Breast prostheses

Wednesday 30 November, 2011

On this page: Material used in prostheses ι Types of prostheses ι Buying a breast prosthesis ι Where to buy breast prostheses ι Choosing a bra ι At the fitting ι Getting the fit right ι Costs and financial assistance ι Information reviewed by

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Material used in prostheses

Most breast prostheses for long-term use are now made from a solid type of silicone gel. They are moulded into the natural shape of a woman's breast or part of a breast. Temporary forms tend to be made with foam, fibrefill or fleece; these are usually worn in the first couple of months after surgery. Some women prefer to wear a soft form in bed.

The top and front surface of a breast prosthesis feels soft and smooth. The back surface that rests against your body varies and depends on whether the prosthesis is designed to go into a bra pocket or stick directly to your skin. It can be firm and smooth, flat or hollow, have ridges that are soft and flexible, have sticky (adhesive) spots, or be made of fabric.

Most permanent prostheses are weighted to feel similar to your remaining breast (if only one breast has been removed), but lightweight styles are also available. Some prostheses include a nipple outline or you can buy a nipple that sticks to the form.

What is silicone?

Silicone is a non-toxic, synthetically-made substance that is heat resistant and rubbery. This makes it useful for moulding to the shape of a natural breast and placing next to the skin. If a prosthesis tears or punctures, the silicone can't be absorbed by the skin.

Silicone also feels like a natural breast through clothing, and some types of prostheses move in the same way as natural breast tissue. 

"Forms are very well designed these days. Anyone pressing up against you would not know the difference - not like the days when they were filled with bird seed or rice." — Jan

Types of prostheses

Every woman's body is different so there is a large range of prostheses available in various shapes (triangles, circles or teardrops), cup sizes (shallow, average, full) and skin colours.

There are also partial breast forms (triangles, ovals, curves and shells) for women who have had breast-conserving surgery or a breast reconstruction and want to fill out their breast shape.

Different prostheses have different amounts or layers of silicone. This allows women to match the breast form to the structure and movement of their remaining breast.

Some prostheses are even on both sides (symmetric) or uneven (asymmetric). Symmetric forms can be worn on either side of the body; asymmetric forms are either worn on the right side or the left side.

The type of prosthesis you can wear will depend on the amount and location of tissue removed during surgery. You should be able to find one that is close to your original breast shape and suits your lifestyle. Your fitter will be able to guide you through the range of prostheses that are suitable for you.

Soft breast form	This light breast form usually has a polyester front cover and a cotton back cover. It is mainly used in the weeks immediately after surgery and is good if you have sensitive scar tissue or if you like to have a light breast shape while sleeping. It can also be used for swimming, although there are other special forms for this purpose. Due to their light weight, soft forms are not suitable if you need a prosthesis for balance.
Basic breast form	This is a full breast form with a natural curve and weight that helps fill the bra cup completely. The form is made as a single mould using one layer of silicone only. It tends to be heavier than other types of forms. There are different sizes and shapes for you to get the best fit and comfort. Many have a nipple shape styled into the silicone.
Two-layer breast form	Two-layer breast forms are made with two different layers of silicone. This gives the form a more natural drape depending on the type of breast it is matching, for example, a younger breast, an older breast or a smaller breast. The layering also helps the breast form have a more realistic movement. They are lighter than basic forms but heavier than lightweight forms. Some two-layer forms include temperature-control technology.
Partial breast form or shaper	Many women have part of their breast removed. If surgery or radiotherapy has changed your breast shape significantly, you can use a small, specially shaped breast form. This will help fill the space in your bra and achieve symmetry. Some breast prostheses can be filled with machine-washable fleece to obtain the desired size. Some brands of partial breast forms stick directly to the skin, so they can be worn with a regular, non-pocketed bra. You can also place the form in a pocketed (mastectomy) bra.
Shell breast form	A shell breast form is a type of partial breast form. It is hollow (concave) and fits over any remaining breast tissue to restore your breast to its original shape and size. Sometimes women who have had a breast reconstruction find that the size of their remaining breast changes if they gain or lose weight. They can use a shell breast form to make their reconstructed breast match the size of their natural breast.
Lightweight breast form	Lightweight breast forms are made with a lightweight silicone and are about a third lighter than a basic breast form. Lightweight breast forms are useful for women with lymphoedema, osteoporosis or arthritis, or for women with larger breasts. Some lightweight forms have temperature-control technology.
Attachable or contact breast form	While many breast forms are designed to be worn in a bra pocket, others are designed to stick directly to your skin. Many women think a form that attaches to their skin looks and feels more natural. You will still need to wear a well-fitting bra.
Swim breast form	Some women prefer to swim without their breast form or to use a soft form, but if you swim often, there are advantages of buying a swim form. They are made with a type of silicone that retains its shape in and out of the water. Swim forms are much lighter than a regular prosthesis and are resistant to chlorine and saltwater. They dry quickly and can be worn in a pocketed swimsuit. Some manufacturers don't recommend wearing a silicone form in a sauna or spa as it may heat up against your skin. Try a foam or fibrefill one instead.

