THE number one fear of women diagnosed with breast cancer is the loss of their womanhood – that is their breasts.
They may end up with only one breast, part of their breast or a deformed breast.
Removal of a whole breast (mastectomy) or part of the breast (lumpectomy) will leave most women feeling inferior and some don’t even dare venture outside their homes.
Cancerous tissues are only the parts to be removed and the rest is conserved to give back the joy of being a woman — via breast conservation which is immediately done after mastectomy or lumpectomy.
“Women can go for neo-adjuvant therapy — chemotherapy to shrink the cancerous lump before surgery — to achieve the best chance of saving the breast.
“The normal tissues and skin are kept and the breast is reconstructed,” said Gleneagles Medical Centre Consultant (Singapore) breast and general surgeon Dr Esther Chuwa.
If only a small part is removed, the resulting breast will be slightly smaller and if a lot of the breast tissues is removed and there is noticeable depression (donut look), then we will take the fat and muscle from the tummy or back and transplant it into the breast and reshape it to match the other breast.”
Dr Esther Chuwa
She added that the procedure was one-off — the removal of the cancerous lump and immediate reconstruction — with total surgery time of five to six hours.
In fact, the surgery was a two-in-one for those who wanted to remove excess fat on their tummy, or even get a breast lift at the same time, she said.
Breast reconstruction allows breast cancer survivors to lead a normal life — and they are less likely to be depressed. Their body image is preserved and they will survive mentally.
“Breast reconstruction is not about vanity and merely looking good. It helps boost the woman’s self-esteem and prevents her from being the centre of attention in public — for having only one breast.
“If she swims, she doesn’t have to stop because of looking funny without one breast. She also doesn’t have to stop socialising.
“Previously, when breast cancer was detected, the best option was to remove the whole breast (mastectomy) and the nearby lymph node. Today, mastectomy is only required if there are cancerous lumps in many spots. Thus, prevention is better than cure, and catching it earlier is the best option.”
Dr Esther urges women to conduct monthly breast self-examinations (BSE) and go for annual mammograms for those aged 40 to 49 and two-yearly mammograms for those 50 and above.
Changes like dimpling, puckering or bulging of the skin, a nipple that has changed position or an inverted nipple, redness, soreness, rash, swelling or fluid coming out of the nipples, should be immediately brought to doctor’s attention.
Those with family history of breast cancer are urged to start BSEs and mammograms earlier. Women leading unhealthy lifestyles like smoking, drinking alcohol and lack of exercise while those having early menstrual cycle or not having a child or having the first child late have a higher risk, she explained.
“Breast cancer is very common. It’s the number one female cancer in the world and all women have to be aware of it. It can happen to anyone, but it’s curable if caught early.
“The most common fear of having breast reconstruction is will it affect cancer recurrence detection. But if the cancerous lump is completely removed, recurrence is very low.”
Dr Esther has been performing breast reconstruction since 2006 but since the concept is still new to Malaysia, she only has a few Malaysian patients so far.
“Some are doubtful while some think it involves a massive operation but this is not true. However, it’s not suitable for those aged above 65 but that still depends on other factors.”
She pointed out that in Singapore of late, breast cancer was becoming increasingly common during pregnancy.
This is because women are delaying pregnancy for the first child until the age of 36, 37 and even 40 years. She said the pregnancy hormone may help the cancer to grow faster.
“Treatment for breast cancer in pregnant women is the same — just have to time it properly. Chemotherapy is safe after the first trimester while surgery is safe after the second trimester. We avoid doing chemotherapy or surgery during the third trimester.”
Dr Esther said girls who had their menstruation very early were more exposed to the estrogen hormone, adding: “Women who get pregnant take nine months break from the hormone while those who breast-feed extend the break further. For breast-feeding, a minimum six months is needed to benefit from it but the longer the better.”
Unlike cervical cancer, there is currently no vaccine available for breast cancer. Only 5 per cent of breast cancer cases are due to genetics.
Based on the National Cancer Registry Report 2010, Malaysia recorded 4,846 new breast cancer cases annually while the probability of breast cancer for females aged 15 to 79 is 7.3 per cent.
In Sarawak, the commonest age for breast cancer is between 41 and 55 years, based on a Sarawak General Hospital Audit for Breast Cancer 2008-2012. Most patients seek medical help when the lump is between 2cm and 5cm.
Those interested in learning more about breast reconstruction can contact CanHOPE East Malaysia Kuching Regional office at No. 32, 1st Floor Mendu Commercial Centre, Jalan Mendu, Kuching, email kuching @canhope.org or call the hotline numbers, 012-8883778 or 016-5752378.