergo immediate reconstruction have similar survival rates to patients who do not have reconstruction. Breast reconstruction is a medical procedure that forms part of the treatment for breast cancer, not an addition to it.
Dr Ong Wei Chen plans breast reconstruction in Singapore alongside the patient’s breast-cancer treatment, in discussion with the breast and oncology teams involved in her care.
When can breast reconstruction be done — immediate or delayed?
Breast reconstruction surgery can be performed at any time after a mastectomy. Some women choose immediate reconstruction on the same day as their mastectomy; others delay it, preferring to decide about reconstruction after completing their breast cancer treatment.
Reconstruction may be a one-staged or a two-staged procedure. The decision is made from medical factors as well as individual ones, and further surgery may be recommended to obtain an optimal outcome.
1.Immediate reconstruction — at the same time as the mastectomy or lumpectomy
In immediate reconstruction, the surgeon reconstructs the breast mound in the same operation as the mastectomy. The patient does not go through the psychological impact of waking from surgery and living without a breast, and does not need a separate operation at a later date.
A further benefit is reduced scarring and a better cosmetic appearance of the reconstructed breast. This is because the resecting breast surgeon is usually able to preserve more of the breast skin and, in some cases, the nipple.
Not all women can undergo immediate reconstruction. Women with late-stage breast cancer are less likely to be suitable. Women who require radiation therapy after mastectomy may need two-staged reconstruction, as radiation therapy can change the shape of the reconstructed breast mound.
2. Delayed reconstruction — after the mastectomy
Delayed reconstruction takes place after breast cancer treatment is complete — months, or even years, after the mastectomy. Some women prefer the time to consider their options; others cannot undergo an additional surgery immediately for medical reasons.
The option of breast reconstruction remains available either way. Surgery can take place years later, and Dr Ong Wei Chen sees patients in Singapore who come to discuss reconstruction long after their original mastectomy.
What are the types of breast reconstruction in Singapore?
Breast reconstruction generally falls into two categories: implant-based reconstruction, and autologous (flap) reconstruction, which uses one’s own body tissue to form the new breast. Sometimes a combination of the two is used. The goal in every case is to create a breast mound symmetrical to the opposite breast.
Implant-based reconstruction | Autologous (flap) reconstruction | |
What it uses | A silicone breast implant to replace the volume removed at mastectomy | Your own skin, fat and sometimes muscle from the abdomen, back or thighs |
Staging | One-staged (direct to implant) or two-staged (expander implant) | Usually one operation, with revision surgery if needed |
Recovery | Generally quicker, with less recovery time | Longer — a more complex operation |
Scars | Chest only | Chest plus an additional scar at the donor site |
Suited to | Women without enough donor tissue, without droopy breasts, or who prefer a shorter recovery; also well suited to bilateral reconstruction | Women with sufficient donor tissue who want a result that behaves more like a natural breast |
Over time | Stable; may need exchange or revision surgery | Look and feel can be more natural, and results may improve over time |
1. Implant-based breast reconstruction:
Implant-based reconstruction uses a silicone breast implant to replace the volume of breast tissue removed during mastectomy. It is the most common method of breast reconstruction in the USA, and can be performed as a one-staged procedure (direct to implant) or as a two-staged reconstruction using an expander implant.
There are many types of breast implant, but the most commonly used are silicone implants — a silicone shell filled with silicone gel. Anatomical shaped implants are usually chosen because they most closely resemble the natural shape of a breast.
For direct-to-implant reconstruction, the woman should ideally have a moderately sized breast, with no extra skin needing to be resected at the mastectomy. The remaining breast skin must be healthy with a good blood supply, so that it provides adequate outer covering over the implant placed beneath it.
Implant reconstruction is generally quicker and involves less recovery time than flap reconstruction. It is a common choice for women who do not have enough body fat or tissue available for a flap, or who prefer a shorter recovery. It may also be offered where multiple medical issues would make a longer autologous operation carry additional risk.
When is a tissue expander used?
An expander implant, used in two-staged reconstruction, is required when some breast skin or the nipple-areolar complex must be excised, leaving the skin too tight to close over an implant of the same volume as the original breast. Women who require adjuvant radiation therapy after mastectomy, or who require large-volume reconstruction, are also candidates for two-staged expander implant reconstruction.