 

Buying a breast prosthesis

It is best for you to see a trained fitter who can help you choose the right prosthesis, as well as a mastectomy bra, if necessary. You will need to make an appointment - this means you will have uninterrupted time with the fitter and you can ask any questions on the phone beforehand. Allow about an hour.

For some women, having a fitting can be an emotional or distressing experience, especially the first time. They may be embarrassed at the thought of having another woman see the site of their surgery, or they may feel upset about needing a breast prosthesis. Remember that your fitter regularly sees women who have been in a similar situation to you, so they will be sensitive to your feelings.

You might also like to take a friend with you to the fitting for support. The other person doesn't have to come into the dressing room with you.

Talking to someone who has needed a breast prosthesis may help ease your concerns. 

You might find it helpful to see some breast forms before your appointment, or even before your operation, to give you an idea of what to expect. Your breast care nurse may have samples of breast forms and bras you can look at.

Where to buy a breast prosthesis

Call the Cancer Council Helpline on 13 11 20 for a list of stores where you can purchase breast prostheses, mastectomy lingerie and accessories. There are some specialist stores that only sell breast forms and associated products, but the lingerie section of some major department stores and lingerie boutiques also have trained fitters. There may also be a free home service available in your area.

If you live in a rural area, you might have fewer options for what you can buy and where you can shop. It is important for your health and comfort for the prosthesis and bra to fit correctly, so it will benefit you if you are able to make a trip to a large town or city to shop. This may also appeal if you don't want to shop where people know you.

Some women ask retailers to send them catalogues so they can look at the full range of bras and breast prostheses available. While fitters can order in bras and prostheses for you, they prefer to see and measure you in person, particularly if you are buying your first one.

Choosing a bra

To make sure your breast prosthesis is comfortable and fits well, it is important that you also wear a bra that fits correctly. You can bring your own bras (regular, post-surgical or mastectomy) to your prosthesis fitting or your fitter can suggest a mastectomy bra from their range of stock.

The bra supports the prosthesis and protects it from damage. It also supports and shapes the remaining breast, which is used to determine the size of the breast form. A bra that is supportive and fits well:

• may have underwire, if this is comfortable for you
• needs full cups with firm, elasticised edges
• should fit close to your chest wall between the cups and have a high front at the centre
• should have elasticised, adjustable, comfortable straps
• should have reasonably thick sides that don't cut into the skin
• minimises slipping or movement of the prosthesis.

A tight bra or one that has narrow shoulder straps may obstruct the flow of lymph fluid in your body and cause swelling in the arm (lymphoedema). A good fit will reduce the chance of this.

If you choose to use a regular bra, you can buy or make a pocket to sew into the bra to hold in the prosthesis. A bra pocket pattern can be downloaded from www.cancercouncil.com.au.

While some women find that their ordinary bra, a sports bra or a sports crop top adequately supports their prosthesis, mastectomy bras are specially designed for this purpose. As well as being cut wider under the arm, across the chest and in the straps, mastectomy bras have a pocket in the cup to hold the breast prosthesis in place.

The material in a mastectomy bra is also wide enough to cover an attachable or contact form. There are many attractive designs available.

At the fitting

You may be embarrassed about being fitted for a bra and/or prosthesis, but most fitters have been professionally trained and are understanding about women's needs after a mastectomy. It normally takes 40-60 minutes and you will have privacy when being measured and getting changed. Most fitters carry out the fitting in a similar way:

• The female fitter checks your bra size with a tape measure.
• The fitter will ask you about what type of bras you like and how active you are, or will check that your own bras are suitable.
• If you've had a double mastectomy, the fitter will ask you what breast size you were and what size you would like to be. You might like to keep your original size or go up or down a size.
• The fitter brings you a selection of bras to choose from.
• When you've chosen your bra, the fitter will help you try on different prostheses until you find a good fit.
• The fitter often has a slip-on T-shirt (like a smock) for you to try over the bra and prosthesis to check that the form is the right size and looks symmetrical under clothing. You can put your own clothes on but many women find the T-shirt easier.
• The fitter then shows you how to make sure the prosthesis sits properly in the bra and how to take care of it.

Getting the right fit

The key to a well-fitting breast form is getting it to match your natural breast as closely as possible. Breast form design has improved over the years so that they appear realistic. With a correctly fitting prosthesis and bra, it is very unlikely that a form will fall out or be noticeable to others.

Aim for a fit that looks natural and feels comfortable. The various styles and materials used in making the forms may feel quite different on your skin or in the bra. This will help you decide which prosthesis is best for you.

Ideally, you will get used to wearing the prosthesis, whether it sticks to your skin or is in a bra pocket, although this may take some time. If the breast form feels uncomfortable or looks obvious, it is probably not the right fit.

