Helping women feel whole again

SINGAPORE - Reconstructive surgery for breast cancer patients, who have undergone surgery to remove the whole or part of the breast, helps them return to normality.

But a downside has always been a lack of sensation in the new breast that can persist for years.

That is changing, as surgeons are now able to connect the severed nerves in the breast following mastectomy with the nerves in the replacement flap of skin taken from the abdomen.

Madam Sutinah Abu Bakar is among the more than 70 breast cancer patients who have opted for this procedure at the National University Hospital (NUH) since it was offered two years ago. She had stage two breast cancer.

The 52-year-old, who is unemployed, said she started regaining some feeling in her left breast just two months after undergoing total mastectomy and breast reconstruction surgery in February.

Now, seven months on, she has close to normal feeling in her left breast.

In the past, patients who had their breasts reconstructed using their own lower abdominal flaps could suffer numbness in the reconstructed breast skin for more than 10 years, said Dr Jane Lim, senior consultant at the division of plastic, reconstructive and aesthetic surgery at NUH.

She was the first surgeon to perform the new procedure at NUH, which is currently the only restructured hospital here offering it.

Checks with Changi General Hospital and Tan Tock Seng Hospital showed that they do not offer the procedure.

Dr Ong Wei Chen, a consultant at the division of plastic, reconstructive and aesthetic surgery at NUH, said patients who had reconstructive surgery before this procedure was available would start to have sensation after only five to eight years.

Sensation can return as nerves supplying the surrounding tissue may regenerate into the reconstructed breast.

With the new procedure done under a microscope, surgeons at NUH join the breast sensory nerves to nerves supplying sensation to the lower abdominal skin flap.

The procedure is done as part of breast reconstructive surgery, which can be carried out in the same sitting after the cancer is removed, or later in an operation done separately from the mastectomy.

The procedure to reconnect the nerves takes 45minutes to an hour to perform.

Dr Ong said: "In immediate reconstruction with abdominal skin flaps, we have always been able to find the stump of sensory nerves to the breast after the breast has been removed."

In delayed reconstruction, it is more difficult to find the nerve stumps because of fibrosis or scarring after radiation therapy, she added.

Radiation therapy is typically given after partial mastectomy to kill any stray cancer cells left in the remaining breast tissue.

NUH surgeons are analysing their patient data to determine how successful the new operation is. Early results show that patients have regained sensation as early as two months after surgery.

Innervated (with nerves rejoined) reconstructed breasts have been shown in studies overseas to have a greater magnitude of recovery, and sensation returns earlier when compared to non-innervated flaps, DrOng said.

So women with innervated reconstructed breasts would still be able to experience what doctors call the light touch.

"That means that they are quite sensitive," said Dr Ong.

The surgeons are also collecting data to compare the patients' sense of touch to what was measured before surgery and to that in normal breasts.

There are no additional risks or side effects in undergoing this procedure, said Dr Ong. At NUH, the new procedure costs an additional $2,000 for B1 class patients and $4,000 for A class patients.

Charges for B2 and C class patients vary according to the amount of the subsidy.

In a restructured hospital, the cost of breast reconstructive surgery done at the same sitting as a mastectomy can range from $6,000 to $30,000, depending on the amount of subsidies given.

The new procedure is now routinely offered to all breast cancer patients who are undergoing breast reconstructive surgery at NUH. So far, no woman has turned it down.

Madam Sutinah, who is a divorced grandmother of one, said she feels so normal now that she does not even mind not having her nipple reconstructed.

Typically, nipple and areola reconstruction is performed at about three to six months after the reconstruction of the breast. The interval allows for optimal healing and the dissipation of post-operative swelling.

"I feel like my normal self and I look like my normal self in a bikini. That's good enough already," said Madam Sutinah, who has a boyfriend.

The return to a truly normal life is why Dr Ong and Dr Lim want to offer the surgery, as women who undergo breast cancer surgery often suffer problems with self-confidence and sexuality. These are issues not frequently addressed.

Dr Ong said: "Refinements in reconstruction after breast cancer surgery can improve the woman's self-confidence and quality of life."

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