Breast Cancer & Reconstruction

Breast Cancer & Reconstruction

A DxD Session with Dr Evan Woo


Ended on Sun Mar 31 2019
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Top Answers


Hi Eli thank you for your direct to doctor query. Sorry to hear about your breast cancer diagnosis.

Whether you need chemotherapy depends on the stage of your cancer and specific cancer characteristics. I agree with Dr Lim Hwee Yong , there are very established treatment algorithms that is based on good scientific data according to breast cancer type.

I don't know the details of the histological report of your breast cancer but if you are still in a quandary about chemotherapy there are tests available to test genes in the cancer to predict risk of cancer coming back or to predict the likelihood of the benefit of chemotherapy. For example, for patients with early-stage, ER-positive, HER2-negative, node negative, and node-positive (1-3) breast cancer Oncotype Dx can be ordered.

The subject matter expert for chemotherapy would be oncologists like Dr Lim. So do get some opinions from them.

My input from my area of expertise surgical oncology is I would want to make sure that the cancer is removed with sufficient margins (completely removed) as that would impact on you cancer outcome. There is no reason why adequate margins cannot be obtained.

And wearing my plastic surgeon hat, I would say that chemotherapy is not a problem if you have had a reconstruction neither is it a problem if you are planning to do reconstruction after your chemotherapy treatment.

Wishing you all the best


Dr Evan Woo
MRCSC (Edinburgh), M Med (Surgery), FAMS (Plastic Surgery)

Evan Woo Breast & Plastic Surgery

Evan Woo Breast & Plastic Surgery 

38 Irrawaddy Road #07-21
Mount Elizabeth Novena Specialist Centre
Singapore 329563


9 Nov 2018

At your age with no personal or family history to suspect hereditary breast cancer (e.g. BRCA gene mutations that can be passed from parent to child) the chances of your lump being cancerous is really not very high.

That said, any breast lump should be checked by a doctor to be certain.

Besides a physical examination, imaging of the lump will be performed to better inform us if the lump needs to be removed. A needle biopsy (sampling of tissue from the lump) may also be offered.

Most experienced breast surgeons would not suggest that all lumps need to be removed. The decision is best made after a consultation.


Dr Evan Woo
MRCSC (Edinburgh), M Med (Surgery), FAMS (Plastic Surgery)

Evan Woo Breast & Plastic Surgery

Evan Woo Breast & Plastic Surgery 

38 Irrawaddy Road #07-21
Mount Elizabeth Novena Specialist Centre
Singapore 329563


25 Oct 2018

The possible scar locations are :

Inframammary - i.e. in the fold beneath the breast. 

The commonest incision used in Singapore. If properly planned and executed, the scar should be very inconspicuous as it is right in the crease. Incision length usually varies with size of implant ( larger = longer incision), implant type ( textured, shaped implants = longer) and surgeon's prerogative (some like longer incisions, some like really tiny incisions).

Axillary - in the armpit. Can be quite discreet as its often placed at the highest point of the hollow in the armpit. The main disadvantage it is more technically challenging to insert shaped (tear drop) implants and remove implants especially if a capsulectomy is required ( and it is often required).

Periareolar - just outside the pigmented areolar skin. If placed properly scar can be quite unnoticeable. Not the first choice placement for most surgeons due to concerns about contamination from bacteria around the breast ducts in and around the nipple.

Transumbilical - incision is at the navel. This is mentioned more for curiosity value cos nobody I am aware of does this here.

Most scars fade and are not very noticeable with time. As a rule, Asian skin types take a little longer for the pigmentation to settle and have higher tendency to bad scarring. Thankfully there are many tools at our disposal now to help achieve a better scar outcome and the scars are generally not noticeable.

Thank you for your question.

Best wishes


Dr Evan Woo
MRCSC (Edinburgh), M Med (Surgery), FAMS (Plastic Surgery)

Evan Woo Breast & Plastic Surgery

Evan Woo Breast & Plastic Surgery 

38 Irrawaddy Road #07-21
Mount Elizabeth Novena Specialist Centre
Singapore 329563


15 Nov 2018

I would strongly suggest genetic counselling and getting yourself checked for hereditary breast cancer based on your family history. But before that I usually advise that my patients have medical and hospitalisation insurance sorted for yourself and your family members.

Even with such a strong family history, it is not given that you may be carrying genes that increase your risk of breast cancer. 

Prophylactic mastectomy ( mastectomy before diagnosis of breast cancer) is an option for those who are carrying genes that put them at very high risk of having breast cancer e.g. BRCA gene mutation. Close surveillance is the other option. 

The clear cut advantage for a prophylactic mastectomy is reduction in worry about breast cancer and NOT breast cancer survival. So this is something that needs a lot more discussion with your doctor. I generally go through the options of either with my patients. It is a long consultation and usually more than one before a decision for a prophylactic mastectomy is made. Then, very often, there are more consultations about reconstruction as the same studies that report on the efficacy of prophylactic mastectomies also report about the negative impact on cosmetic result and sexuality if no reconstruction was performed.

All in all, careful consideration and some tests need to be done before a mastectomy should be considered.

Thank you for the question and best wishes.


Dr Evan Woo
MRCSC (Edinburgh), M Med (Surgery), FAMS (Plastic Surgery)

Evan Woo Breast & Plastic Surgery

Evan Woo Breast & Plastic Surgery 

38 Irrawaddy Road #07-21
Mount Elizabeth Novena Specialist Centre
Singapore 329563


16 Nov 2018

 

I have a number of treatment protocols for non invasive breast firming and lifting, but unfortunately, for major weight loss, it is usually quite difficult to get significant or what I would consider pleasing results with non invasive treatments. 

Surgery to address this is a breast lift or mastopexy.

I find this link a very good source of information:

https://www.plasticsurgery.org/cosmetic-procedures/breast-lift

Best wishes.


Dr Evan Woo
MRCSC (Edinburgh), M Med (Surgery), FAMS (Plastic Surgery)

Evan Woo Breast & Plastic Surgery

Evan Woo Breast & Plastic Surgery 

38 Irrawaddy Road #07-21
Mount Elizabeth Novena Specialist Centre
Singapore 329563


30 Nov 2018

Top Questions


Hi Drs, I am 27 years old this year and my mother has passed away from breast cancer when I was young. What are the chances of me getting breast cancer? What can be done as a preventive measure, and how much can I trust the results? Thanks!

I'm 30. I experience breast soreness for almost the entire month. In the past, my breasts were only sore before my period. Is this any cause for worry? 

I'm a 21 year old female. I'm having issues with my left nipple for 1.5 years. It has been swollen and very itchy for quite awhile. Sometimes it gives a very slight throbbing sensation, although it is not painful. The itchiness worsens when I stay in sweaty clothes for a long time. What are possible causes, and what should I do next? Thank you. 

I had a mastectomy last year. I am planning a delayed reconstruction. How long must I wait for breast reconstruction after a mastectomy? I understand that breast tissue expansion must be completed first - is this factored into the wait? How long does it take to complete breast tissue expansion before I can proceed with the implant surgery? 

I'm a 26 year old female. I exercise regularly and eat relatively healthy. Recently I discovered a small lump under my right armpit. It's slightly bigger than a cherry seed, and gets a bit tender when pressed. My family has no history of breast cancer, although my mother has a similar (but larger) lump under her left armpit. Should I be worried, and what can I do?

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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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