App helps breast cancer patients pick surgical options

Madam Jane Din, 38, a mother of three, experienced sharp pain in her left breast for two to three weeks before going for a check-up at Yishun Polyclinic in June.

She was referred to Khoo Teck Puat Hospital (KTPH) in July, where mammogram and ultrasound scans revealed two suspicious lumps in her left breast.

After undergoing biopsy for both lumps, the kindergarten teacher was diagnosed with breast cancer on Oct 4. She was informed on the same day that a mastectomy on her left breast was necessary.

For information on such procedures, she looked up an app called Reborn, or Redefining Education for Breast Oncology Reconstruction.

It was developed by a team of doctors and researchers from KTPH, NTU, Lee Kong Chian School of Medicine and tech company Mages Studio in June 2023 to inform patients like Madam Din on what they need to know before undergoing breast reconstruction surgery.

The app helps patients to understand their surgical options, surgical procedures and possible complications of surgery before giving informed consent.

Including Madam Din, 10 patients from KTPH, aged 38 to 65, have used the app as part of a pilot programme.

“I knew what my best option was after reading the information provided on the app. Everything was very clear. I didn’t have to refer to the Reborn website at home because I made my decision,” Madam Din said.

Breast cancer is the most common cancer among women with one in 13 here diagnosed with it.

From 2018 to 2022, 13,193 cases were diagnosed, according to the Singapore Cancer Registry Annual Report 2022.

Currently, plastic surgeons use 2D pamphlets to explain types of surgical options, risks and procedures, which are not sufficiently realistic or interactive, making it hard for patients to visualise the outcome.

Assistant Professor Clement Chia, head of KTPH’s breast surgery service and project lead of Reborn, said: “Sometimes when I explain to patients about reconstruction, I (would) point to my own body, like my tummy… We remove some fat here to put on the breast or remove some back muscles, so the visualisation is not optimal.”

Dr Jolie Hwee, head of KTPH’s plastic, reconstructive and aesthetics surgery, said combining a cancer diagnosis with an overwhelming amount of information about complex surgical procedures often leaves patients feeling confused and unable to make informed decisions about their options.

With the Reborn app, patients waiting for their consultation with the plastic surgeon can take the time to read the bite-sized information provided about the five types of reconstruction options that are most common.

Patients can revisit the information anytime at their convenience by logging on to the Reborn website with their unique patient ID. This will be useful for them to inform family members about the possible surgical options and procedures before making a decision together.

The Reborn app has been integrated into routine clinical use since July 2024 by breast and plastic surgeons at KTPH and Tan Tock Seng Hospital, both of which are under the National Healthcare Group.

Between April 2023 and March 2024, 82 patients underwent mastectomy in KTPH, out of whom 29 chose to undergo breast reconstruction surgery there.

The team will continue to refine the app and hope to pilot its use at other hospitals in Singapore which have indicated interest.

Patients who have used the app reported that it significantly aided their understanding and visualisation of surgical options.

Use of the app has contributed to a 41 per cent reduction in average consultation time, from 52.5 minutes to 30 minutes.

Madam Din said the app’s augmented reality function is the most helpful as it shows her how the reconstruction will be done.

“I could understand about 70 to 80 per cent of the information about my surgical options before my husband and I met Dr Hwee. We chose the surgical option on the same day that Prof Chia referred me to Dr Hwee,” she added.

Dr Hwee, who is also the co-project lead of Reborn, said: “With Reborn, we simplify intricate medical information, thus enhancing patient understanding and retention of essential details.”

Madam Din underwent a successful endoscopic mastectomy with reconstruction on Oct 11 and was discharged after four days. She is recovering well and can perform basic household chores while on hospitalisation leave.

Assistant Professor Mok Chi Wei, consultant oncoplastic and minimally invasive (endoscopic and robotic) breast surgeon at SingHealth Duke-NUS Breast Centre, said Reborn offers multiple benefits by helping patients make informed decisions and reducing anxiety.

“With easy access to comprehensive information on reconstructive options, patients can review and process details at their own pace, empowering them to actively participate in their care choices,” he added.