Breast prostheses & reconstruction

Wednesday 30 November, 2011

On this page: What is a breast prosthesis? ι What is a breast reconstruction? ι Do I need a prosthesis or reconstruction? ι Which is better? ι When can I wear a prosthesis? ι When can I have a reconstruction? ι Information reviewed by  

This information is for women who have had a partial or complete removal of one or both breasts (mastectomy). The surgery may have been because of cancer or to prevent cancer.

For many women, breasts symbolise things like femininity, sexual attractiveness and motherhood. They may influence a woman's body image and confidence. Losing all or part of a breast may be devastating; it can change the way a woman feels about herself.

Some time before or after a mastectomy, you may think about getting a breast prosthesis or a breast reconstruction. Many women find this an important step in their recovery. A prosthesis is an artificial breast worn inside a bra. It is also called a breast form.

A reconstruction is a surgical procedure to create a permanent breast using your own tissue and skin, and/or an implant. We aim to help you understand both options and cover the types of breast prostheses and reconstructions that are available, the process for getting them, costs, decisionmaking and follow-up care.

Every woman's needs are different. Only you, with help from your health care team, family and accurate information, can make the decision that is right for you.

Note that for simplicity we mainly refer to ‘breast prosthesis', ‘breast form' and ‘breast reconstruction' in the singular, but we acknowledge that some women have both their breasts removed and therefore need to consider getting two prostheses or a double-sided reconstruction.

 

What is a breast prosthesis?

A breast prosthesis (plural: prostheses) is a synthetic breast or part of a breast that appears real when worn in a bra or under clothing. The manufacturers usually call them breast forms. Prostheses can be used after the full removal of a breast (mastectomy) or after partial removal (lumpectomy or breast-conserving surgery).

Most breast prostheses have the weight, shape and feel of a natural breast, and they can be attached directly onto the skin or inserted into specially made pockets in bras, swimwear and nightdresses.

What is a breast reconstruction?

Many women have a breast reconstruction after they've had a mastectomy. A breast reconstruction is a type of surgery in which a breast shape is created using either a silicone or saline implant, or your own skin, muscle and fat from another part of your body such as your back or tummy (abdomen). Sometimes the reconstructed breast is called a mound or a breast mound.

Although the aim of surgery is to make a breast that looks as natural as possible, the reconstructed breast (and nipple, if created) will not look exactly the same as a natural breast. However, most women who have a breast reconstruction are pleased with the result.

Some facts about reconstructed breasts

  • The breast won't have much or any feeling, as the nerves will be damaged during the mastectomy.
  • A breast reconstructed using an implant won't change in size (for example, due to hormones or weight changes), but a breast made with your own tissue can.
  • A reconstructed breast won't produce milk if you have a baby. 

Do I need to have a prosthesis or a reconstruction?

Deciding to wear a prosthesis or to get a reconstruction is a personal decision. Reactions to the loss of a breast or breasts vary from woman to woman. Only you can choose what feels right for you.

Most women who have had a mastectomy choose to have a prosthesis or a reconstruction. Many women who have had breast-conserving surgery don't need either because their breast shape has not changed a lot. However, some women feel more comfortable using a partial breast prosthesis to fill out their bra.

There are a number of reasons why women who have had a mastectomy use a full or partial breast prosthesis, or have a reconstruction.

To replace the weight of the lost breast - When a natural breast is removed, the body is no longer balanced. This can cause a slight curving of the spine and a drop of the shoulder on the affected side. These changes may lead to lower back and neck pain over time, unless you get a prosthesis or reconstruction. Even women with small breasts can develop these problems.

To have symmetry when wearing clothing - Most women don't have identical breasts - the muscle and tissue on each side of the body is different. After a mastectomy, these differences will probably be more noticeable. A prosthesis or reconstruction can help you feel and look balanced.

To help restore self-esteem - Many women find it valuable to recreate a natural appearance with a prosthesis or reconstruction. This can help boost their confidence - including sexual confidence - after a mastectomy. For more information about body image and sexuality see our Sexuality and cancer pages.

To put the cancer behind them - Many women don't wish to be reminded of having cancer, but getting a reconstruction, in particular, can help them move on from their experience of cancer. Other women find that using a prosthesis is enough. Talk to your surgeon and breast care nurse about your options, both before and after your mastectomy.

Which is better?

