The Complete Guide To Seeing A Breast Surgeon For Cancer In Singapore (2020)

Breast cancer has consistently accounted for the greatest number of deaths among all cancers diagnosed in women. It accounts for one in three cancers in women. However, when you google “breast surgeon Singapore”, you may be hard pressed to find helpful and educational information on this field in Singapore.

Therefore, as a specialist surgeon with more than 10 years of experience, I have decided to write this article. I want to help anyone who is seeking a breast surgeon for cancer treatment in Singapore.

It provides an overview of topics such as:

  • When you need to see a breast surgeon for cancer
  • The ‘different types’ of breast surgeons treating breast cancer in Singapore
  • How to find the best breast surgeon for yourself
  • The cost of seeing a breast surgeon in Singapore

When do you need to see a breast surgeon for cancer?

doctor talking to a patient

Most breast lumps (90%) are not cancerous, but it is always best to have them checked by your doctor. 

The first symptom of breast cancer most women notice is a lump or an area of thickened tissue in their breast.  

What are the common symptoms of breast cancer?

You should see your doctor if you notice any of the following:

  • A new lump or area of thickened tissue in either breast that was not there before
  • Change in the size or shape of one or both breasts
  • Bloodstained discharge from either of your nipples
  • A lump or swelling in either of your armpits
  • Dimpling on the skin of your breasts
  • Rashes on or around your nipple
  • A change in the appearance of your nipple, such as becoming sunken into your breast

illustrated list of symptoms of breast cancer

Breast pain is not usually a symptom of breast cancer. Having said that, it is still better to get a check up if this is something new or different from before.

What happens during a visit to the breast surgeon in Singapore?

Your breast clinic appointment may take up to a couple of hours so that all the necessary tests for breast cancer can be performed.

If you see a breast surgeon, he or she may:

  • Ask you questions about your medical history, breast history, and family history
  • Perform a breast examination where the surgeon will check both your breasts when you are sitting or lying down
  • Order further tests, such as a biopsy and breast imaging such as a mammogram, ultrasound etc.
  • Depending on the type of clinic and tests, you might be able to get all your results within the same day
  • Advise you on your next course of action

What is the treatment process for breast cancer?

Many breast cancer patients I have came across often describe the process of their treatment decision making as confusing and intimidating.

Many women often do not feel completely informed about the options available to them in Singapore. Consequently, a lot may feel pressured into making hasty decisions.

a chart showing the steps to seeing a breast cancer surgeon in singapore

Breast cancer surgery is not an emergency surgery that needs to be done as soon as possible. Any doctor who advises surgery in that manner is probably not serving the best interest of the patient.

I always advise my patients to remain calm and consider their treatment options carefully. Studies have shown no adverse outcomes if patients get their treatment within a month (or even two months, depending on type of cancer) of discovery of their cancer.

Hence, you have a good amount of time to gather information and make decisions. Patients (and even doctors not in this field) do not know how much expertise have advanced. It is possible to look the same or even better than before the surgery for breast cancer.

As most patients are likely to do well and live long, fruitful lives after treatment it is well worth the consideration. I often hear of patients expressing their regret that they were too hasty.

What are the differences between the public and private treatment routes for breast cancer in Singapore?

1.  Time and convenience

stethoscope with a clock diagram on the end

In private practice, you are able to move things at a faster pace.

As a result, you get:

  • Personalised care by an experienced surgeon of your choice
  • A much quicker response time when it comes to arranging imaging, procedures, and surgery.

Private clinics in Singapore are able to give you an appointment within a few days of your call or accept walk-ins. On the other hand, the wait time at a public hospital can take up to 2 or 3 weeks.

Follow-up appointments are scheduled according to the urgency of the situation. In busy public hospitals, scheduling early follow-ups might be challenging.

Furthermore, the turnaround time for test results and such are usually much faster in private hospitals. For example, it is a norm to get histology results in about three days or quicker in private clinics. However, it may take up to two weeks in public hospitals.

2. Overall patient experience

woman preparing with a nurse for a breast scan

If you are seeing a breast surgeon in a Singapore public hospital as a subsidised patient, you are unable to select the doctor who you would wish to see. Your follow up appointments are also likely to be with different doctors, often junior ones.