Ask yourself the following questions to help decide if the breast prosthesis and bra fit correctly:

• Does the bra feel comfortable when I take a deep breath?
• Does the surface of the bra look smooth?
• Does the bra sit flat against my chest when I lean forward?
• Do I like how I look with the prosthesis in place?
• Do I feel balanced?
• Does the prosthesis feel secure in the bra?
• Can I see any edges of the prosthesis sticking out of the top or sides of the bra? (If you do, the bra or the form is not the right fit.)
• Does the colour of the prosthesis blend in with my skin tone?

If you are unsure about which breast form or bra to buy, you don't have to decide right away. If nothing in the shop is suitable, the fitter may be able to order in other styles for you. You could also try another retailer who may carry different products. Don't be pressured into settling for a prosthesis you're not entirely happy with.

"It's like buying anything valuable. You need to take your time and make sure it's right." — Mary-Anne

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Tips

• If you have radiation treatment, wait 6-8 weeks after it is completed before making an appointment to buy a prosthesis.

• Ask other women about their experiences, but remember that what suited them might not suit you.

• Try different types of prostheses to get the best fit and comfort for your body.

• Check with the store about its return policy. You may be able to return the prosthesis if the one you buy feels uncomfortable, but this is not possible with all stores.

• If you have private health insurance, check whether it covers prostheses and mastectomy bras.

• Don't buy too many new bras if you are getting a reconstruction later on as you may need to get different bras to suit the reconstructed breast.

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Costs and financial assistance

Money may influence the type of breast prosthesis and bras you buy. The cost of a silicone breast form ranges from about $250-$450. A silicone swim form is about $130. A foam form is about $70. Mastectomy bras cost about $60-$100 each. Bra pockets that you can sew into a regular bra cost $10-$15.

Financial assistance towards the cost of breast prostheses is available from Medicare Australia. The Department of Veterans' Affairs also provides free prostheses and bras to eligible women.

Women with health insurance may be able to get rebates for bras and prostheses depending on their cover. As rules change, check what assistance is available whenever you buy prostheses or bras.

Medicare's External Breast Prostheses Reimbursement Program

Women who are permanent residents of Australia, have a current Medicare entitlement and have had a full or partial mastectomy as a result of breast cancer or as a preventative measure against breast cancer can receive a reimbursement of up to $400 for each new or replacement breast prosthesis from Medicare. If you have had a bilateral mastectomy, you are eligible for a reimbursement for two breast prostheses of up to $400 each.

To make a claim for a replacement prosthesis, there must be a period of two years or more between the purchase dates of the prostheses, but you may find that your breast prosthesis lasts longer than that. Only external breast forms can be claimed. Bras and surgically implanted (internal) prostheses aren't covered. 

Claim forms are available from any Medicare office or can be downloaded from their website. Attach the original receipt to the claim form and hand it in at any Medicare office or post it to the address listed on the form. The payment will be made by electronic funds transfer into your bank account. For more information visit Medicare Australia, call 13 20 11 or visit any Medicare office.

The Department of Veterans' Affairs provides free breast forms and mastectomy bras to eligible war widows and veterans. You need a referral from your GP or surgeon. For more information, call 13 32 54 (Sydney) or 1800 555 254 (other areas).

Private health insurance

Private health funds vary in their rebates for breast prostheses and related products such as mastectomy bras. Some rebates only apply to members with extras cover.

Most health funds have waiting periods and other terms and conditions. They may also require a letter from your surgeon stating why you need a prosthesis. Ask your health fund what is covered and what information is needed.

You can claim a reimbursement for a prosthesis from Medicare even if you have received a refund from your health fund, as long as the amount you received is less than both the full purchase cost and the External Breast Prostheses Reimbursement Program reimbursement limit ($400).

Examples of costs

• If your prosthesis cost $420 and your health fund refunds you $100, you will receive $300 from the External Breast Prostheses Reimbursement Program. You will be out of pocket by $20.

• If your prosthesis cost $380 and your health fund refunds you $100, you will receive $280 from the External Breast Prostheses Reimbursement Program. You will not be out of pocket. 

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Reviewed by: Staff from Westmead Breast Cancer Institute - Dr Thomas Lam, Plastic Surgeon; Dr Meagan Brennan, Breast Physician; Elisabeth Black, Jenny Cooper, Kim Kerin-Ayres and Mary Sweeney, Breast Care Nurses. Also Bronwyn Chalmers, Cancer Information Consultant, Helpline, Cancer Council NSW; Tracy Cosgrove, Breast Care Nurse, Royal North Shore Hospital; Marie Harland and Pauline Campbell, Breast Prostheses Fitters, Leila O'Toole Corsetry Salon; Lesley Jakes, Viviane Rubinstein and Kathryn Rutkowski, Consumers; and the Oncoplastic Subgroup of the Breast Surgeons Society of Australia and New Zealand (BreastSurgANZ).

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