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The Straits Times
Friday, Feb 3, 2017
The Singapore Medical Council's complaints committee has ruled there was no professional misconduct by a plastic surgeon whose patient complained he had botched her breast reconstruction 2 ½ years ago.
Ms Chia Wei Hong, 56, is now challenging this decision by appealing to Health Minister Gan Kim Yong.
She said Dr Tan Bien Keem, the head of Plastic, Reconstructive and Aesthetic Surgery at Singapore General Hospital (SGH), had not given her a reconstructed breast that was close to the look of her natural breast.
Because of this, she said she needed additional surgery to correct the reconstruction, resulting in more scarring and medical fees.
Ms Chia complained to the SMC in September 2014. The council replied in November last year to say there was no professional misconduct on the part of Dr Tan. It said "symmetry of the breast cannot be achieved immediately", and that a second stage of reconstruction could solve the problem.
However, Ms Chia had not chosen to have that second stage of reconstruction by Dr Tan.
She was diagnosed with breast cancer in April 2014. Following a mastectomy and tests which showed the cancer had not spread, she opted for a breast implant, which was inserted in two stages.
First, an expander was inserted under the skin immediately after the mastectomy, stretching the skin as it was gradually filled with saline. This was replaced 10 weeks later, in July, by a 310cc implant.
She did not require either radiotherapy or chemotherapy.
Ms Chia said her reconstructed breast was more than twice the size of her remaining natural breast even after the swelling had receded. "I could not wear my normal fitting clothes. The reconstructed breast 'starts' high up on my chest and takes up a lot of volume so my clothes are pulled in a series of folds upwards to the shoulder," she told The Straits Times.
Dr Tan assured her the size would go down once the swelling caused by the surgery had subsided. He also told her that if she was not satisfied, she could return to have it downsized.
In September, she filed a complaint with the Singapore Medical Council (SMC).
While revisions of reconstruction do not happen often, they are not unheard of.
Dr Ong Wei Chen, a senior reconstructive surgeon at the National University Cancer Institute, Singapore (NCIS) and the National University Hospital (NUH), estimates the number of women needing such revision to be less than 20 per cent. She said: "The aim of breast reconstructive surgery is to reconstruct a mound that is as symmetrical to the other breast (as possible). However, it may not always be so.
"As long as the patient is able to fit her breasts... in a bra without too much discomfort, it should be an acceptable difference."
Being unable to fit her breast inside a bra, Ms Chia decided to look elsewhere for corrective surgery. In February 2015, she went to Raffles Hospital where plastic surgeon Walter Tan replaced the 310cc implant with one that was 120cc.
This cost her more than $15,000, for which she had to fork over $4,000, with the rest paid for by insurance. Her insurance plan covered the full bill of more than $25,000 for both operations at SGH but pro-rated coverage for surgery at a private hospital.
In its reply to her, SMC's complaints committee said it would advise Dr Tan by letter to "improve on his communication with his patients".
But Ms Chia has decided not to let her grievance rest. She said: "I appealed to Health Minister Gan Kim Yong on Dec 2, 2016, against the decision of the SMC."
The law allows the minister to ask the SMC to hold a disciplinary hearing if he feels the case justifies it. When contacted, the spokesman for SGH said the hospital and the doctor would not comment.