Hi Luna Lovers,
Welcome to October! Hasn’t this year just flown by…
If you’re new here, my name is Bella, I’m the social media and marketing coordinator for Love Luna; if you’ve been following along at home, then hello again! This blog is a personal one from me, as this October we turned our focus to Breast Cancer Awareness Month.
Our guest on the blog for the month of October is Dr Natalie Ngan, who is a Plastic Surgeon based here in Melbourne.
Now, like many of you reading along at home, I’m sure this article hits close to home. Whether you or someone you know has experienced breast cancer, undergone plastic surgery, or perhaps it’s something you’re considering, there’s something here for everyone.
I (Bella) first met Dr Ngan back in December when I scheduled in a consult for a breast reduction. Naturally, I was incredibly nervous. But after walking into her consulting office, I felt instantly at ease. Dr Ngan and her team of incredible women made my experience a dream. I have never felt so warmly embraced and understood by a medical team in my life. I went on to have my breast reduction in May and it has been the best thing I’ve ever done to date.
With Breast Cancer Awareness Month upon us, we wanted to take the opportunity to interview someone who understood the issue from all sides. Dr Ngan performs breast surgery every day, and like many of us, has too been touched by Breast Cancer in one way or another.
Now before we dive in, we want to issue a trigger warning. This blog discusses a variety of issues from mental health, breast cancer, body dysmorphia and plastic surgery. If you find any of these topics triggering, please consider your mental capacity before proceeding. You can return to this blog at any time, but your mental health comes first. Proceed with love, empathy and understanding.
Luna: Good morning, Dr Ngan! It’s so nice to see you again, how are you?
Dr Ngan: I’m doing very well thank you for asking! How are you?
Luna: That’s so great to hear, I’m doing really well thank you! So, as you know, October is Breast Cancer Awareness Month, and here on The Monthly we are turning our focus to all thing’s breasts. We’re unpacking everything from Breast Cancer, to plastic surgery, mental health and everything in between. We are so excited to be chatting with you today!
Dr Ngan: Likewise!
Luna: Let’s kick this off shall we- could you tell us a bit about yourself, and what it is that you do?
Dr Ngan: Sure! So, I work as a plastic and reconstructive surgeon. Being a plastic surgeon encompasses everything from Breast Augmentation to Cancer Reconstruction, they lend themselves well because they are so similar. I trained in New Zealand and then went to Toronto to subspecialise purely in breast. So, breast reconstruction specifically after mastectomy or cancer and then came to Melbourne and did further cosmetic training. My practice now is predominately around 90% breast surgery, whether it be reduction, augmentation, cosmetic and then of course those who have had a mastectomy and require reconstruction. As you know, my practice is really focused around women.
Luna: For sure! Because your practice is so heavily focused around breast procedures, we were curious as to whether there is a reason for that? What led you to want to focus on that specific area?
Dr Ngan: So, I spent 6 years in medical school, and then after that time you become a junior Doctor. As a junior Doctor you try lots of different things from general medicine like treating pneumonia, to surgery and then other areas. I got exposure to plastic surgery my second year out and loved it. I was always very interested in breast surgery. When you’re in training, most of the surgery you see is reconstruction. Personally, for me however, my grandmother had breast cancer at a young age, she was in her 50’s. Then my mum’s cousin unfortunately passed in her 40’s from breast cancer. So, it became quite personal for me. I saw how much they struggled with it. But also, I think being a woman, you know, I have breasts, I take this personally. On the flip side, I love the technical aspect of it and the challenge I guess plastic surgery involves, but also, I love the patient and find it to be really rewarding.
Luna: It’s so interesting, we’ve interviewed a few industry professionals now and it’s becoming more and more prevalent that those we interview seem to have a personal story that aligns with their professional choices. From a holistic standpoint, what would you say is the most common reason someone books in for a consult with you?
Dr Ngan: The vast majority of patients refer for reconstruction. I work closely with two main breast surgeons. I work closely with three breast surgeons. I have worked with a lot of surgeons, but the ones I work with are so special. I think the concept of ‘holistic’ really rings true, you know, they really see the patient as a whole. I mean we’re all women, we have children, we have families. Often the woman is the central person in any family, and if they get sick everything crumbles. So, it’s really important for us to ensure that there is some form of support in place. Women tend to not let themselves take adequate time to recover, so when I see a patient it’s not as a simple as step 1, 2 and 3. I get to know them, I build a real connection with them, because I need them to invest in themselves and the whole experience from surgery to recovery. It’s not just about how the surgery will affect you on a physical level, we have to consider how it will impact your social and emotional environment. If you’ve got kids or daughters, is a mastectomy alone right for you? I think the surgeons I work with and myself really understand because we live that. At the centre of everything we do you know it feels deeply personal, because we see ourselves in our patients.
