When 62-year-old polytechnic lecturer Kua Sai Geok was diagnosed with Stage 1 breast cancer last year, she had initially braced herself for a tough road ahead and the prospect of living with a body that looked drastically different.
What she didn’t expect was just how quickly she would get back on her feet despite removing her entire breast.
Kua underwent minimal-scar endoscopic breast surgery at Tan Tock Seng Hospital (TTSH), which lasted 7.5 hours. The minimally-invasive method combined a keyhole mastectomy, performed through a 4cm incision, with breast reconstruction. Kua’s abdominal tissue was used to fill her breast cavity.
After surgery, she spent four days in the hospital and another 12 days recovering at home. Speaking to CNA Women, Kua said: “Everyone who saw me after the surgery said I didn’t look like someone who went through a seven-and-a-half-hour operation. I was still talking and looked as normal.”
She returned to work about four months later, and even resumed her weight training the following month.
Polytechnic lecturer Kua Sai Geok underwent minimal-scar endoscopic breast surgery at Tan Tock Seng Hospital in November last year. (Photo: Kua Sai Geok)
Kua’s experience reflects how advances in surgical techniques are reshaping what treatment looks like for many women affected by the top female cancer in Singapore.
Breast cancer accounts for 29.6 per cent of all female cancers, according to the Singapore Cancer Registry Annual Report 2022. This works out to about seven new cases diagnosed every day.
For many women, the thought of breast cancer surgery may come with the fear of losing one or both breasts. But not every diagnosis automatically means large scars or living with significant changes to one’s appearance.
Dr Melanie Seah, breast surgeon at PanAsia Surgery Group, said: “Many times, it is possible to keep the breast and remove the cancer (through) a lumpectomy, or breast-conserving surgery. When the tumour is smaller, we can remove it with a clear margin of breast tissue, rearrange the breast tissue to close the gap and still keep scars discreet.”
After a breast cancer diagnosis, it is advisable to have an open discussion on treatment options with the medical team, which may include reconstruction surgery. (Photo: PonyWang)
This approach allows some women to keep most of their breast tissue while achieving similar cancer outcomes to more aggressive surgery.
In the past, many believed that the safest option after a breast cancer diagnosis was to remove the entire breast, said Dr Ang Wei-Wen, consultant at TTSH Breast Surgery Service.
However, data has shown that women who undergo breast-conserving surgery – where only the cancerous tissue is removed – or those who opt for reconstruction, have similar overall survival outcomes as those who choose a mastectomy, especially if they keep up with regular checks and follow-up monitoring, he added.
One of the advances in breast cancer surgery is minimal-scar endoscopic mastectomy. Using this approach, surgeons make discreet incisions – some as small as 4cm – at the axillary region, around the armpit area.
Dr Ang said it has been around for some years but has become increasingly popular in the past two years.
Through these tiny openings, they insert endoscopic instruments, which includes a long thin tube equipped with a video camera and light, to precisely visualise and remove the breast tissue and cancer.
“The surgery uses a much smaller incision, placed in a more aesthetic position to remove the entire breast tissue, followed by reconstruction,” explained Dr Ang, one of the surgeons who operated on Kua. “This allows us to preserve most of the skin of the breast and the nipple for better cosmetic outcomes.”
Advances in breast reconstruction mean that many women who remove their entire breast can opt to replace the lost volume at the same time as a mastectomy. (Photo: Panuwat Dangsungnoen)
For patients like Kua, the approach means less visible scarring and pain, and smoother recovery. The smaller incision helps maintain blood flow to the skin and nipple, lowering the risk of complications like ischaemia and necrosis of the skin and the nipple, Dr Ang added. This refers to skin tissue death due to poor blood flow.
He added that the next step for minimal-scar breast surgery would be the use of robotics, which would allow for even smaller incisions and greater dexterity. Dr Ang said that although robotic surgery has been used in some centres here, it has yet to become a regular practice in Singapore.
Still, endoscopic mastectomy is not for everyone. The doctors stressed that suitability depends on the tumour type, location, size of the affected breast, as well as the patient’s overall health.
According to Dr Seah, it is generally more suitable for patients with smaller tumours that do not involve the skin or underlying muscle.
“For patients who are not suitable, especially those with other co-morbidities or who cannot tolerate longer operations, the traditional open mastectomy (where there is no reconstruction)
For Kua, being fit and active prior to her diagnosis played a role in her quick recovery. “I was lucky that I was undergoing training with a personal trainer at the time,” she said. “My advice is to always keep yourself as fit as you can. If anything unexpected happens, not necessarily cancer, you will manage it much better.”
