And I Said I Would Never Have Plastic Surgery

Saturday 19 June

When I was a teenager, I swore I would never have plastic surgery.

It seemed to me a superficial and disrespectful thing for any woman to do (my version of women’s lib). Bigger boobs, fuller lips, higher cheekbones … what’s the point if it’s fake?

See, I should have known my words would come back one day and bite me in the ass.

I have watched friends go for breast augmentations (ah, the old silicone vs saline debate), breast reductions (always happier than the breast augmentation cases), butt lifts, tummy tucks, liposuction (the most unhappy of the lost), nose jobs, double eyelid additions, Botox, and (arguably not plastic surgery but hey, since we’re listing procedures) IPL, Lasik and Fraxel.

I’ve had famous plastic surgeons tell me “You’re very nice looking but I can make you prettier with just a little insertion here that will make your nose sharp like a Korean movie star.” I’ve had ambitious GPs tell me “Wah, you got a lot of skin tags on your cheeks, I can laser them out for you. It’ll cost $4,000.”

Okay, so it is more than a little ironic to me that this morning I am going to see a plastic surgeon. Dr Hoe works closely with Dr Andrew Khoo from Mount Elizabeth.

I had a chat with Karen’s hubby Swee Chong the night before. Have I told you he is the most soothing doctor after Prof Tham?

He tsked and gasped at all the right places as I told him my story. He asked, “So who’s your plastics doctor?”

Turned out he knows Andrew Khoo. “Tell him you know me. You are Quek Swee Chong’s friend.”

I laughed, “Does that mean I get a discount?” I am such a skintflint. But I’m jesting — my hospitalization insurance should cover it. What price a good doctor, huh?

Mr Threez and I turn up at Andrew Khoo’s cool-looking clinic (he has WIRED, Conde Nast Traveler and Vanity Fair for waiting room reading material. Win already). It’s a short wait and we’re ushered in for the consult.

I have a curiosity about plastic surgeons — some of them have really bad skin (which makes you think, “Hmmm…”) and some of them have super-taut, shiny skin like a plastic bag stretched over an orange (which sometimes doesn’t match their crepey necks or backs-of-hands). Andrew Khoo has good skin, neither pock-marked nor supertautandshiny. I take it as a good sign.

Like Dr Hoe, Dr Khoo takes out a sheet of paper and draws us our options, following a skin-sparing mastectomy by Dr Hoe.

1. Mastectomy without reconstruction. For that, he won’t be involved at all. I would come out of surgery with one breast and a minus sign.

“No,” I say to Mr Threez firmly. “Remember, I need to come out of my GA with TWO breasts. I don’t care how it’s done, you make sure it happens.”

2. Mastectomy followed by Latissimus Dorsi reconstruction. This method takes skin, fat, and tissue from the long muscle running the your armpit diagonally across the back, and tunnels it under the skin to form a breast. This is a pedicle flap, meaning that the blood supply from this back muscle will continue to service this area even when it transforms into a new breast.

“As there won’t be enough fat to fill the whole breast so I’ll insert a small silicone implant. It will be cushioned by the flap, so it’ll look more natural.”

Dr Khoo asks, “Do you do any sports?” Nothing strenuous: gym work, running on treadmill, yoga and Pilates. He says for women who play tennis or do dragonboating (which I hope to one day) he would rule out this method of reconstruction altogether.

Plus I would have a long scar across my back. “We normally try to make the incision where your bra strap would be,” he says, but I think my mind’s already waiting for another option.

*For a kosher medical explanation of how latissimus dorsi reconstruction works, click here.

3. Mastectomy followed by TRAM flap reconstruction. This method isn’t too different from #2 except for the location of the donor site. A TRAM flap is basically a tummy tuck-turned-breast. He would cut off the skin and fat from my lower belly (that paunch that never leaves you after your third child no matter how many body combat or Pilates classes you take), tunnel it under the skin together with the blood supply, and form a new breast under the breast skin.

I’m thinking: “A tummy tuck and a new breast! Two for the price of one!”

Dr Khoo speaks my thoughts out loud. “So you basically get a tummy tuck at the same time. For this, you wouldn’t need to have any implant in your breast, and if you need radiation treatment, you won’t have to worry about the implant hardening.”

