Breast Reconstruction

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Breast reconstruction rebuilds the shape of the breast after cancer surgery, using either a breast implant or the patient’s own tissue, called a flap. It can be done at the same operation as the mastectomy, or years later. At Melanie Seah Breast Specialist in Singapore, it is performed by plastic surgeon Dr Timothy Shim, working alongside Dr Melanie Seah.

Deciding about reconstruction while you are still absorbing a cancer diagnosis is a great deal to ask of anyone. It is worth knowing early that it is a choice, not a default, and that it does not have to be made in the same week as the cancer decision. At Melanie Seah Breast Specialist in Singapore, Dr Melanie Seah plans the cancer surgery, and breast reconstruction is carried out in conjunction with a plastic surgeon, Dr Timothy Shim. This page covers what reconstruction involves, how implant and flap methods differ, timing, and recovery.

What is breast reconstruction?

Breast reconstruction is surgery to rebuild the shape of a breast after it has been removed, in whole or in part, to treat breast cancer. It does not treat the cancer itself — the cancer operation does that. Its purpose is the shape of the chest afterwards, and how a woman lives with it.

There are two broad routes. An implant reconstruction uses a silicone or saline implant to recreate the volume, while a flap reconstruction uses the patient’s own skin, fat and sometimes muscle, taken from the back, the abdomen, or the buttock or thigh, and moved to the chest.

Which page you want depends on the question. This page is about rebuilding the shape. If you are looking for the cancer operation itself — mastectomy, breast-conserving surgery and what follows — that is covered on breast cancer surgery and treatment. Reconstruction is planned alongside that decision, not instead of it, and many women choose not to have it at all.

Implant or flap: what is the difference?

An implant rebuilds volume with a manufactured device and is the shorter, simpler operation; a flap rebuilds it with your own tissue and is the longer one, with a second wound where the tissue was taken from. Neither is better in general — they suit different bodies, different treatment plans and different priorities. The figures below are published by the SingHealth Duke-NUS Breast Centre as general guidance for Singapore.

IMPLANT RECONSTRUCTIONFLAP — YOUR OWN TISSUE
What is usedA silicone or saline implant placed on the chest wallSkin, fat and sometimes muscle taken from the

back, abdomen, buttock or thigh

Usual length of operationAbout 4 to 5 hoursAbout 6 to 8 hours
Usual hospital stayAbout 3 to 5 days, with drainage bottles in placeAbout 1 to 2 weeks, with drains removed after one to two weeks
Number of operationsOne stage, or two if a tissue expander is used first and exchanged laterGenerally one operation, but with a second wound at the donor site
Over the yearsAn implant is a device and may need attention or replacement in futureYour own tissue ages with you, and changes as your weight changes

These are general figures for Singapore and not this clinic’s results. What applies to you depends on the technique chosen, your body, and whether radiotherapy is part of the plan — all of which are discussed before anything is decided.

Can reconstruction be done at the same time as the cancer surgery?

Yes, and it is one of the main decisions to make before the operation. Reconstruction started at the same time as the mastectomy is called immediate; reconstruction done at a later stage is called delayed. Both are established options, and the right one depends on the cancer treatment plan as much as on preference.

Immediate reconstruction

Done during the same operation as the mastectomy. It is usually paired with a skin-sparing mastectomy, which preserves the breast skin envelope, or a nipple-sparing mastectomy where the nipple is kept as well. One anaesthetic, one recovery, and the shape is never entirely lost.

Delayed reconstruction

Done at a later stage, from months to many years after the cancer surgery. It suits women who would rather concentrate on cancer treatment first, or who simply are not ready to decide. There is no deadline for choosing it.

The nipple can only be preserved when the tissue at its base tests clear of cancer, and if the final laboratory result later shows cancer behind it, removal is recommended. Radiotherapy is the other common reason to delay, because it changes how reconstructed tissue heals and settles.
At Melanie Seah Breast Specialist in Singapore, Dr Melanie Seah plans this timing with you and with the plastic surgeon before the cancer operation is booked.

Immediate and delayed reconstruction, skin-sparing and nipple-sparing mastectomy: SingHealth Duke-NUS Breast Centre, Mastectomy With Breast Reconstruction.

recovery-after-Breast-reconstruction

What is recovery like after breast reconstruction?

