Key Questions

What is a breast prosthesis?

A breast prosthesis (plural: prostheses) is a synthetic breast or part breast that replaces the shape of all or part of your breast. It is also called a breast form.

Prostheses can be used after either the whole breast (mastectomy) or after part of the breast (breast-conserving surgery, lumpectomy or wide local excision) is removed.

Most breast prostheses have the weight, shape and feel of a breast. They are attached directly onto the skin or inserted into specially-made pockets in bras, swimwear, activewear and sleepwear. 

If you don't want to buy a mastectomy bra or a bra pocket to sew into your regular bra, you can make your own pocket from a pattern.

What is a breast reconstruction?

A breast reconstruction is an operation to make a new breast shape. You may choose to have a breast reconstruction at the time of the mastectomy or later.

The aim of a breast reconstruction is to make a breast that looks as similar to your original breast shape or other breast as possible, however, the reconstructed breast will not look or feel exactly the same.

There are two main options:

• Implant reconstruction: a new breast shape is created using a sac filled with either silicone gel or saline.
• Flap or autologous reconstruction: using skin, muscle and fat from another part of your body.

Do I need to have a prosthesis or a reconstruction?

It is your decision whether you choose to stay flat, wear a prosthesis or have a reconstruction after surgery. Only you can choose what feels right. You do not need to decide immediately.

Unless you want to have a reconstruction at the same time as the mastectomy, there is no time limit on when you must decide. See your doctor as many times as you want before making a decision and ask questions about what to expect. You may be able to have a temporary tissue expander to give you time to decide.

Some reasons for using a breast prosthesis or having a breast reconstruction after a mastectomy include:

• Replacing the weight of the lost breast: When a 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. Issues with balance after having a mastectomy can affect women of any breast size. A prosthesis or reconstruction can help with balance.
• Creating symmetry when wearing clothing: Most women don't have identical breasts – the muscle and tissue on each side of the body is different. However, after a mastectomy, these differences are usually more noticeable. A prosthesis or reconstruction may help you feel and look more symmetrical.
• Restoring self-esteem: Recreating the shape of your breasts with a prosthesis or reconstruction may help to boost your confidence – including sexual confidence – about the way your body looks after a mastectomy. See more information about body image and sexuality issues.
• Adjusting to the diagnosis and treatment: Wearing a prosthesis or having a reconstruction may help you cope better with the cancer diagnosis. You might feel like you are taking control of the way you look.

Can I go flat?

If you decide not to have a reconstruction or wear a prosthesis, you may consider going flat – also called staying flat or living flat. This may be because you are comfortable with how your body looks after surgery for breast cancer.

Your reasons for going flat may include:

• to avoid having more surgery and any potential complications
• for an easier, faster and less complicated physical recovery
• to return to your usual activities as soon as possible
• to avoid the possible side effects of breast reconstruction
• not liking the feeling of a reconstructed breast
• not wanting to wear a prosthesis
• to avoid the costs of surgery, new mastectomy bras or prostheses
• to avoid possible weakness in the shoulder that may make some activities, such as tennis and golf, more difficult
• not being suitable for a reconstruction.

If you decide to go flat, talk to your breast surgeon about what the finished result will look like. Ideally, the surgeon would remove extra skin, excess tissue and pockets of fat, and then smooth out the remaining tissue and skin to create an even chest wall. Your breast surgeon may work with a reconstructive (plastic) surgeon to achieve a good result.

"I chose to go flat after my double mastectomy and 2 years later, I’m happy with that decision. I felt that my breasts couldn’t be replaced, so I needed to learn to live with my new shape. It was helpful to talk to my surgeon and see photos of other people who had gone flat.” BETH

Making decisions

If you need breast cancer surgery, you may choose to remain flat, wear a breast prosthesis or have a breast reconstruction. It is a good idea to discuss the different options with your breast surgeon, a reconstructive (plastic) surgeon and/or a breast care nurse. Sometimes it is difficult to decide what you want. Take what time you can before making a decision.

Know your options

Understanding the available options, possible complications and costs can help you weigh up the options and make a well-informed decision. Seeing photos of a flat chest, reconstructed breasts and prostheses will help you understand what to expect. You don’t necessarily have to choose between the options – you may start with a prosthesis, then decide later to have a breast reconstruction or go flat.

Keep in mind that not all options may be suitable for you. There may be some situations where your surgeon advises against having a reconstruction. This might be due to the type of breast cancer or treatment you had, because you need further treatment for the cancer or due to your general health. Talk to your doctor about what is possible for you.

Record the details

When your doctor first talks to you before and after breast cancer surgery, you may not remember everything you are told. Taking notes can help. If you would like to record the discussion, ask your doctor first. It is a good idea to have a family member or friend go with you to appointments to join in the discussion, write notes or simply listen.

Ask questions

If you are confused or want to check anything, it is important to ask questions of your breast surgeon, breast care nurse and prosthesis fitter. Try to prepare a list of questions before appointments. This will help you think through the information you need to make your decision.

Consider a second opinion

You may want to ask for a second opinion from another breast surgeon or reconstructive (plastic) surgeon to confirm or clarify your specialist’s recommendations, or to reassure you that you have explored all of your options. Specialists are used to people doing this. Your general practitioner (GP) or surgeon can refer you to another surgeon and send your initial results to that person. Ask how much the second opinion may cost, as some doctors charge more for this. If you decide on a breast reconstruction, you can then decide which surgeon you would prefer.

It’s your decision

Choosing to wear a breast prosthesis, have a breast reconstruction or go flat is a personal choice. Although it’s useful to talk to other people, try not to feel pressured into a decision based on what they think. You also have the right to accept or decline any of the reconstruction options offered to you.

For help through the decision-making process, try the Breconda Breast Reconstruction Decision Aid or call Cancer Council 13 11 20 to arrange to speak with a Cancer Connect volunteer who has been through the decision themselves.