Immediate breast reconstruction, often performed at the same time as a mastectomy, has become an increasingly common choice for breast cancer patients in Singapore, said Dr Seah.
A 2018 study published in the Singapore Medical Journal found that immediate reconstructions accounted for the vast majority (96.7 per cent) of the 241 patients in the sample who underwent breast reconstruction procedures.
For women who opt not to undergo breast reconstruction after a mastectomy, breast prostheses can be used to fill the bra to give survivors confidence. (Photo: ChayTee)
In cases where breast-conserving surgery isn’t possible, for instance when the tumour is too large or when multiple tumours are found in different locations in the same breast, a mastectomy would be the safer route, said Dr Seah.
In most cases, reconstruction can be considered in the same surgery, she added.
“Women drift to sleep under general anaesthesia and wake up with the cancer and breast tissue on the affected side removed, but with the appearance of the breast intact. We retain the original skin envelope and nipple areola while removing the cancer and replacing the lost volume,” explained Dr Seah.
Knowing there are options can bring relief during an already stressful time, and ease the fear that some women feel about losing their breast to cancer.
“When one has the weight of the cancer diagnosis on her mind, it is difficult to deal with the possibility of losing the breast and permanently altering her body appearance at the same time,” said Dr Seah. “That being said, being cancer free and preserving life is always at the forefront of priorities for most patients.”
Even with advances in breast cancer surgery, the doctors stressed that removing the cancer effectively will always come first. Every patient’s treatment journey is unique, and they advise having open discussions with the medical team, taking into account one’s personal expectations and priorities.
“For example, if body image and cosmesis are a very important part of you, we can explore reconstruction options. But if your main priority is to get the cancer out (without considering body image), with the simplest operation and lowest risk of complications, of course, we will discuss those options as well,” said Dr Ang.
Dr Seah added that it helps to ask for a timeline of the treatment plan. Knowing what to expect in the next six to 12 months can provide a sense of clarity during what can be an overwhelming time.
To women fearful of losing part of their identity to breast cancer, Dr Seah’s advice is to “choose life”.
“There are so many wonderful ways to preserve the shape and appearance of the breast. That is important and can be done but being cancer free is always the foremost priority,” Dr Seah said.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg (CNAWomen[at]mediacorp[dot]com[dot]sg).
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What she didn’t expect was just how quickly she would get back on her feet despite removing her entire breast.
Kua underwent minimal-scar endoscopic breast surgery at Tan Tock Seng Hospital (TTSH), which lasted 7.5 hours. The minimally-invasive method combined a keyhole mastectomy, performed through a 4cm incision, with breast reconstruction. Kua’s abdominal tissue was used to fill her breast cavity.
After surgery, she spent four days in the hospital and another 12 days recovering at home. Speaking to CNA Women, Kua said: “Everyone who saw me after the surgery said I didn’t look like someone who went through a seven-and-a-half-hour operation. I was still talking and looked as normal.”
She returned to work about four months later, and even resumed her weight training the following month.
Polytechnic lecturer Kua Sai Geok underwent minimal-scar endoscopic breast surgery at Tan Tock Seng Hospital in November last year. (Photo: Kua Sai Geok)
Kua’s experience reflects how advances in surgical techniques are reshaping what treatment looks like for many women affected by the top female cancer in Singapore.
Breast cancer accounts for 29.6 per cent of all female cancers, according to the Singapore Cancer Registry Annual Report 2022. This works out to about seven new cases diagnosed every day.
SURGICAL OPTIONS AFTER A BREAST CANCER DIAGNOSIS
For many women, the thought of breast cancer surgery may come with the fear of losing one or both breasts. But not every diagnosis automatically means large scars or living with significant changes to one’s appearance.
Dr Melanie Seah, breast surgeon at PanAsia Surgery Group, said: “Many times, it is possible to keep the breast and remove the cancer (through) a lumpectomy, or breast-conserving surgery. When the tumour is smaller, we can remove it with a clear margin of breast tissue, rearrange the breast tissue to close the gap and still keep scars discreet.”
After a breast cancer diagnosis, it is advisable to have an open discussion on treatment options with the medical team, which may include reconstruction surgery. (Photo: PonyWang)
This approach allows some women to keep most of their breast tissue while achieving similar cancer outcomes to more aggressive surgery.
In the past, many believed that the safest option after a breast cancer diagnosis was to remove the entire breast, said Dr Ang Wei-Wen, consultant at TTSH Breast Surgery Service.
However, data has shown that women who undergo breast-conserving surgery – where only the cancerous tissue is removed – or those who opt for reconstruction, have similar overall survival outcomes as those who choose a mastectomy, especially if they keep up with regular checks and follow-up monitoring, he added.
