A New Breast, A New Life
By Dr. Tan Gie Hooi (Consultant Breast & Oncoplastic Surgeon) | Tropicana Medical Centre | Wed Jan 04, 2017 6:32pm
It is always good to see Susie again.
“Good morning, Dr Tan. I am so glad to see you today. I had missed you for my past few visits as you were away.” She gave me a big hug while saying this. She was wearing a brown wig as her hair is still quite short after the chemotherapy. She told me that she just completed her last cycle of chemotherapy 6 weeks ago and currently she is doing fine.
We went through the physical examination and all was well. She was very happy and satisfied with the left reconstructed breast. “Thank you for doing such a good job. The reconstructed breast looked really good. I can never imagine seeing myself in the mirror with a missing breast. You had given me not just a new breast, but a new life.”
This brings me back to the memory of our first meeting.
As usual, I was feeling quite exhausted at the end of the clinic session. A young lady in her mid-30 walked in nervously with her husband. After introducing myself, I asked her what brought her here today. Without saying much and very short eye contact time, she said, “Dr Tan, I would like you to have a look at my report.” There was a sad tone to her voice.
The report showed that she had 2 lumps in her left breast, size (3x2)cm and (1.5x1)cm. The bigger one was just underneath the left nipple. Both of these lumps had been biopsied and proven to be cancerous. She had been told that she need to have the entire left breast removed as the disease is extensive in the left breast (multiple spots). At the age of 36, mother of two young children, she was not ready to lose her breast though she knew that she had breast cancer and needed treatment urgently.
She revealed that she had received this result three months ago, she had been sitting on it as she was not ready for the surgery. She looked at me straight in the eyes, “As a woman, I am sure you understand very well this is a very difficult decision. To have one breast removed, I don’t think I can even see myself in the mirror. I know life is more important than breast, but I just want to know if there is no other way? Can’t I save my life and breast at the same time?”
Patting her shoulder gently, “Don’t worry, we will figure this out together. There are always ways to deal with this. First let me understand more about your medical history, carry out the physical examination, then we will go through the reports in detail and discuss the options of treatment.”
On physical examination, her breasts were of cup B size. There were two palpable tumors in the left breast, the bigger one was just underneath the left nipple. Fortunately, there was no swelling in the armpit which could be suggestive of lymph node involvement. Right breast examination was normal. Then I checked the thickness of the skin and muscle of her left back. “Why are you checking this? Is this relevant?” “Yes, this is important if we are going to discuss about breast reconstruction later. This will be your donor site for that.” Subsequently I took a look at her tummy, she had quite flabby tummy most probably due to the previous pregnancies and lack of abdominal exercise.
Based on the findings so far, she had a left breast multifocal (multiple spots) breast cancer, the lymph nodes looked normal (not involved by cancer) from the scans. Hence, she most probably had stage 2 breast cancer (the definite stage will only be known after surgery when the tumor and lymph nodes are removed and examined by the pathologist).
“Since you have more than one cancerous lumps in the left breast, so a lumpectomy (surgery removing just the lump) is not advisable. In another word, the left breast cannot be kept as it will not be safe to do so.” Tears started to well up in her eyes.
“But we can make a new breast for you after we remove the breast during the same surgery. This is what we call immediate breast reconstruction. You will go into the operating room with two breasts, come out after the surgery with two breasts too. What do you think of this idea?” Her eyes lightened up and beaming with hope, “Really? You can do that? So I get to save my life and breasts? Is this safe?”
I went on to explain to her regarding various options of breast reconstruction, either using a silicone implant, or our own body tissue (autologous). Breast reconstruction with implant is simpler comparatively, shorter operating time with no additional wound. The disadvantage is it is costly, and may need to be changed after 5 to 10 years if became hardened (developed capsular contracture). On the other hand, reconstruction with our own body tissue takes slightly longer time for the surgery (about 3 to 4 hours), and it involves an additional wound for harvesting of the tissue (donor site). The commonest donor site are the back muscle (Latissimus dorsi flap) and the tummy (TRAM flap – Transverse Rectus Abdominis Myocutaneous flap). However, using one’s own body tissue for reconstruction will give permanent result, usually do not need further surgery unless for touching up or revision. Hence, there are pros and cons of each technique. After a detailed and lengthy discussion, she opted for the TRAM flap reconstruction after fully understood the pros and cons, with the possible complications. Another added advantage of getting a TRAM flap is that the tummy area will be tightened up, so it is like a “tummy- tug” at the same time.
She underwent a skin sparing mastectomy and immediate TRAM flap reconstruction (removal of the entire breast but keeping most of the skin pocket; the nipple and areola removed) 2 weeks later. The surgery went well, she was discharged after 5 days of hospital stay. She went on for chemotherapy and hormonal therapy later as part of her adjuvant treatment.
I can still remember vividly how happy she was upon discharge and the hugs given spoke of her gratitude loudly.
“Looking back, I am very glad that I didn’t run away from the disease but chose to face it with courage. This journey has made me a stronger woman. My family is very proud of me.”
All my exhaustion of the day went away after seeing her. She had made my day.
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