When choosing between a prosthesis and a reconstruction, it is helpful to weigh up the advantages and disadvantages of both. Many women prefer only to use a prosthesis. Others start off with a prosthesis, then later decide to have a reconstruction. There is no time limit on when you must decide to have a reconstruction unless you are considering having one at the same time as the mastectomy.

Prosthesis advantages

Prosthesis disadvantages

  • You don't need further surgery, which has risks and sometimes a long recovery time.
  • Medicare subsidises the cost of prostheses.
  • You can change the size of your prosthesis if your other breast size changes.
  • You can wear the prosthesis with different clothes and when you're exercising.
  • A breast prosthesis is easily replaced if it wears out or is damaged.
  • You can wear a prosthesis while you're waiting for reconstructive surgery.
  • Some women don't like the idea of having an artificial breast.
  • The prosthesis has special washing and storage instructions.
  • It needs to be replaced every few years.
  • The cost of mastectomy bras can add up.
  • You may need to wear different clothes or accessories.
  • You may be reminded of having cancer when you undress.
  • Some women find a prosthesis uncomfortable (e.g. heavy or hot).
  • Some women feel self-conscious with their partner or embarrassed in public.

 

Reconstruction advantages

Reconstruction disadvantages

  • A breast made with your own tissue is permanent and usually won't require any further care after you have healed from surgery.
  • Implant reconstructions last 10-15 years or longer.
  • You may feel reassured to have a new breast that is a part of you.
  • Often after the surgical scars have faded the breast looks very natural.
  • Women having a TRAM flap procedure benefit from having a ‘tummy tuck' at the same time.
  • Many women find a reconstruction easier than a breast prosthesis to manage in the long term.
 
  • A reconstruction will require more surgery and extra time in hospital and for recovery at home.
  • As with all operations, problems may occur and there is no guarantee of your desired result.
  • Private patients, in particular, may have to pay a lot of extra costs.
  • The waiting period for an operation may be more than 12 months if you are treated in a public hospital. Even private patients may not be able to have surgery immediately.
  • You may feel self-conscious due to the result or the scarring.
  • A reconstructed breast may not change in shape, size or perkiness over time, unlike your other breast.
  • An implant reconstruction may need to be redone in the future.
 

 

"Even with Medicare and health insurance, I was significantly out of pocket for a bilateral reconstruction. Worth it? Without hesitation."
— Sharon Tregoning, author of ‘Accepting with Grace: Mastectomy & Reconstruction'

When can I wear a prosthesis?

Although the breast area will be tender after surgery, a soft, light, temporary breast prosthesis called a soft form can be worn right away, usually for up to two months.

The soft form can be worn in a post-surgical bra that has a pocket. If the bra is too constricting or rubs against your scar, you can purchase a pocketed crop top or camisole.

Because it is light and made from a gentle material, the soft form can be worn during radiotherapy.

When you have recovered from treatment, you can be fitted for a permanent prosthesis. You may need to wait up to two months after surgery and for six weeks after radiotherapy to give the skin and other tissue time to heal. If you have chemotherapy between surgery and radiotherapy, it may be some time before you can get your permanent form.

My Care Kit

Breast Cancer Network Australia provides a free postsurgical bra and temporary soft form for women who have recently had breast surgery. Order a kit through your breast care nurse or from Cancer Council Helpline on 13 11 20.
You can also purchase more durable soft forms and post-surgical bras from retail outlets specialising in breast prostheses. Call Cancer Council Helpline for information on where you can buy these.

When can I have a reconstruction?

There are different opinions about the best time for a breast reconstruction. It can be done or started at the time of the mastectomy (immediate reconstruction) or at a later stage (delayed reconstruction). This can be months or years later.

The timing depends on the type of breast cancer you were diagnosed with, whether you need further treatment (for example, chemotherapy or radiotherapy), how you feel about the loss of your breast or breasts, your general health, and other concerns, such as the cost.

For some women, it is important to plan reconstruction from the time of their mastectomy, but other women prefer to focus on the cancer treatment and think about reconstruction later. Sometimes you won't be able to have an immediate reconstruction due to the surgery schedule at the hospital.

You need to talk over these issues with your breast cancer surgeon and reconstructive (plastic) surgeon. It is okay to ask for a second opinion if you would like one.

"I wore a breast form for six years and then decided to have a reconstruction. After the diagnosis, all I wanted was to have the tumour removed and save my life. Now I'm tired of wearing and maintaining the form." — Sandra
 
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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