I mean, come on! Who wouldn’t choose this if insurance covered it?! SOLD!

He names the downside factors: I can forget about ever getting a six-pack (my friend, that dream left when I had my firstborn), I might get hernia after surgery, I will find I cannot do everything at my Pilates classes…

Blah blah blah. Gimme the tummy tuck already.

There is a fourth option which takes just the skin and fat from the tummy area without the blood supply. But surgery is very long as he would have to cauterise all the blood vessels. “But,” says Dr Khoo a little grudgingly, “the end result is the most natural.” Obviously, he didn’t relish all that micro work.

So now Mr Threez and I know our options, and it’s clear that TRAM flap is my preferred method of reconstruction, Dr Khoo has to check and see if I have enough belly fat to make a new breast.

“I assure you,” I say, “I have enough fat.”

“You really can’t tell,” says Dr Khoo. “Some women have very little belly fat and the breast turns out 10, 15% smaller. What cup size are you?”

Gosh, I think I haven’t been asked that since some sleazy guy tried to pick me up at Zouk in the early 90s.

“34B.”

“Okay, let’s have a look.”

I go behind the curtain with Dr Khoo and a nurse, and take off my top and bra and pull down my pants and underwear to below my C-section scar.

“You are not a B cup lah,” Dr Khoo snorts. “You are a Japanese C-cup.”

“I don’t wear Japanese bras,” I sputter. I buy Elle McPherson underwear from Australia, sorry!

“You are definitely a C-cup,” he says.

“Honey!” I call out over the curtain. “Guess what I’m a C-cup!” I hear Mr Threez chortle.

“Oh dear,” Dr Khoo is now bunching my belly fat under my bellybutton. “I’m not that sure we have enough to make a same-size breast. You might have to be prepared for a 20% smaller breast.”

WHAT??!!! I worked hard dieting and exercising to get to this size six months ago and now I’m going to be penalised for it?! Unprintable thoughts enter my mind.

“You are large-breasted with a small waist,” declares Dr Khoo. Tragically, he is the absolute last person I wish to be hearing this from. My life is a black comedy. Glumly, I pull on my clothes.

As if to make me feel better, he pulls out post-op photos of previous patients. One thing I don’t think I quite realised up to this point is that, once you have reconstruction, your new breast will never look or feel or behave like the old one. It is, despite the fact it tries to look as close to the old one, just not the same.

We discuss the possibility of nipple reconstruction, which can be performed four to eight weeks after the initial reconstruction, or even later. Nipple reconstruction involves more surgery, and skin is taken from darker areas. “We would take a portion of the areola from the left breast,” he names, “Or behind the ear, and commonly the labia.”

I instinctively cross my legs. Ow. I would have to undergo genital mutilation to put back a “fake” nipple that will have no feeling. Is it worth it? Is it?

Having asked all our questions, I tell Dr Khoo honestly that I am hoping for a lumpectomy. He doesn’t seem to think I have much of an option but to have a mastectomy. “Your cancer is quite big already, it’s 3cm. And it’s close to the nipple. Anyway, you can discuss that with Dr Hoe. I will be on standby in any case.”

Standby fee: $2,000-$3,000. But I figure, worth it to try for a nipple-saving procedure first.

As we go out to pay for the consult, I suddenly remember.

“Oh! Dr Khoo, Quek Swee Chong says to say hi.”

Dr Khoo appraises my face. “You’re not his sister?”

I wish! Swee Chong’s sister is a great beauty. “No, I’m his wife’s friend.”

“Ah… now this is called ‘putting pressure on your surgeon’.”

We laugh, and say goodbye.

As Mr Threez drives me home, I can’t get the images of the nipple-less post-op breasts out of my mind. It’s really quite depressing.

RESOURCES

The following articles have really educated (and entertained) me on the topic of reconstruction after mastectomy:

Life After Mastectomy: Adjusting to Reconstruction by Jeanette Vagnozzi

The Peg Procedures by MD Care

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2 Comments (+add yours?)

  1. cathy
    May 28, 2013 @ 09:46:38

    Hi brave lady, which insurance type or category actually covers ur reconstruction of breasts? Did u hv to pay a high premium?

    Reply

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