Luna: Something interesting that you touched on that I’d like to talk about, because I think it’s so important and something I know I certainly appreciated when I saw you, was that you do offer an all-female practice and team. Was there a point you got to when starting your practice that you decided that’s what felt right for you?
Dr Ngan: I’m really lucky, a lot of people, like yourself come out of surgery and say “wow, that was so positive”, or you know “I was so lucky to have an all-female team that day,” but it’s not luck at all. It’s actually a thought-out decision manufactured by myself and my team. I have chosen a certain hospital to work out of, I have certain relationships with nurses and my team of course a lot of their training is around being an extension of my ethos as a doctor. I’m so lucky with my team, you have to have a consistent ethos across the board. I think you know I have a lot of really great relationships with some amazing male surgeons, but at the end of the day it is harder for women to get to where we are in this field, you know we have to be the best of the best. Patients get nervous you know, these are their lives and they’re trusting us to have their best interest, so it’s really important that the experience is positive from the minute they step foot in my practice to post-surgery and after.
Luna: For sure. I have to say I never felt nervous. But I do think that is solely because of you and your team. I just knew I was in safe hands.
Dr Ngan: Absolutely, people can get really nervous about the anaesthetic and I think that’s more than fair. You know, by the time it comes to surgery day, the patients have met me and that aspect is fine, but the anaesthetic is really the unknown. So, the anaesthetist only has a few minutes on the day to build that rapport with people, but those that I work with are just so personal and incredible at what they do.
Luna: I think as well it does come back to you being a female yourself. Breast surgery does take such a toll on a patient. It’s such an intimate area. The choice to have a reduction myself was not something I took lightly, and certainly affected my mental health. I can’t begin to imagine the toll surgery of that nature would take when something as devastating as cancer is involved. When it comes to reconstructive surgery, can you take us through that process, who is eligible, what does it involve etc?
Dr Ngan: Sure! So, you can categorise reconstruction in two ways, it comes down to timing. There is immediate and delayed. Immediate is at the time of mastectomy reconstruction is performed, which is the most common way I tend to work. Delayed is a variable time after mastectomy. With regards to the aesthetic outcome, when you do it immediately the breast surgeon keeps all the skin and then we fill that with a reconstruction. But for some, they may not be a candidate for the immediate option. Those who aren’t a candidate for this are someone who has severe disease, someone who isn’t medically well and couldn’t tolerate such a big surgery, or someone who couldn’t psychologically cope. Candidates for surgery aren’t so much age dependant but health. The oldest person I have done a reconstruction on was in their late 70’s, but she did really well. At the end of the day the oncological treatment is the priority and if reconstruction is going to interfere with your healing, then we put oncology first and you won’t be offered a reconstruction as the delay in healing can interfere with chemotherapy etc.
Luna: With the breast reconstruction, post-surgery what does the healing process look like?
Dr Ngan: Reconstruction is the most complex surgery that I perform from a technical perspective. It’s longer and the risks are higher. The recovery for a reconstruction with implants is shorter, you’ll likely stay in hospital for 2 - 3 nights, you’ll go home with drain tubes. You’re taking it easier for longer. So, for those that have an implant reconstruction we recommend being off work for at least 4 weeks, but for some it might be longer. If we reconstruct using your own tissue, you’re likely in hospital for 5 – 7 days, so even longer, and then your recovery is really closer to that 6-week mark. Long term, 3 months before you’re back to doing exercise. It’s a much bigger procedure because you’re often combining mastectomy, reconstruction and in some cases lymph nodes need to be taken out, and that adds to the recovery time.
Luna: Absolutely, there’s a lot of variables that have to be considered. I know when I last saw you for my follow up, we were chatting about the new laws that have come into place surrounding eligibility for plastic surgery with regards to mental health parameters, and how it’s now a requirement to undergo psychological evaluation before plastic surgery. Is this something that is taken into consideration with patients who are having a reconstruction? Is there after-care from a mental health aspect?
