Pros and cons of breast reconstruction

NUH breast cancer surgeon, Dr Shaik Ahmad Buhari (right), and breast reconstruction plastic surgeon, Dr Ong Wei Chen with a breast implant.
PHOTO: Pros and cons of breast reconstruction

The latest innovations for breast reconstruction involve transferring the patient's own tissue from the tummy, buttocks, thigh or back, said Dr Evan Woo, a consultant at the department of plastic, reconstructive and aesthetic surgery at KK Women's and Children's Hospital.

Surgeons then have to take only the skin and subcutaneous fat from another part of the body to reconstruct the excised part.

Using the patient's own tissues to reconstruct the breast results in an outcome that looks and feels the most natural, said Dr Woo, who also runs the Evan Woo Plastic Surgery Clinic at Mount Elizabeth Novena Medical Centre.

The breast will grow and age with her. It gets bigger when she puts on weight and smaller when she loses weight, he added.

The lower abdomen is the most common source for reconstructing the breast.

A plastic surgeon can contour the body, ridding it of unwanted skin and fat and purifying it to rebuild the breast. The patient benefits from a tummy tuck at the same time.

Some possible complications include weakness of the abdominal wall after the surgery, if part or the whole of the central abdominal muscle has to be sacrificed.

This is because even when surgeons try to spare as much muscle as possible, they are still dissecting through the muscle to get a length of a blood vessel which supplies the skin and fat.

"If it doesn't heal properly, the patient can get weakness there," explained Dr Woo.

Weakness in the abdominal wall is manifested as a slight bulge of the tummy.

In very rare cases, if the weakness is severe, the bulge can be large enough to contain some parts of the bowel. This is known as a hernia.

However, the weakness and the hernia can usually be repaired with minor surgery, said Dr Woo.

One of the newest methods for reconstructing the breast is the transverse upper gracilis (TUG) flap.

In this procedure, the gracilis muscle in the inner thigh and its blood vessels are taken together with the overlying skin and fat and transferred into the breast pocket.

The blood supply to the gracilis muscle and the overlying skin is then reconnected to keep it alive.

This requires microsurgery expertise, typically to connect the blood vessels in the chest with those from the gracilis muscle.

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Women who have smaller breasts (A or B cup) with some excess fat in the inner thighs are good candidates for this procedure. There is also the benefit of lifting and tightening the inner thigh.

Anyone without enough tissue in the inner thigh or who previously had a thigh lift or liposuction at the inner thigh is not suitable.

Because of the microsurgery techniques, this procedure can take six to eight hours to complete, compared with around three to five hours for the other methods.

There is also a small risk of failure when re-establishing blood flow to the gracilis flap.

Breast reconstruction can be partly paid for with Medisave and some insurance plans cover it.

Having a mastectomy and reconstruction done together means less general anaesthesia used and a shorter recovery period, reducing the length of stay in the hospital and medical costs, said Dr Woo.

Reconstruction is also easier as the skin which covers the breast (skin envelope) and the infra-mammary fold (lower border of the breast) are preserved, and the surgeon can mould a new breast into this skin envelope, said Dr Woo.

The patient also need not go through the experience of being "breast-less" and will be able to wear the same bra and clothes.

However, having two operations together will result in a longer operating time, sad Dr Woo.

In any case, breast reconstruction can be performed much later as well, after additional cancer treatment such as chemotherapy or radiotherapy has been completed.

This article was published on May 15 in Mind Your Body, The Straits Times. Get a copy of Mind Your Body, The Straits Times or go to straitstimes.com for more stories.