Regaining Beauty and Dignity with Breast Reconstruction

Breasts are considered a symbol of beauty for women. However, breast cancer, like a dark cloud hanging over women's heads, has always been a concern. Fortunately, with advancements in medical technology, breast cancer is no longer a death sentence. Early detection and seeking medical treatment can lead to a very high cure rate. Currently, breast reconstruction techniques are also highly advanced, allowing patients to dispel the dark cloud hanging over their heads and making coexistence of healing and beauty a reality. Dr. Teh Mei Sze, Consultant Oncoplastic Breast Surgeon at SJMC, explores the latest breast cancer treatments and the benefits of breast reconstruction in restoring beauty and dignity for patients.

For many women, breasts hold significance beyond being just organs; they are linked to attractiveness and self-confidence.

Breast cancer is a leading cause of female health issues in Malaysia for many years. According to World Health Organization's data from 2020, the number of diagnosed breast cancer cases worldwide reached 2.3 million, with 685,000 deaths attributed to breast cancer.

Furthermore, the Malaysia National Cancer Registry Report (2012-2016) found that number of breast cancer cases in Malaysia is 34.1 per 100,000 people. Chinese women have a rate of 40.7 per 100,000 people, Indian women have a rate of 38.1 per 100,000 people, and Malay women have a rate of 31.7 per 100,000 people.

Research has also found that in Malaysia, one out of 27 women will develop breast cancer before the age of 70. The high-risk age group for developing breast cancer is between 45 and 74 years old (over 60%), while patients younger than 45 or older than 75 make up around 40% of cases. Considering breast cancer as an 'enemy' that women must deal with throughout their lives is not an exaggeration.

Fortunately, with ongoing research and developments, the battle against breast cancer has more 'weapons' at its disposal, including new treatment technologies and drugs. When breast cancer is detected early and treated bravely, the chances of cure are very high. Among many types of cancer, breast cancer is one of the easiest to detect in its early stages.

Invasive Ductal Carcinoma is Most Common

According to statistics, when breast cancer is detected in situ (i.e. stage 0 cancer) and removed surgically, the 5-year survival rate can reach 100%. In stage I, it ranges from 90% to 95%, in stage II it's about 80%, and even in stage III, it's still over 70%. However, in stage IV, the 5-year survival rate drops significantly. Therefore, the key lies in early detection of breast cancer. Fortunately, public awareness of breast cancer has increased, and patients bravely seek medical attention early, which is a positive phenomenon.

Cancer refers to genetic mutations, specifically abnormal proliferation of breast epithelial cells. The most common type is invasive ductal carcinoma, accounting for over 90%, followed by lobular carcinoma, which accounts for 5% to 10%.

Breast-conserving surgery maintains the appearance of the breast and does not significantly affect overall survival rates, shared Dr Teh Mei Sze.

Breast Cancer Cells are Prone to Spread

Clinically, breast cancer is categorised into 5 stages, including in situ cancer such as ductal carcinoma in situ (DCIS). In stage I, patients may notice subtle symptoms like a small lump in the breast (less than 2 cm), breast swelling, itchy skin, nipple discharge, or changes in breast contour. In stage II, there may be a lump between 2 and 5 cm, and the possibility of lymph node involvement.

Stage III involves a lump larger than 5 cm, skin changes such as redness and ulcers, and a majority of axillary lymph node involvement. In stage IV, it becomes metastatic breast cancer, where cancer cells have spread to other parts of the body like the liver, bones, brain, or lungs. It's important to note that breast cancer cells are prone to spreading, so early detection not only improves the chance of cure but also reduces the mortality rate.

Postoperative Radiation is Key

Breast cancer's genetic expression can be classified based on hormone receptors like estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and the proliferation index (Ki-67). This classification leads to different and targeted treatment approaches. Current breast cancer treatments include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Surgery can involve total mastectomy (removing the entire breast) or breast-conserving surgery (lumpectomy).

Total mastectomy involves removing the entire breast, including the nipple and the tumor. Lumpectomy, on the other hand, involves removing only the tumour and surrounding tissue, followed by further treatment like radiation therapy and chemotherapy by an oncologist. What's the difference in survival rates between the two? According to data, the survival rates are not significantly different, but for lumpectomy, postoperative radiation therapy is crucial.

