Breast prostheses & reconstruction

What is a breast prosthesis?

A breast prosthesis (plural: prostheses) is a synthetic breast or part of a breast that is worn in a bra or under clothing to replace all or part of your breast. The manufacturers usually call them breast forms.

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

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

What is a breast reconstruction?

A breast reconstruction is an operation to make a new breast shape. Sometimes the reconstructed breast is called a breast mound. 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 natural and similar to your other breast as possible, however, the reconstructed breast will not look or feel exactly the same. There are several options – see types of breast reconstruction below. Reconstructed breasts may not have a nipple, but one can be made surgically. Otherwise, stick-on nipples or nipple tattoos can be used.

Types of breast reconstruction

A new breast shape is created using an implant, or a flap of your own skin, muscle and fat from another part of your body.

Do I need to have a prosthesis or a reconstruction?

Deciding whether or not to wear a prosthesis or get a reconstruction after surgery 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.

You do not need to make a decision immediately. Unless you are considering having a reconstruction at the same time as the mastectomy, there is no time limit on when you must decide. Take the time you need to consider your options.

There may be a number of reasons why women who have had a mastectomy choose to use a breast prosthesis or to have a reconstruction. However, some women decide not to use a prosthesis or have a reconstruction. For example, if you had breast-conserving surgery, you may feel that your breast shape didn't change much.

Some reasons women choose to wear a breast prosthesis or have a reconstruction 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

You may find that recreating a more natural appearance with a prosthesis or reconstruction helps 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

Using a prosthesis or having a reconstruction may help some women cope better with the experience of cancer. You might feel like you are taking control of your appearance.

Making decisions

Choosing to wear a breast prosthesis or having a breast reconstruction is a personal choice. You may find it helpful to learn more about the options available and to consider the benefits, drawbacks and possible complications of all options:

You don't necessarily have to choose between the options – you may start off with a prosthesis, then decide later to have a breast reconstruction. Keep in mind, that not all options are suitable for all women.

Take time to understand what a prosthesis or reconstruction involves so your expectations of the end result are realistic. You may chose to have a reconstruction at the time of your mastectomy or you can have a reconstruction in the future. If you decide to have a delayed reconstruction or not to have a reconstruction at all, you can use a breast form to create the look of a natural breast. A breast care nurse or counsellor can also help you think through the issues.

As a breast reconstruction is a specialised form of surgery, you should talk with your breast surgeon first about your options, including the best time to have the procedure. Many women can have a reconstruction, but there are some situations where your surgeon may advise against it. 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.

What to consider when making a decision:

  • If you are referred to a reconstructive surgeon, ask to see photos of their work and to talk to some of their previous patients.
  • If you are offered a choice of reconstructive operations, you will need to weigh up the benefits and drawbacks. Consider the impact of the side effects and the length of recovery. If only one type of reconstruction is recommended, ask your doctor to explain why other options have not been offered.
  • If you live in a regional or rural area, your breast prosthesis or reconstruction options may be limited. For more options, you may consider travelling to a major city centre.
  • If you have a partner, you may want to talk about the options with them and ask them to come to appointments. You can also talk to friends, family or other women who have had a similar experience to you. See information on support groups and services such as Cancer Council Connect.

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 refuse any of the reconstructive options offered to you.

The website BRECONDA (Breast Reconstruction Decision Aid) has been developed specifically to help guide women through the decision-making process about whether breast reconstruction is the right choice for them.

To help you understand the different surgical procedures and think through the information you need to make your decision, see the relevant question checklist. If your doctors use medical terms you don't understand, it's okay to ask for a simpler explanation or check a word's meaning in the glossary.

A second opinion

Getting a second opinion from another breast surgeon or plastic surgeon may be a valuable part of your decision-making process. It can confirm or clarify the first doctor's recommendations and reassure you that you have explored different options.

Some people feel uncomfortable asking their doctor for a second opinion, but specialists are used to patients doing this. It is important that you feel comfortable with, and have trust in, your surgeon. Ask your surgeon or general practitioner about getting a second opinion if you want to. You can then decide which surgeon you would prefer to do your breast reconstruction. See a list of people involved in your care.

Expert content reviewers:

A/Prof Elisabeth Elder, Specialist Breast Surgeon, Westmead Breast Cancer Institute and Clinical Associate Professor, University of Sydney, NSW; Jo Cockwill, Consumer; Suzanne Elliott, Consumer; Bronwyn Flanagan, Breast Care Nurse, Brightways, Cabrini Hospital, VIC; Maina Gordon, Consumer; Gillian Horton, Owner and Corsetry Specialist, Colleen’s Post-Mastectomy Connection, ACT; Kerry Nash, Sales and Marketing Manager, Amoena Australia, NSW; A/Prof Kerry Sherman, Macquarie University and Westmead Breast Cancer Institute, NSW. We are grateful to Amoena Australia Pty Ltd for supplying the breast form images. The breast reconstruction images have been reproduced with permission from Breast Cancer: Taking Control, © Boycare Publishing 2010.

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