LESS SCARRING, FASTER HEALING WITH ENDOSCOPIC SURGERY
One of the advances in breast cancer surgery is minimal-scar endoscopic mastectomy. Using this approach, surgeons make discreet incisions – some as small as 4cm – at the axillary region, around the armpit area.
Dr Ang said it has been around for some years but has become increasingly popular in the past two years.
Through these tiny openings, they insert endoscopic instruments, which includes a long thin tube equipped with a video camera and light, to precisely visualise and remove the breast tissue and cancer.
“The surgery uses a much smaller incision, placed in a more aesthetic position to remove the entire breast tissue, followed by reconstruction,” explained Dr Ang, one of the surgeons who operated on Kua. “This allows us to preserve most of the skin of the breast and the nipple for better cosmetic outcomes.”
Advances in breast reconstruction mean that many women who remove their entire breast can opt to replace the lost volume at the same time as a mastectomy. (Photo: Panuwat Dangsungnoen)
For patients like Kua, the approach means less visible scarring and pain, and smoother recovery. The smaller incision helps maintain blood flow to the skin and nipple, lowering the risk of complications like ischaemia and necrosis of the skin and the nipple, Dr Ang added. This refers to skin tissue death due to poor blood flow.
He added that the next step for minimal-scar breast surgery would be the use of robotics, which would allow for even smaller incisions and greater dexterity. Dr Ang said that although robotic surgery has been used in some centres here, it has yet to become a regular practice in Singapore.
Still, endoscopic mastectomy is not for everyone. The doctors stressed that suitability depends on the tumour type, location, size of the affected breast, as well as the patient’s overall health.
According to Dr Seah, it is generally more suitable for patients with smaller tumours that do not involve the skin or underlying muscle.
“For patients who are not suitable, especially those with other co-morbidities or who cannot tolerate longer operations, the traditional open mastectomy (where there is no reconstruction)
For Kua, being fit and active prior to her diagnosis played a role in her quick recovery. “I was lucky that I was undergoing training with a personal trainer at the time,” she said. “My advice is to always keep yourself as fit as you can. If anything unexpected happens, not necessarily cancer, you will manage it much better.”
CONFIDENCE WITH BREAST RECONSTRUCTION
Immediate breast reconstruction, often performed at the same time as a mastectomy, has become an increasingly common choice for breast cancer patients in Singapore, said Dr Seah.
A 2018 study published in the Singapore Medical Journal found that immediate reconstructions accounted for the vast majority (96.7 per cent) of the 241 patients in the sample who underwent breast reconstruction procedures.
For women who opt not to undergo breast reconstruction after a mastectomy, breast prostheses can be used to fill the bra to give survivors confidence. (Photo: ChayTee)
In cases where breast-conserving surgery isn’t possible, for instance when the tumour is too large or when multiple tumours are found in different locations in the same breast, a mastectomy would be the safer route, said Dr Seah.
In most cases, reconstruction can be considered in the same surgery, she added.
“Women drift to sleep under general anaesthesia and wake up with the cancer and breast tissue on the affected side removed, but with the appearance of the breast intact. We retain the original skin envelope and nipple areola while removing the cancer and replacing the lost volume,” explained Dr Seah.
Knowing there are options can bring relief during an already stressful time, and ease the fear that some women feel about losing their breast to cancer.
“When one has the weight of the cancer diagnosis on her mind, it is difficult to deal with the possibility of losing the breast and permanently altering her body appearance at the same time,” said Dr Seah. “That being said, being cancer free and preserving life is always at the forefront of priorities for most patients.”
TAKING CHARGE OF YOUR CANCER JOURNEY
Even with advances in breast cancer surgery, the doctors stressed that removing the cancer effectively will always come first. Every patient’s treatment journey is unique, and they advise having open discussions with the medical team, taking into account one’s personal expectations and priorities.
“For example, if body image and cosmesis are a very important part of you, we can explore reconstruction options. But if your main priority is to get the cancer out (without considering body image), with the simplest operation and lowest risk of complications, of course, we will discuss those options as well,” said Dr Ang.
Dr Seah added that it helps to ask for a timeline of the treatment plan. Knowing what to expect in the next six to 12 months can provide a sense of clarity during what can be an overwhelming time.
To women fearful of losing part of their identity to breast cancer, Dr Seah’s advice is to “choose life”.
“There are so many wonderful ways to preserve the shape and appearance of the breast. That is important and can be done but being cancer free is always the foremost priority,” Dr Seah said.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg (CNAWomen[at]mediacorp[dot]com[dot]sg).
Continue reading...