GetDoc: What is Breast Surgery? What are the services you offer under this category?
Dr Bertha: Breast surgery is any surgery to remove abnormalities in the breast. These include (non-exhaustive):
a) removal of breast lumps, complicated cysts, intraduct papillomas,
b) surgery for breast cancer
c) mastectomy and axillary clearance
d) skin sparing or nipple sparing mastectomy and axillary clearance with immediate reconstruction
e) breast conservation surgery, where only the tumour with a margin is removed
f) breast conservation surgery with oncoplastic surgery.
g) removal of accessory breasts (extra breasts)
h) prophylactic mastectomy for BRCA1/2 positive patients
i) drainage of breast abscesses
j) stereotactic guided mammotome biopsies of mammographic abnormalities (i.e. microcalcifications)
k) hookwire localization excision biopsies of breast abnormalities
l) axillary lymph node clearance, or axillary lymph node sampling or sentinel lymph node biopsy
m) microdochectomy (removal of diseased breast ducts)
GetDoc: Who must/can undergo Breast Surgery?
Dr Bertha: People who have abnormalities in the breast that have to be removed, because physical examination, imaging or biopsy has shown that the abnormality is suspicious.
GetDoc: Why is Breast Conservation important?
Dr Bertha: It is important so that the patient concerned has a faster recovery, better cosmesis, and less morbidity.
GetDoc: How does Breast Conservation surgery affect the confidence of the patient?
Dr Bertha: It is good for their body image and in most cases results in patients not requiring to change their wardrobe. The scars are usually minimal and, where possible, hidden within existing skin creases or at the periareolar region.
GetDoc: What are the procedures that can be done in clinic setting?
Dr Bertha: Some of the procedures that can be done under clinic setting include:
1. Bedside Ultrasound
2. Aspiration (either freehand or ultrasound-guided) of symptomatic cysts,
3. Fine needle aspiration cytology of lumps and cysts or cancer for investigations. We have an in-house cytology technologist who stains the specimen on the spot and stains it so we can see under the microscope whether there is adequate sample for the pathologist to make a diagnosis. The final diagnosis takes about a week or less because the specimen needs to be reviewed under higher magnification in the laboratory.
4. Aspiration and Drainage of breast abscesses
5. Nipple smears for nipple discharge
6. Trucut biopsies of breast cancer for histopathology examination,
7. Insertion of clips into cancer masses after two cycles or so of neoadjuvant chemotherapy so that the location of the original tumour can be ascertained during surgery, especially when chemotherapy has caused most of the cancer to go into remission
8. Wound dressings
9. Blood tests
10. Gene testing for BRCA1/2 or others where necessary
GetDoc: Are there any risks and complications for breast surgery?
Dr Bertha: These would be the usual risks and complications of breast surgery. Specifically for breast surgery, we follow the standard proforma from the College of Surgeons Singapore. All patients requiring surgery will be given the proforma specific to their case.
GetDoc: Does the patient receive counselling before they undergo surgery?
Dr Bertha: Yes. The counselling is patient-specific.
GetDoc: What is the recovery time?
Dr Bertha: It depends on what the surgery is, the patient’s baseline fitness, and what kind of activities the patient usually engages in. Usually for a simple breast lump, I would prescribe a week's rest. For breast conservation surgery, I recommend about 3 weeks rest and for major surgery with reconstruction, it would take about a month.
GetDoc: Is breast surgery applicable only for women?
Dr Bertha: No. Men may develop gynecomastia (colloquially known as man boobs or moobs) due to a variety of reasons and may need to see a breast surgeon. This is because sometimes, gynecomastia appears in men who have testicular cancer. Rarely, men can also develop breast cancer if they have a very strong family history of breast cancer.
There you have it, we hope this Q & A has answered your doubts and queries about Breast Surgery. For further information on this topic or to fix an appointment with Dr Bertha, click this
by Hridya Anand
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya Anand.