Longer than after the cancer surgery alone, and it varies a great deal with the method. A flap reconstruction involves two healing sites rather than one, so it asks more of the body.

  • Drainage bottles are in place at first and removed once output settles — after one to two weeks in the case of a flap
  • Hospital stay is typically a few days for an implant and one to two weeks for a flap
  • Arm and shoulder movement is built back gradually rather than pushed
  • Driving, lifting and exercise resume in stages, on the surgeon’s advice
  • Swelling settles and the reconstructed breast changes shape over months, so the final result is judged late rather than early
  • A donor site — back, abdomen, buttock or thigh — has its own wound and its own recovery

Physiotherapy is part of this rather than an optional extra. The clinic’s physiotherapists work with patients on shoulder movement and on managing lymphoedema of the arm after axillary lymph node surgery — see physiotherapy and wound management.

Who performs breast reconstruction at the clinic?

Breast reconstruction at Melanie Seah Breast Specialist is carried out by a plastic surgeon, Dr Timothy Shim, working with Dr Melanie Seah, who plans and performs the breast cancer surgery and continues your follow-up afterwards.

Dr Shim graduated from the National University of Singapore Faculty of Medicine in 2002, completed basic surgical training in 2005, and completed advanced training in plastic, reconstructive and aesthetic surgery in 2011. He went on to a fellowship in reconstructive microsurgery at the University of Tokyo, has trained in supermicrosurgery, and was previously programme director of the NHG Plastic Surgery Residency Programme.

Two surgeons in one plan is the usual arrangement for reconstruction, and it is worth understanding before your first consultation. The cancer decision and the reconstruction decision are made together — see Our People for both surgeons’ full profiles.

Frequently Asked Questions

No — reconstruction is not regarded as an obstacle to follow-up. Most recurrences after mastectomy appear in the skin or the chest wall rather than deep inside the reconstructed breast, and those are found by examination, which reconstruction does not prevent. Your follow-up schedule after cancer surgery continues in the same way, and any new lump, skin change or thickening is assessed rather than assumed to be scar tissue. At Melanie Seah Breast Specialist in Singapore, Dr Melanie Seah continues the breast cancer follow-up regardless of whether a reconstruction has been done and by whom. If you notice a change in a reconstructed breast, it is examined on its own merits.

The lump that was removed does not usually come back, but a new one can form elsewhere. Excision takes the lump out with a margin of surrounding tissue, so recurrence at the same site is uncommon for a benign lump that has been completely removed. What is more common is a separate new lump in either breast, particularly in women who have had a fibroadenoma before, because the tendency to form them is not removed with the lump. That is why a new lump after previous surgery is assessed on its own merits rather than assumed to be a recurrence. According to the National Cancer Centre Singapore, having a simple fibroadenoma does not in itself raise the risk of breast cancer. Any new lump should still be examined..

Sometimes, and it depends on the method chosen. According to the SingHealth Duke-NUS Breast Centre, implant reconstruction may be done in one stage, or in two stages using a tissue expander that is gradually filled to stretch the skin and then exchanged for the permanent implant at a later operation. Flap reconstruction is generally a single major operation, though it creates a second wound at the site the tissue was taken from. Beyond that, many women later choose a smaller procedure to reconstruct a nipple or to adjust symmetry with the other breast, and those are elective rather than necessary. Ask at the planning consultation how many stages your particular plan involves, because it affects time off work as much as anything else.

It will look far more natural than it feels. Mastectomy divides the nerves that supply sensation to the breast skin, so a reconstructed breast is usually numb or has much reduced feeling, and that is true whether an implant or your own tissue was used. Some sensation may return slowly over months or years, but it is rarely what it was. A flap reconstruction generally feels softer and moves more like natural breast tissue, while an implant tends to feel firmer, particularly when lying down. This is the part of the result most often left out of the conversation beforehand, and it is worth asking about directly so that what you get matches what you expected.

Weighing up reconstruction?

Speak with Dr Melanie Seah, Consultant Breast Surgeon in Singapore, about whether reconstruction fits your treatment plan, and what implant and flap methods would each mean for you.



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