When you visit a private breast surgeon in Singapore, you get to choose the specific surgeon you wish to see. Similarly, your subsequent follow up clinic visits will be with the same breast surgeon.

This allows the surgeon to provide a more “personalised” experience for the patient. He/she has a more comprehensive and in-depth understanding of the patient’s condition.

The time allocated to each patient can be as long as an hour. The clinic has the flexibility to extend or shorten the duration depending on the needs of the patient.

Furthermore, in private practice, consultation takes place in a setting where there is more privacy. The waiting area is more private, and spacing of appointments are such that not a lot of patients are waiting together.

3. Cost

Private breast surgeons in Singapore typically charge about $120 - $200 for a first consultation. If medication or screening is needed, it will typically add on another $150 - $400 to your final bill.

a woman having a mammogram

Type of screening

Cost (SGD)

Where

Mammogram

$100 - $150

Public & Private
 class or clinics

Ultrasound scan

$160 - $200

Public & Private
 class or clinics

Breast MRI

From $1,400

Private clinics


Treatment options for patients who are diagnosed with breast cancer depend on the stage of the cancer. Most of them will usually have to undergo surgery.

Here is an approximate cost breakdown of the two most common breast surgeries done in Singapore. This is indicative of the difference in prices. However, there are many more procedures related to breast surgeries.

Type of surgery

What does it do?

Operation fees (SGD)

  

Public Hospital

Private Hospital

Lumpectomy

Surgery to remove
>  breast lump

$1,422 - $2,191*

$2,112 - $10,504

Mastectomy

Surgery to remove the whole breast

$3,937 - $6,646*

$12,686 - $18,238

*Prices exclude subsidies (Source: Ministry of Health)

For patients who have decided to go for a breast reconstruction after a mastectomy, as an estimate, you can add an additional 50% to your hospital bill for both public and private hospitals.

Do you get a subsidy from Medisave for seeing a breast surgeon in Singapore?

In Singapore, our healthcare needs are well taken care of. Any treatments related to breast cancer or diseases are all covered by Medisave and MediShield.

For subsidised patients, very often, you pay very little out of your pocket.

How do I qualify for subsidised healthcare in a public hospital?

woman resting in a hospital bed

In order to qualify for subsidised healthcare in a public institution to see a breast surgeon, you need to:

  • Be a Singaporean or a Permanent Resident (holding a Singapore NRIC)
  • Obtain a referral letter from a Singapore polyclinic, or from an SAF medical officer/camp

Patients who do not qualify for subsidized healthcare in a public institution include:

  • All foreigners
  • Those referred to see a specific breast surgeon in public hospitals
  • Referrals made by a private doctor or private hospital

How does private health and hospitalization insurance for breast cancer work?

a stethoscope on a table with insurance papers

In private healthcare, having private health and hospitalization insurance would be really useful as Medisave/Medishield often does not cover the entire bill. You often have to pay the difference.

The good news is that there are many private insurance plans available where patients only need to pay a (relatively) small amount for co-payment, or at times even nothing at all (in the case of first dollar claim policies).

In my practice, we provide financial counseling to help patients make better and more informed decisions.

Should you delay breast reconstruction until after the breast cancer is removed? 

Sometimes patients choose to put off reconstruction till later. Some common reasons cited for an example are:

  • “I know I will want a reconstruction but I cannot really think through it now”
  • “I just want to remove the cancer first, I am not mentally prepared for additional surgery”

If you decide to forgo immediate breast reconstruction, i.e. reconstruction in the same surgery as cancer removal, you might not be able to claim the fees for it should you go for reconstruction later. Therefore, if you do choose to go for it after, it may not be claimable.

The feedback I received from the insurance companies is that, when patients split the cancer removal and breast reconstruction as two separate surgeries, they regard the latter as a cosmetic surgery.

This is a major area of contention I have with the insurance companies but I have been appealing. Hopefully we will have a breakthrough.

Are all breast surgeons treating cancer in Singapore the same?

asian doctor speaking to a female patient

Breast is a subspecialty interest that a surgeon can pursue after board certification as a specialist.

Technically speaking, all doctors who are certified as breast surgeons are able to provide care and management for patients for most breast conditions. Each breast surgeon can have his/her own special interest and expertise in a particular type of procedure.

