Low uptake of breast reconstruction in Brunei
BANDAR SERI BEGAWAN
THE Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital now pro-vides comprehensive services for breast reconstruction, but uptake remains low among mastectomy patients.
According to plastic surgeon Dr Chan Koo Guan, only 1.3 per cent of mastectomy patients have undergone breast reconstruction in Brunei, whereas the breast reconstruction rate in the United States has increased to 50 per cent among mastectomy patients.
He said the poor uptake of breast reconstruction were mainly due to women not wanting additional surgery, whilst others cited religious reasons or were unaware of the surgical procedure.
“I think it’s cultural. In the more developed countries, they are worried about their appearance and how they look, so they are more upfront about having breast reconstruction. In Brunei, when breast reconstruction is offered to patients, they are usually reluctant,” said the plastic surgeon.
He stressed that mastectomy patients in Brunei deserve to be given the option of breast reconstruction especially at the time of diagnosis.
“Breast reconstruction should not be a taboo subject. It’s not cosmetic surgery,” said Dr Chan in his presentation at the Breast Cancer Symposium 2014 yesterday, adding that better awareness will allow patients to seek consultation for breast reconstruction at the early stages of their treatment.
Prior to August 2011, no breast reconstruction was offered in Brunei. Dr Chan said only external prosthesis were previously available for mastectomy patients.
Breast reconstruction was viewed as a better option to external prosthesis, which often caused skin discomfort to mastectomy patients. External prosthesis does not feel natural to the body and are difficult to maintain in place. Unlike external prosthesis, breast reconstruction offers a realistic aesthetic expectation and appears normal in clothes.
“Breast reconstruction can help to restore body image as the breast mound is created to match the patient’s body and age. It can lead to better self esteem,” said the plastic surgeon, pointing out that breast reconstruction is also durable.
He disclosed that seven mastectomy patients under the age of 60 have undergone breast reconstruction since it was made available at RIPAS with very satisfied results and no failure rate.
Dr Chan explained that immediate breast reconstruction at the time of mastectomy has major psychological advantages, decreased sense of loss and avoids repeated hospitalisation. Meanwhile, delayed breast reconstruction after mastectomy required multiple hospitalisation.
“My message is that it is available in Brunei. It’s a well-established surgical technique and it’s safe. It doesn’t affect the cancer survival outcome,” he said.
The plastic surgeon underlined that the single greatest predictor of whether a woman underwent breast reconstruction was the mention of the surgical procedure by the breast surgeon during the initial consultation.
“In Brunei, the surgical teams have yet to work together, but because of all these results, the surgeons are seeing what can actually be done and they are starting to refer the patients,” he said.
Dr Chan noted that response to breast reconstruction “is still very slow”, however he was optimistic the situation will change. He explained that Singapore, which now records a 10 per cent uptake, also experienced a poor response when breast reconstruction was introduced to the republic 20 years ago.
The all-day symposium, organised by The Brunei Cancer Centre, was held at the Centrepoint Hotel, Gadong.
The Brunei Times