An expander implant is a silicone shell implant that is either partially filled or not filled at all when placed inside the mastectomy pocket. Two types of breast tissue expander are commonly used.
- Fully saline-filled expander — the entire volume is filled with saline. The port where saline is injected sits in the centre of the implant, so filling takes place directly over the reconstructed breast. This expander is exchanged for a silicone implant at the second-stage surgery.
- Part-silicone expander — partially filled with silicone, with the remaining volume filled by saline through tubing connected to a separate port placed under the skin at the side of the chest. This allows saline to be injected away from the reconstructed breast, and gives the option of keeping the implant and removing only the tubing and injection port once filling is complete.
Filling of the expander implant is carried out in the clinic after the wounds have healed. The expander is sequentially inflated until its volume matches the other side, which can take place over several months.
Is the implant placed over or under the chest muscle?
In implant-based reconstruction the implant can be placed either under or over the pectoralis major muscle of the chest. The decision depends on how healthy the breast skin is after the mastectomy. In both positions a scaffold is created using a mesh or dermal matrix graft, with or without the muscle, allowing the implant to be positioned to recreate the breast shape.
The advantages of placing the implant over the muscle include slightly less pain in the first few days after surgery and, in the longer term, less movement of the implant when the chest muscles are flexed. If the remaining breast skin is thin, or the woman has a low BMI, rippling of the implant shell may be visible where there is not enough tissue cover over the implant. Some studies have also shown a higher infection risk.
Where an expander implant has been used, the expander is removed at the second-stage operation and a silicone implant is placed in the pocket that has formed. The second surgery is usually performed at least six months after the initial surgery. If radiation therapy is required, it is advised to allow the reconstructed breast to settle for six months or more before further surgery is carried out.
2. Autologous (flap) breast reconstruction:
Autologous or “flap” reconstruction uses your own tissue — skin, fat and sometimes muscle — from another part of your body, such as the abdomen, back or thighs, to create a new breast mound. This type of reconstruction involves a more complex operation and an additional scar apart from the chest.
Reconstruction with your own tissue can produce a more natural look and feel than an implant, and the results may even improve over time. Three types of flap reconstruction are commonly performed in Singapore, and Dr Ong Wei Chen discusses which is appropriate at consultation.
DIEP flap (Deep Inferior Epigastric Perforator) — uses skin and fat from the lower abdomen, sparing the abdominal
muscle.
TRAM flap (Transverse Rectus Abdominis Myocutaneous) — uses lower abdominal tissue together with part of the
rectus abdominis muscle.
LD flap (Latissimus Dorsi) — uses tissue from the back, on the same side as the affected breast.
What surgical options are available for breast reconstruction?
Dr Ong Wei Chen offers the following breast reconstruction options at WC Ong Plastic Reconstructive Surgery in Singapore:
- Implant-based breast reconstruction after complete mastectomy
- Autologous (flap) breast reconstruction after complete mastectomy
- Sensory innervation of tissue transfer (autologous) breast reconstruction
- Partial breast reconstruction
- Delayed breast reconstruction
- Fat grafting / fat transfer
- Nipple reconstruction
- Contralateral breast surgery to improve symmetry after mastectomy — breast augmentation, breast lift or breast reduction
How do I know which reconstruction option is suitable for me?
The right option depends on overall health, breast size and shape, the amount of donor tissue available, lifestyle requirements and personal preference. There is no single correct answer — the choice is made together at consultation.
Implant-based reconstruction is suitable for women who do not have droopy breasts, who do not have enough donor tissue, or who prefer not to have a second surgical site at the donor area. Implants are also well suited to bilateral breast reconstruction.
Using one’s own tissue can allow the reconstructed breast to behave more like a real breast over time, and results tend to improve. Nerves have been reported to grow into the transferred tissue, leading to better sensation over time. Additional procedures to improve the symmetry and shape of both breasts may also be performed.
“I begin with a detailed consultation to understand each patient’s goals and medical history, then tailor a customised plan for each individual. Reconstructive principles form the basis of my work, even in my aesthetic work, prioritising safety and natural-looking results.”
— Dr Ong Wei Chen, Senior Consultant Plastic Surgeon
How does a woman manage after mastectomy without reconstruction?
