Published on 29 November 2022

    New breast-preserving surgical techniques allow breast cancer patients to keep the size and shape of their breast.

    Fear, anxiety, a general sense of despondency, and maybe anger – these are some of the common emotions that patients feel when they are first diagnosed with breast cancer.

    Women in particular often find themselves significantly affected – both mentally and emotionally – by the potential loss of their breasts, which, for many, symbolises femininity, beauty, and motherhood. 

    So for most patients, their vision of a future with breast cancer is often bleak and painful. 

    While this may have been true in the past, more patients are today able to beat breast cancer thanks to innovations in modern medicine. Crucially, the majority of them now also have the ability to continue living their life as it was before, including wearing the same bra or clothes after treatment.

    “The idea is to look at cancer treatment as just a speedbump in life. The aim of treatment is to allow the patient to go back to their previous lifestyle with no issues,” said Dr Jesse Hu, Senior Consultant at the Division of Surgical Oncology, National University Cancer Institute (NCIS).

    What is breast cancer and how does it form?

    Breast cancer is the most common cancer for women – on average, one in 13 Singaporean women would have been diagnosed with breast cancer at some point in their lives. 

    But, what causes it? 

    In short, breast cancer occurs when cancerous cells develop from breast tissue, which are the milk ducts and milk lobules. 

    Common symptoms of breast cancer include the appearance of a lump in the breast or armpit, nipple discharge, a rash around the nipple, dimpling of the skin, or a change in breast shape or size. 

    “Other tissue in the breast, such as fats, don’t become breast cancer,” Dr Jesse explained. “Most patients present with a lump, which is usually about 2cm by the time they see us, so it will be at least stage two. 

    “When cancerous cells invade tissue and spread to other organs such as the bones, liver, lung, or brain, that’s known as stage four cancer, and that’s when it kills.”

    Symptoms and risk factors

    Breast cancer, however, can be hard to detect on its own, as patients oftentimes do not feel unwell or present with many symptoms. In fact, some symptoms, such as weight loss, may only appear when the cancer has reached stage four. By then, the chances of successfully treating the cancer would have diminished significantly.

    In contrast, early detection of the cancer dramatically increases the chances of a full recovery for the patient. Going for a mammogram on an annual basis is therefore highly recommended, especially for those aged 40 and above.

    It is far less common for those under the age of 40 to be diagnosed with breast cancer. Indeed, even a mammogram might not be able to effectively detect the presence of cancer in a patient under 40, as Dr Jesse said: “Younger breasts are denser, and in mammograms, cancer presents as a density – a white patch against a black backdrop. 

    While age is certainly a risk factor for breast cancer, other factors include being female, having a family history of breast and ovarian cancer, having your first pregnancy over 30, alcohol consumption, being overweight, and being on hormone replacement therapy. 

    Treatment option

    The treatment your doctor is likely to suggest for you depends on the type of cancer you have, with there being many different subtypes. “Luminal A is the most common type and accounts for 60% to 70% of breast cancer that we see,” said Dr Jesse. “If cancer is caught early, surgery is usually the first point of treatment. However, if yours is triple-negative or HER-2 cancer, we usually aim for chemotherapy first because it responds better.”

    Traditionally, the surgery offered to you will fall into one of two categories: either a mastectomy (whole breast removal) or a lumpectomy (breast-conserving therapy). 

    If the lump is too big, breast conservation will not be possible, but mastectomy with immediate reconstruction of the breast is. This means the surgeon will replace breast tissue with something else – an implant or your own tissue, such tummy fat or back tissue.  

    New breast-preserving techniques

    Today, oncoplastic surgery – using plastic surgery techniques to remove bigger cancers that were previously impossible to remove without a mastectomy – allows surgeons to preserve the size and shape of the breast in more and more cases.

    The two main techniques are:

    Volume displacement This is similar to a breast lift. After excision of the cancer (lumpectomy), the breast tissues are rearranged to reshape the breast, resulting in a “younger, perkier” breast.
    Volume replacementAfter removal of the cancer, volume loss is replaced with tissue from another part of the body, such as the side, from just below the bra line, or from the omentum (tissue from inside the abdomen).


    “Over the last 10 to 20 years, these techniques have been growing in popularity, and safety has improved to the point where they are no longer inferior to traditional techniques,” said Dr Jesse. “Oncoplastic surgery for breast cancer is now completely safe from an oncological point of view.

    “Generally women can tolerate about 20% volume loss without the breast looking any different. Remember that when I take away the cancerous lump in surgery, I also have to take normal tissue in a one cm circumference around the lump.

    “To figure out what’s right for you, your surgeon will help you make an informed decision. Counselling is part of a very lengthy process. But no matter what option you choose, you will be able to wear the same t-shirt and bra, and nobody will be able to tell that you underwent treatment or surgery for breast cancer.”

    In consultation with Dr Jesse Hu, Senior Consultant, Division of Surgical Oncology, NCIS.

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