The range runs the gamut from special biopsy procedures for the breast, breast cancer management, surgical removal of breast tumors, breast conservation surgery, etc.

The large majority of breast surgeons in Singapore come from General Surgery backgrounds while a small select few (really few; there are only 3 of us now) are Plastic Surgeons.

Plastic surgeons who want to be considered to have an interest in breast cancer surgery need to work in a center where they see breast cancer patients regularly; more than a usual plastic surgery practice. This is why there are only a handful of plastic surgeons doing breast cancer surgery.

However, these plastic surgeons with a special interest in breasts are equipped with a very complete and unique skill set because they are not limited in either the resection skills or the reconstruction skills.

How do I make the best decision for myself?

doctor looking at an xray against the light

I understand that this decision can be really unnerving. I often urge my patients to reflect on what is important to them. You have to consider what you would like to prioritise.

From my experience, patients' priorities can differ a fair bit. The two ends of the spectrum are:

  1. “I need to remove the cancer NOW!”. Patients who are only focused on removing the cancer. As a result, they are unable to contemplate on any additional procedures. Very often, these patients will decide to go for a mastectomy as soon as possible. Not wrong, but for me I feel a responsibility to assure the patient it is well worth the effort to take more time to consider options.
  2. “Let me settle [insert commitment here] first”. These patients often put other priorities such as family or work matters ahead of their treatment, and need prompting to make a commitment to undergo treatment.

My favoured approach to breast surgery

doctor writing with a clipboard and pen

In my practice, my favoured approach to breast surgery is (if the patient is willing) to restore every breast to its original form, hence the term oncoplastic surgery. It is essential that I give patients a range of choices to choose from.

I would also like to put the point across that the importance of body image varies from individual to individual. This is not something to be trivialized or ascribed to vanity.

Numerous studies have proven that the benefits are not just physical, but also emotional and psychological outcomes when the surgery is less deforming.

From my experience, this is something that I see every day in my patients. Therefore, the issues are not merely superficial or skin deep.

How do you find the best breast surgeon in Singapore for your needs?

doctor reassuring a patient in a clinic

If you are seeking a breast surgeon, these are the points you should consider:

  • Convenience and overall patient experience versus cost (public vs private)
  • Type of procedure you prefer - if you are considering niche procedures such as minimally invasive surgery, or oncoplastic breast surgery, you have to be more specific in your searches for your surgeon
  • Training, accolades, and experience - You can always find the information from the doctor’s biography.
  • Feedback from patients - You can find them from the patient support groups available in Singapore, e.g. Breast Cancer Foundation and KK Alpine Blossoms.
  • The transparency of the doctor's ability - It is important that your doctor is upfront with the procedures that they are able to perform. They should not hide options that they are unable to do, and push you towards the procedures that they offer.
  • The doctor's treatment philosophy - You should find a doctor that you feel comfortable with, and can relate to. 

On the other hand, from my experience, doctors have a preference for taking in patients who understand their treatment philosophy.

In my practice, I appreciate an open discussion with my patients. I do not prescribe a fixed treatment plan because I believe that my role is to educate the patients on their available options, and have them take their time to think about what is best for themselves.

I pride myself on being able to provide a wide range of treatment options.

Conclusion

Patients should always stay calm, and resist the urge to rush into surgery.

From my experience, upon the diagnosis of breast cancer, I would recommend my patients to undergo surgery in the next few weeks. There is a lot to take in in just one session, so it is common for my patients to come back for a few more consultations before their surgery date.

You should definitely have enough time to understand the available options and how you want to go about with your treatment plan.

Take care!


Dr Evan Woo is a certified plastic surgeon accredited by the Ministry of Health.

His practice is unique, he is both a breast surgeon (breast cancer removal) as well as a plastic surgeon (reconstruction and cosmetic enhancements of the breast).  He has devoted nearly his entire practice to treating the breast as his belief is the more one specializes, the better one becomes.


 

References:

  1. Groutz A et al. Do Women Prefer Seeing a female Breast Surgeon? Isr J Health Policy Res. (2016)
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Medically reviewed by Dr Evan Woo on 31/10/2018.
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