A woman who does not have a reconstructed breast can choose to use a silicone breast prosthesis. This is a weighted silicone mould made in a shape that simulates the breast, inserted into a pocket in a special mastectomy brassiere. These can be purchased from specialty shops, which your doctor will be able to advise you on.
The prosthesis creates the shape of a breast underneath clothing, but the woman will still feel the loss of her breast once clothing is removed. Even with the weight of the prosthesis in the bra, the uneven weight distribution across the chest can be noticeable. A prosthesis also cannot give the cleavage that a breast mound created by reconstructive surgery recreates, so certain types of clothing may pose some inconvenience.
Breast skin normally allows some degree of laxity over the chest, particularly when the arm is fully stretched or the shoulder fully extended. Where excess skin has all been removed at mastectomy, some women may feel tightness over their mastectomy scars.
FREQUENT ASKED QUESTIONS
Is breast reconstruction safe after breast cancer in Singapore?
Yes — breast reconstruction does not affect breast-cancer recurrence or survival. Clinical studies show that women who undergo immediate reconstruction have similar survival rates to women who do not, and reconstruction is recognised as part of breast-cancer treatment rather than an optional addition to it. Historically it was delayed for years in the belief that it compromised treatment, but that is no longer the position. Dr Ong Wei Chen, a MOH-accredited plastic surgeon, provides breast reconstruction at WC Ong Plastic Reconstructive Surgery, Gleneagles Medical Centre, planning the reconstruction alongside the patient’s cancer treatment.
Should I have immediate or delayed breast reconstruction?
Both are valid — the choice depends on your cancer treatment and your own preference. Immediate reconstruction is performed in the same operation as the mastectomy, avoids a separate surgery, and often preserves more breast skin and sometimes the nipple, giving a better cosmetic result. Delayed reconstruction is chosen when radiation therapy is planned, when late-stage disease makes immediate reconstruction unsuitable, or simply when more time is needed to decide. The option remains open for months or years after the mastectomy. Dr Ong Wei Chen will advise which is appropriate after assessing your treatment plan.
What is the difference between implant and flap breast reconstruction?
Implant reconstruction replaces breast volume with a silicone implant and generally has a quicker recovery; flap (autologous) reconstruction uses your own skin, fat and sometimes muscle from the abdomen, back or thighs. Implant reconstruction can be direct-to-implant in one stage, or two-staged using a tissue expander that is filled in clinic over several months. Flap surgery is more complex and leaves an additional scar at the donor site, but produces a more natural look and feel, and results may improve over time. The right option depends on your body, your health and your preferences, and is decided at consultation in Singapore with Dr Ong Wei Chen.
Can I have breast reconstruction years after my mastectomy?
Yes — delayed breast reconstruction can be performed months or even years after a mastectomy. Some women complete their breast cancer treatment first, some are advised to wait for medical reasons, and some simply need time to decide. Where radiation therapy has been given, the chest tissue is usually allowed to settle for six months or more before reconstruction. Reconstruction after a delay may use an implant, an expander implant, or your own tissue in a DIEP, TRAM or LD flap. Dr Ong
Wei Chen sees patients at Gleneagles Medical Centre who come to discuss reconstruction long after their original surgery.
How long does recovery from breast reconstruction take?
Recovery depends on which procedure is performed — implant reconstruction generally involves less recovery time than flap reconstruction, which is a more complex operation with a second surgical site. Where a tissue expander is used, filling continues in the clinic after the wounds have healed and may take place over several months, with second-stage surgery usually at least six months after the first. Radiation therapy adds further time, as the reconstructed breast is allowed to settle for six months or more before any additional surgery. Dr Ong Wei Chen sets out the expected downtime for your specific procedure at consultation.
Can breast reconstruction be claimed under Medisave or insurance in Singapore?
Breast reconstruction after mastectomy for cancer is a medical procedure and is generally claimable under Medisave and medical insurance, unlike purely cosmetic surgery. WC Ong Plastic Reconstructive Surgery is a Medisave-accredited clinic, and the clinic team assists patients with claims and e-filing. Coverage and limits vary by policy and by the hospital and ward class chosen, so check the specific terms with your insurer before surgery. Dr Ong Wei Chen operates across the IHH Healthcare hospitals, Mount Alvernia, Farrer Park and Thomson Medical Centre, which affects how a claim is filed.
