Dr Terence Goh

There are checks that you need to do to make sure that you’re fit enough for the surgery. That depends on your age. If you’re a young and fit individual, and you don’t smoke, basically we call it ASA1 which means you’re perfectly cleared for anaesthesia. Then you don’t really need to do anything, you don’t even need a blood test. If you’re above a certain age, then you may need to do some blood tests to make sure that you’re safe for anaesthesia.

A mastectomy is a surgery we do for patients with breast cancer. That’s when you remove parts of your breast or the whole breast. Yes, we do use implants and we use them immediately. So you can have a mastectomy and we can use the implant to do a reconstruction, or it can also be used in a delayed fashion. Some patients have a mastectomy done but no reconstruction and they come back at a later date for a reconstruction. So yes, implants are always an option.

The thing about textured implants is that most of the textured implants at the moment, there’s still some risk relation to ALCL. Studies have shown patients with round implants also have ALCL. But upon clarification, they realised that these patients have had both round and textured implants before. So they’re not exactly sure if round implants do cause ALCL. But the belief is that textured implant causes it. So round implants are definitely safer. To answer the question, I would say that I would definitely choose a round implant where possible.

Most of the time you can go straight to the implants. The idea behind this is that you’re using the implant to take up the slack of the skin. So you imagine if you have a plastic bag and a larger one. If you want to fill up the whole bag then you’ll definitely need a larger implant. That’s one condition, whether you want larger breasts. If you don’t, then maybe we need to reduce the size of the bag which means that we need to do some surgery to remove some skin or reshape the breast so that the bag is smaller.

Different manufacturers would have different suggested numbers. But it would be somewhere between 15-20 years. Of course, if you have complications earlier such as ruptures or capsular contracture, then you may need to have it removed earlier.

That’s a very valid question because you could have made a decision to have the implants in before you had kids. Certainly, you could also have it after, but it is a concern for patients who are planning to have children. The truth is that it is safe to breastfeed after you’ve had implants because all that silicone and gel is actually kept within the shell so there’s no worry that this silicone will leak into the breast milk. So it is safe to breastfeed. The other question is will there be any effect on breast milk production. So again, the answer is no.

The disadvantage is that the implant is fairly new, it’s only been in the market for 10 years or slightly less. And because of this, it’s not FDA approved. But it’s HSA approved in Singapore. So I do have some patients with concerns because it’s not FDA approved yet. I believe they are doing trials in America and they will apply for it pretty soon but because it’s not approved yet, some patients are hesitant to use it. To add on, because it’s been in use for a shorter period of time, there could be problems that we have not picked up yet.

The cost of the surgery would involve several factors. The first is the surgeon fees. Then the anaesthesia fees, and then the facility choice that you pick -- whether you need to stay overnight. Most of the time, you do not need to stay overnight for breast implants. It’s a day surgery procedure. Once it’s done and you recover from the anaesthesia, you can go home. Then, of course, the final factor is the choice of implants. What brand of implant you pick and different implants would have different prices. So the total cost could be somewhere in the $10,000 to $15,000 range.

Generally, you just need to make sure that you’re not taking foods that you’re allergic to. But there’s no strict diet that you need to comply with.

Capsular contracture is a very specific condition whereby when you have an implant, your body creates a capsule around it because it is a foreign object. Every foreign object in your body will have a capsule around it. And these capsules, over time, can have problems. Not that it will, but it can. One of the problems you may have is that the capsule will start to shrink and because of that the implant will start to feel a bit harder, it may become misshapen. And then the patients may start to feel pain. So they can feel the implant hardening, they can change shape, they can shift a bit.

There is no limitation, because like I mentioned, when it comes to breast implants, it really depends on what you buy off the shelf. But in practice, of course, there are certain sizes that are more ideal that suit your frame, your height, your breasts, like whether you have sufficient tissue to contain this volume. In short, you can pretty much pick any volume that you want, but it is important that it is an appropriate volume for you. And the truth is that the larger the implant is, the higher the chance of problems and complications.

The advice is to be very well informed. It’s to find out as much as you can so that you have an idea. There’s so much information available and it’s all readily available for you to read up. You can look in Human, et cetera. Basically, you have to know what your options are. Besides breast implants, there’s also fat grafting. At least you can make that decision with all these considerations and not hastily so that you will not regret your decisions later.

Yes. My preferred technique is to go to the inframammary fold, where the incision is made between the breast fold and the chest wall. Through that approach, it is very easy to do a dual-plane technique. So the objective of the dual-plane is to separate the muscle from the breast tissue, and this allows the breast tissue to actually fall and droop over the implant. It also allows the implant to project lower.

In fat grafting, there are two sets of incisions. One is for liposuction, so that would be done wherever we need to harvest the fat. Those are normally hidden within, for example, the underwear line or within the belly button. So it’s usually sited somewhere inconspicuous. Those incisions are slightly bigger, it could be up to 5mm or up to 1cm. For the breast, we basically put numerous incisions to inject the fat. Typically, they’re put around the areolar. So where the nipple skin meets the normal breast skin.

There’s quite a long list of things you can do. The first these things is, essentially, you need to be compliant with the instructions that are given by the variant doctors. Usually, for example in my practice, we’ll put on a bra for you. This is different from the underwire bras that you’d probably have, it is a surgical bra to give the support. And then the patients are given painkillers as well as antibiotics. The incisions are dressed, so they don’t need to check the incisions until we see them again.