Dr Ngan: Great question, obviously for some women it’s a huge psychological toll. Part of the team I work with are psychologists and psychiatrists. If you choose to have a mastectomy for risk reducing purposes, so someone who has a genetic mutation, they don’t have cancer, you must see a psychologist or psychiatrist before proceeding with surgery. For those who have cancer, it is not a requirement for them to be evaluated before surgery, but psychology is offered post-surgery. A really important person in the team is the breast care nurse. They’re a nurse who is specialised in oncology and breast cancer and they really hold the patients’ hand through all treatments, not just surgery, but chemo and radiation too and they really offer a lot of psychological support.
Luna: That’s amazing to know that assistance is there for these patients, and so important for the whole process I could imagine. Do you have any advice for someone who is considering plastic surgery in general?
Dr Ngan: I think the thing about plastic surgery in general, and even reconstruction, you don’t need it per say. It’s not like needing a cancer cut out. There is a lot of data to suggest that reconstruction post mastectomy, for those who do choose to have that done, have a better quality of life. Whether it be ease of putting clothes on, their recovery, intimacy and returning to normal life etc. But whether that is right for that person is another question. In general, when it comes to plastic surgery like augmentation or reduction, it’s elective, it’s not necessary. It changes your body, and you can’t go back to the way it was, it’s a big decision. Do your research. The medical field in a way has been poorly regulated, and with cosmetic surgery becoming more and more popular people have kind of thought ‘this is a good way to make money’. As surgical specialists we train for an absolute minimum of 7 years, but realistically it takes us longer, all up around 16 years or so to be a qualified surgeon, let alone to then be selected as a plastic surgeon. So, if someone comes along and they can’t provide you with their FRACS (Fellow of the Royal Australasian College of Surgeons) they are not a surgeon. They do surgery, they are allowed to in this country, but they haven’t achieved a standard most people would consider a specialist surgeon to possess. I guess, if you have doubts when you’re in that consultation don’t do it. Think about it for a bit longer. Be really informed before you do decide to have surgery. You have to really trust that surgeon and if you don’t then don’t do it. The relationship between patient and surgeon is really important, as you know. Be empowered and chose someone who is right for you.
Luna: Absolutely, it’s so important to follow your gut in those consults. What’s something you wish more people understood about plastic surgery?
Dr Ngan: I think we as people spend a lot of time judging each other. Social media has really been a catalyst for that. For those who haven’t undergone plastic surgery, I think it’s important in someway to just stay in your lane, don’t comment on something that has nothing to do with you. I know people ask me “what would you do if you were me?” I always say I can’t give you that answer, because what’s right for me, may not be right for you. I guess it’s about giving people the space to do what they want with their body, and you know cosmetic surgery can really change peoples lives for the better. It’s not just about appearance, it’s the physical psychological improvement. Maybe we shouldn’t be so vain, we don’t need Botox or implants and we should just accept our body, but the fact of the matter is it’s available and if it’s going to help you on a mental scale then why not? But do it in a safe way.
Luna: I couldn’t agree more. Ok Dr Ngan tell us what is the pit and the peak of your job as a surgeon? What do you find most difficult and what do you find most rewarding?
Dr Ngan: You ask very tough questions! Ok, lets start with the pit – the hardest part of my job is I can’t leave my job at work, and I don’t know if many surgeons can. You know, its really hard, I go home and my kids can be affected, if I’ve had a complication, which can happen I’m only human, it weighs on me, I’m exhausted, and it affects me a lot. What I find really hard is when patients don’t see me for me, or don’t feel I’ve done my best. But sometimes patients’ expectations don’t always meet what we’ve communicated in consult and leading up to surgery. Dissatisfaction, from a patient perspective I take really personally. I probably shouldn’t, but I care so much about my work and my patients so I always want there to be a positive outcome. On the flip side of all of the hard work and sacrifice along the way I meet people like you. It brightens my day when I get to build relationships with patients, or when they come out of surgery and I guess they appreciate the time and effort. Its so funny, but you know I think we all experience imposter syndrome in one way or another, but for me as a surgeon its really true. What keeps you better and what keeps you growing is not thinking that you’re good enough in a way, and I guess we all struggle with that. But hearing things from people like, “you really have changed my life, look what I can do now, what I can wear now”, I never get tired of that, I love that and I want to hear that. The operation I perform the most are breast reductions and it’s because I think it’s a really powerful surgery. I can’t get enough of when a patient is happy and feels like I’ve achieved their dream. To be honest though, I love surgery, I get such a buzz, I feel like what a cool job, I’m so lucky, the positives really outweigh the negatives and the sacrifices we as surgeons have to make. I could never have imagined that I get to get up every morning and do what I love.