It's important to note that breast-conserving surgery not only helps preserve the breast physically but also reduces the patient's fear of losing the breast psychologically. From a medical perspective, breast-conserving surgery maintains the appearance of the breast and does not significantly affect overall survival rates. Therefore, unless necessary, doctors generally do not recommend total mastectomy.

Lumpectomy vs Mastectomy

Which breast cancer patients are not suitable for breast-conserving surgery (lumpectomy)? Patients with multifocal breast cancer, meaning cancer in multiple locations within the breast, or tumours larger than 30% (even if reconstruction is attempted, it may be challenging to achieve a good cosmetic result), patients with genetic mutations like BRCA1 and BRCA2, and patients who are not candidates for radiation therapy, such as those who have been pregnant or previously received radiation therapy in the same area, are not suitable for lumpectomy. Total mastectomy is more appropriate for them.

It's worth emphasising that surgical removal, including total mastectomy and breast-conserving surgery, is suitable for breast cancer patients from stage 0 to stage III who can tolerate anaesthesia. After stage III, oncologists play a more prominent role, with breast surgeons providing assistance. Post-surgery treatment, including chemotherapy and radiation therapy, depends on factors like cancer type, stage, and surgery type. If a patient has a large tumour or lymph node involvement, more treatment may be needed.

Breast reconstruction techniques have been developed to make breasts as close as possible to their normal appearance.

Immediate Reconstruction After Breast Removal

Once breast cancer treatment has achieved a certain effect, the next step to enhance the treatment outcome is breast reconstruction, allowing patients to lead a better life. This is not just for cosmetic reasons but also to help patients regain their beauty and dignity, boost their confidence, and live a fulfilling life both physically and mentally. Today, breast reconstruction surgery is very common, and doctors can choose from various techniques and timing for reconstruction based on factors like the patient's breast shape, body type, age, physical condition, activity level, and personal preferences. In most cases, breast reconstruction can be performed immediately after breast removal surgery.

However, for some patients who are petite or in weak physical condition after surgery, doctors may decide when to perform reconstruction based on the patient's condition. Reconstruction surgery generally takes 2 to 5 hours, and it may not be suitable for patients who are already weak after surgery. In such cases, it may be necessary to wait for some time or use breast implants.

Using Breast Implants or Autologous Tissue

Breast reconstruction surgery began in the 1960s and typically involves the implantation of prosthetic devices that match the shape of the breast, such as silicone implants and saline implants. Currently, there are at least three types of silicone implants available on the market, each with different shapes, materials, and technologies, and doctors must choose the most suitable one based on the patient's unique circumstances and financial capacity.

Alternatively, autologous tissue transplantation can be used for breast reconstruction. This tissue can be harvested from various areas of the patient's body, such as the abdomen, buttocks, back, and thighs. Common techniques include the transverse rectus abdominis myocutaneous flap (TRAM flap) and the latissimus dorsi myocutaneous flap.

The TRAM flap has an additional benefit – it can help reduce abdominal fat while simultaneously reconstructing the breast. The treatment plan is tailored to each patient, as everyone is unique, and personal preferences play a significant role.

With evolving technology, various breast reconstruction techniques have been developed to make breasts as close as possible to their normal appearance, whether after total mastectomy or breast-conserving surgery. Therefore, achieving a uniform, symmetrical, and satisfactory breast appearance for patients is one of the challenges faced by doctors.

What are the Risks of Breast Reconstruction?

It's important to remember that breast reconstruction is surgery, and postoperative care, including infection prevention, is crucial. Patients require a longer recovery time. However, compared to the potential benefits, including regaining a symbol of beauty, body image, and an improved quality of life, doctors believe these risks are worth taking.

"Breast cancer that are diagnosed early, have a very high cure rate and excellent survival rates. Thanks to advanced treatment techniques and medications, there is no need to fear screenings. If you notice any symptoms that could indicate breast cancer, such as an unexplained lump in the breast, consult a doctor as soon as possible. Early detection and treatment can help you regain your beauty – it's not just a dream," Dr Teh emphasised. 

Source: Sin Chew Daily