When Mrs Lily Ho was told by her doctor that she would have to choose between her breast or her life, she felt like killing herself.

It didn't help that the 56-year-old housewife was alone, as her husband was overseas. The male surgeon did not seem to understand her distress.

She said: 'It felt so drastic to lose my whole breast. I was numb and flabbergasted by the consultant's cold attitude. I walked out.'

She contemplated throwing herself off the building, but didn't. A second opinion at another hospital gave her the option of breast reconstruction, which she took up gratefully.

Mrs Ho is among a growing number of women who do not want to be disfigured by cancer surgery.

It hasn't always been like that though.

Dr Ong Wei Chen, an associate consultant in the division of plastic, reconstructive and aesthetic surgery at National University Hospital, estimates that only 15 per cent of patients who have an operation to remove a breast, or mastectomy, have reconstruction work done.

A study by Changi General Hospital in 2000, entitled Breast Reconstruction After Mastectomy: A Survey Of General Surgeons In Singapore, found that patients here weren't that keen on reconstruction.

It states: 'Studies in Western populations point to the breast as 'the most important external identification of femininity'... Breast cancer patients in Singapore are culturally very different from their Western counterparts, and are more concerned with surviving the dread diagnosis of cancer than the preservation of their feminine form.'

Last year, 2,110 women lost a breast to cancer through mastectomy surgery, according to Ministry of Health figures.

Unlike previously, when breast cancer was detected late and at a more advanced stage, a mastectomy today does not have to mean losing a breast.

Said Dr Tan Yah Yuen, a consultant surgeon in the breast unit of KK Women's and Children's Hospital: 'If the cancer is diagnosed through a mammogram, then 50 to 70 per cent of the time, we can conserve the breast. By the time there is a lump, that number falls to 30 per cent.'

A mammogram is a an X-ray of the breast, and it can detect cancer in the breast before it can be felt.

Breast cancer is the most common cancer in women, with the risk increasing with age.

There are now about 1,300 new cases of female breast cancer diagnosed annually in Singapore, the Health Ministry said.

So why were there almost double the number of mastectomies than there were new breast cancer patients last year?

Oncologists think the reason for the discrepancy may be due to breast cancer recurrence, or cancer found in the other breast. This would involve more than one operation per patient.

The other explanation is that the number of new cases may only include Singapore residents, while the number of operations may include foreign patients.

Whatever the reason, the number of mastectomies could be reduced, because when breast cancer is found early and has not spread within the breast, doctors can conserve the breast by removing just the lump.

During a lumpectomy operation, a margin of normal breast tissue around the cancer is also removed to ensure all the cancer is taken out.

Radiation therapy is required to destroy any cancer cells that may remain in the area.

Only if the cancer is in several places, is very large, or has spread, then the entire breast must be removed in a mastectomy.

In some cases, women may have the option of replacing the breast at the same time with a saline or silicone implant, or their own tissue.

Mrs Ho opted for the latter, which meant that she woke up from her mastectomy with a newly reconstructed breast.

But women don't need to make that decision so quickly. Dr Chan Ching Wan, an associate consultant in the department of surgery at National University Hospital, thinks that a patient has enough to take in on her day of diagnosis, than whether to have reconstruction or not.

She said: 'The long-term studies from Britain state that if you have an operation within three months of your diagnosis, your stage of cancer will not change.'

In any case, reconstruction can be done even years later, so women have time to consider all their options, which more want these days, aside from being cancer-free, she said

NUH's Dr Ong added: 'Breast reconstruction is gaining popularity, and more and more (research) papers are saying that it improves the emotional well-being of the patient after surgery.'

There are three types of breast reconstruction to 're-create' a breast, an operation usually done by a plastic surgeon.

It can be replaced with implants of silicone or saline (salt water). The sacs are placed under the skin behind the chest muscle.

But surgeons try to discourage implants as they need replacing after 10 to 15 years, said Dr Tan. They also give the breast an unnaturally stiff look, and may look very different from the other unreconstructed breast.

The preferred methods are to use muscle, fat and skin from either the lower abdomen or back. Tissue is taken from the back if a woman already has a very flat tummy or if her breasts are naturally small. This tissue is then enveloped with the breast skin remaining after the mastectomy.

The tummy area feels most like actual breast tissue, said Dr Ong.

Reconstructing the nipple and areola (the dark circle around the nipple) is delayed, however, to allow the breast to settle into position after surgery.

The nipple, said Dr Ong, is created using skin from the breast. The areola can be created from a small skin graft from the groin, or a tattoo.

The nipple is for cosmetic purposes, as there will be no feeling.

Said Dr Ong: 'Most Asian women don't want a nipple and are happy just with a breast shape. Out of all the reconstruction surgeries, only 30 per cent request a nipple.'

Reconstruction does not delay further treatment, such as chemotherapy or radiation, if that is needed.

Not all patients are suitable, of course. Said DrChan: 'We tend not to offer reconstruction for stage three or four cancer.' The later a stage, the more likely the cancer has spread within the breast, and to other parts of the body.

The best case is to not need reconstruction at all, so doctors stress that women should go for screenings and find the cancer at stage zero, when it is confined within the milk ducts. Said KKH's DrTan: 'If the cancer is detected early, no woman needs to lose her breast.'