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Myths about breast reconstruction: Restoring a breast after mastectomy or lumpectomy is not considered a cosmetic procedure, but part of breast cancer treatment. As such, breast reconstruction is covered by health insurance. In Singapore, breast cancer surgeons work closely with plastic surgeons and oncologists to optimise surgical recovery and results.

A study published in the Singapore Medical Journal in 2018 says that more women in Singapore are saying yes to breast reconstruction, with the median age becoming higher too.

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Here are some common myths that these women probably cleared up before undergoing breast reconstruction. Senior consultant plastic surgeon Timothy Shim shares his patients’ most common misconceptions.

Myth #1: Breast reconstructive surgery is painful, lengthy and dangerous.

Breast reconstructive surgery typically takes between six and eight hours, with implant reconstruction being shorter and more straightforward than autologous or “flap” reconstruction. The patient will be hospitalised for up to two days with implant surgery and up to six days with flap surgery. The flap surgery patient will be able to get out of bed and walk on the third day. Wound healing takes about 10 to 14 days. Most women resume normal activities within six to eight weeks. Complete recovery is expected in three months, assuming that the patient does not need to undergo radiation therapy or chemotherapy post-surgery.

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The risks and complications of breast reconstruction surgery are not higher than that of other major surgeries. The patient may experience bleeding, infection and poor healing. In rare cases, an implant could rupture; the patient could experience capsular contracture, which in turn causes pain, distortion, and asymmetry. These can be treated or corrected.

The patient will experience mild discomfort for the first few days after the operation, and will be given pain medication to cope. Some women may experience more pain than others. If anything, the patient’s new breasts might feel more numb than pain, as the nerves have been affected during surgery.

Myth #2: Breast reconstruction is best done in a delayed fashion.

Immediate breast reconstruction yields better aesthetic outcomes than delayed reconstruction. This is because it is easier to reconstruct a breast on a wound site before the breast skin has contracted. The plastic surgeon can use the skin or even the nipple right away, in a skin-saving or nipple-saving mastectomy.

In delayed reconstruction, the surgery would have to be done in two stages. The patient can only return to the plastic surgeon a year after the mastectomy, at earliest, for the first stage. During this stage, a tissue expander will need to be inserted into the chest area to stretch the skin and create a breast pocket. The patient will then return for the second stage, where the temporary inserts are replaced with the final implants or tissue flaps.

Myth #3: A reconstructed breast will come with the nipple.

Freshly reconstructed breasts are smooth and nipple-less. This is because the nipple and areola (the dark area around the nipple) are usually removed during the mastectomy to minimise the chances of cancer returning. In some cases, a nipple-sparing mastectomy can be done, but only if the breast surgeon is certain that the tissue is cancer-free. Therefore, the patient will have to consider whether to undergo nipple reconstruction. It is typically done a few months after breast reconstruction, when the new tissue has healed and settled into place. Plastic surgeons can make a nipple out of tissue taken from the back or abdominal flap. Colour is then tattooed in.

Myth #4: Breast reconstruction will hinder one’s lifestyle.

On the contrary, leading studies show that breast reconstruction – whether immediate or delayed – improves a woman’s quality of life and positively impacts her sense of wholeness and well-being. If you’re wondering whether breast reconstruction is right for you, have a discussion with a qualified plastic surgeon.

This article has been verified medically by Dr Timothy Shim, senior consultant plastic surgeon at The Clifford Surgery Clinic (Singapore), Mount Elizabeth Novena Hospital (Singapore) and Clifford Centre (Singapore).

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