46 years old, at the peak of her career as the Vice President of Finance in Danone-Aqua, Parmaningsih's life took an unexpected turn. In July 2001, the Indonesian discovered that she had stage 3 breast cancer. She consulted different specialists in Jakarta.

Upon an Indonesian oncologist's recommendations, she travelled to Singapore which had a reputation as a hub for quality healthcare services nearest home. Her story is not unfamiliar. More than150, 000 international patients come to Singapore each year for a whole range of medical care, and this number is set to reach 1 million by 2012.

Not satisfied with only one specialists' opinion and wary of having to pay for unnecessary treatment, she sought different opinions. In Singapore, Parma found that given her cancer stage, the medicine and supplements recommended by one specialist were not the solution. Breast surgery was, and best of all, she could opt for breast reconstruction at the same time. 'At that time, Singapore was one of the few centres to offer this latest technique of replacing the breast that was removed. I wanted what was best for my body.'

'I felt that it was so important to consult cancer specialists and not just depend on one source of information. Patients need to consult a few oncologists (cancer specialists) and do their homework to get the necessary information on the right treatment for the right cancer stage', advised Parmaningsih (Parma).

Parma opted for a 12-hour mastectomy together with reconstructive surgery available at National Cancer Centre Singapore and the Singapore General Hospital. Mastectomy involves surgical removal of the entire breast. Sometimes, the surgeon will also remove the lymph nodes or lymph tissue in the armpit area, depending on the type of breast cancer.

Breast reconstruction
In Parma's case, breast reconstruction was performed immediately after a mastectomy during the same operation. The breast was reconstructed by filling the breast skin with tissue from the lower abdomen. The first stage involved creating the breast form and the second, reconstructing the nipple and areola.

According to specialists, the TRAM flap is the most common method of reconstruction and uses skin and fatty tissue from the lower abdomen. The flap is nourished by blood supply from one of the paired abdominal muscles. The nipple is created with the existing tissue on the breast skin or a small graft from the opposite nipple. The dark color of the nipple and areola is produced with a skin graft taken from the groin or labia region, or by tattooing.

Since living tissue is used, the advantage is that it is warm and soft, and moves. 'It feels like a normal breast,' says Parma who was very satisfied and pleasantly surprised. The other plus point was that she had received a tummy tuck at the same time.

Surviving cancer
After the operation, Parma returned to Singapore for monthly follow-ups and presently she returns to the National Cancer Centre Singapore only once every 6 months. Grateful for a new lease of life, she has returned to the hectic corporate world with a new zeal. Her experience has also taught her that even having 'normal' life is precious, and cancer has given her choices to make the most of it.