Luna: Absolutely, I think it’s amazing that you are so transparent across social media or in real life about the daily life of a surgeon, whether that be through consults, in theatre or at home as a mum. It’s so important I think because it’s a nice reminder that at the end of the day you know we are all human. It’s really cool to see, thank you for putting yourself out there and allowing us as viewers to kind of experience it alongside you. Before we wrap up, was there anything else you wanted to say or mention that you feel we may have missed?
Dr Ngan: Look the only thing I’d say is that breast cancer awareness month is in October as we know, and then on the 18th of October is Breast Reconstruction Awareness Day. The figures for reconstruction in Australia are really low. There is a lot of awareness about breast cancer which is really important, but a lot of people don’t know about reconstruction. I don’t do it often, but when I do present to certain groups or whatever it might be with regards to reconstruction it’s because I’ve seen the benefit it has had for women psychologically. Some women don’t know if they are candidates, and yet so many are. A lot of consults I’ve had for reconstruction seem to have this narrative that you know “Oh I’m just being vain,” “I’m being selfish,” or they don’t feel worthy and put themselves down. Women have been expected to put up with these things, and its just not the case. I want everyone to know that many people are candidates and that you deserve the discussion around reconstruction whether you choose to do it or not. Breast surgeons should be offering it, GPs should know about delayed reconstructions and patients need to be informed, because it is an option. Reconstruction can really affect women after breast cancer in a positive way.
Luna: For sure, my grandma had breast cancer in her late 60’s and opted for a double mastectomy without reconstruction. She’s been healthy since, but I know the mental toll it has taken on her to feel like she is without has been enormous. She wasn’t given the option for reconstruction, and its something that has weighed on her confidence ever since. It’s so important that we collectively as a society are informed that reconstruction is there, its not vain, its not selfish and that we are deserving of it.
Dr Ngan: I agree. In relation to plastic surgery in general, I think some people have the view that you know “why are you so worried about how you look”, “your body is fine without”, but its funny because society has told us that we are supposed to look a certain way, its constant, the pressure on women is outrageous. I get really frustrated when I see comments or things like “she should just accept her body”, but it’s like how can they because society doesn’t? We’re supposed to look like something unachievable, but then when you do something for yourself you are judged for it. I think until society changes and we have a diverse voice in the media people will still continue to seek plastic surgery because the expectations for beauty that are imposed on us are so high.
Luna: I completely agree. It’s a big topic we have to navigate as a society, and it’s something I’m hopeful will progress and evolve with time and understanding.
Dr Ngan: Definitely! Actually, the last thing I wanted to say was that I perform Labiaplasty occasionally, and there were cosmetic doctors popularising the term “designer vaginas” and what not, and I think this really highlights not only the misinformation about this procedure but plastic surgery in general. Plastic surgery, more often than not isn’t always about aesthetics. The people I have seen for Labiaplasty are often suffering from frequent tears, can’t wear a bikini, or have been exposed to hateful scrutiny from the public whether that be male or female. This is what society does to us, they tear us down, and then when you decide you want to do something about it, you’re judged for it. It’s disappointing, because people are so quick to criticise and plant ‘problems’ in people’s heads about their bodies but then are unsupportive when you chose to do something.
Luna: Absolutely, it’s such an absurd narrative when it comes to “designer vagina”, the lack of understanding around plastic surgery is baffling. As a society I think we need to be better informed and approach these conversations with empathy. On the surface plastic surgery may seem as though it’s for aesthetic purposes, but more often than not, it’s about something entirely deeper. No different than me opting for a reduction. For sure, the aesthetic reasons play a part, but the physical and mental burden far outweighed that for me.
Dr Ngan: Completely, I couldn’t agree more.
Luna: Thank you so much for your time, Dr Ngan, it’s been such a pleasure and we really appreciate you taking the time to sit and chat with us today!
Dr Ngan: Anytime! It’s been so wonderful, and I feel so grateful to have had the opportunity to talk with you about this topic.
Well Lovers if you’ve made it this far, thank you for joining us this month on the blog. I’d like to close out by saying, plastic surgery isn’t for everyone. In cases where it is elective, please consider the toll it takes on your mental and physical health. As Dr Ngan reiterated, do your research and trust your gut.
For more information on Breast Reconstruction Awareness Day head to: plasticsurgery.org.au
If you or someone you know is struggling mentally or physically, we urge you to reach out to a health care professional. The information in this article is for educational purposes only, we are not doctors. Love Luna is not responsible for actions or decisions made after reading this article.
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