Choosing a Prosthesis After Breast Cancer

After surgery for breast cancer every woman must make a choice about how to restore her appearance. This will depend on her circumstances, the nature of the surgery as well as her expectations and needs.

If breast conserving therapy is not possible or chosen, a mastectomy will be performed. Breast reconstruction can be considered to restore the shape of the breast. If this procedure is not recommended or chosen, a breast prosthesis is available.

For most women their appearance after surgery is important and it helps them to cope with the trauma if they find a satisfactory prosthesis to restore their outward appearance. This helps to improve their self image. Most women who do not undergo breast reconstruction wear a prosthesis.

Why is a prosthesis recommended?
The purpose of a breast prosthesis is aesthetic on the one hand, as it restores your natural appearance. It also has a therapeutic purpose, which is to maintain your body balance.

What are the advantages of a prosthesis?
A prosthesis that is weighted correctly and fits properly helps to maintain your natural posture and improves your appearance. It prevents:

• spinal curvature as a result of imbalance
• shoulder drop
• muscle contracture resulting in neck or back pain
• ill-fitting clothes as a result of an incorrect posture
• obvious difference in the size of the breasts, drawing attention to your appearance

What is a breast prosthesis?
A breast prosthesis is an artificial breast form worn in your bra to simulate the shape and weight of your natural breast.

What does a breast prosthesis look like?
Prostheses are available in different shapes and sizes, as well as different degrees of firmness. They are shaped to follow the natural contour of a woman's breast or part thereof, sometimes including the outline of a nipple. The upper surface of the prosthesis feels soft and smooth, while the part resting against the skin may differ. It can be smooth and firm, made of fabric, be flat or hollow, with or without soft edges. It is specifically designed to be worn comfortably.

What is a breast prosthesis made of?
A breast prosthesis is made of silicone with a covering of polyurethane; lightweight foam or fibre filler. Its weight is determined by the amount of silicone, foam or filler used.

What types of breast prostheses are available?
A wide range of breast prostheses is available in different shapes, sizes and colours:

• Soft prosthesis: This is a lightweight prosthesis made of a synthetic washable fibre in a cotton cover. It is particularly suitable for wearing during the first weeks after surgery and is often worn in a soft elastic camisole, which is comfortable after surgery or during radiotherapy.
• Partial breast prosthesis: This is used to fill out the shape of the breast after a lumpectomy (wide local excision) if the shape of the breast has changed noticeably.
• Shell prosthesis: This is hollow and designed to fit over the breast or remaining breast tissue to enhance the shape of the breast.
• Non-silicone breast prosthesis: This is a lightweight prosthesis made of foam or fibre filler and can be worn during excercise, swimming and warm weather.
• External silicone breast prosthesis: This is a weighted silicone prosthesis designed to simulate natural breast tissue. Because it has the same weight as the natural breast, it can help to maintain a good posture and prevent shoulder drop and problems with balance.
• Self-supporting breast prostheses: This prosthesis has an adhesive substance on the skin side which adheres to the skin. The adhesive may be reactivated when necessary with a special gel or water. This prosthesis may feel more natural and secure, particularly for women who are physically active. It is not recommended during radiotherapy, as the skin may be sensitive.

How do I know whether my bra fits properly?
A well-fitting bra ensures that the prosthesis fits comfortably and securely.

• The bra may have underwire.
• The bra cups should be full and have firm, elasticated edges.
• The bra must fit close to your chest in the centre and have a high front.
• The straps should be elasticated and adjustable.

How soon after surgery can I start to wear a prosthesis?
You will have to wait six to eight weeks after surgery before you can wear a silicone prosthesis. Your surgeon will advise you when you are ready. If you are having radiotherapy your skin may be sensitive and you should then wait until the sensitivity has disappeared. You can wear a soft prosthesis initially and during the recovery phase you may prefer to wear a soft seamless camisole top instead of a bra.

How do I purchase a breast prosthesis?
Breast prostheses are provided by qualified fitters. Consult Reach for Recovery for contact details of providers of prostheses and post-matectomy bras.

• Find out whether your medical aid will pay for the prosthesis in full or partially.
• Make an appointment and ask whether a professional fitter will be available. The fitting may take about an hour.
• Ask a friend or partner to accompany you to the fitting for moral support.
• When you go for the fitting take one of your bras that fits well, as well as a T-shirt, so that you can see what the prosthesis will look like under your clothing.
• Look at the whole range of prostheses before you decide.
• You might want to purchase a spare lightweight prosthesis for recreational activities.
• Some fitters can also provide special bras and swimwear.
• You can wear shoulder pads to prevent the bra straps from cutting into your shoulders.
• The prosthesis ususally comes with a 12 month warranty.

How do I know whether the prosthesis fits correctly?
A professional fitter will help you choose a prosthesis that fits properly, but you should check the folllowing:

• Check that the prosthesis fills your bra cup at the top and the bottom.
• Place the flat of your hand on the prosthesis and on your natural breast and compare the softness and size. A softer silicone will give a more natural shape.
• Check that the form is not too full under the arm by feeling with your hand and swinging your arms forward and backwards.
• At first the prosthesis may feel a bit heavy. Wear it a few hours at a time, until you are used to it.

Will people be able to see that I am wearing a breast prosthesis?
If the prosthesis and your bra fit correctly, no-one will be able to see that you are wearing a breast prosthesis.

How should I take care of my breast prosthesis?

• When visiting a sauna or spa, wear a fibre-filled prosthesis, as a silicone prosthesis may heat up against your skin.
• Handwash your prosthesis every day in warm soapy water and pat it dry with a towel. Do not use a hair dryer.
• Protect your prosthesis from perfume or talcum powder.
• When you are not wearing your prosthesis, store it in the specially designed box it came in.
• Most prostheses last about two years.

Reach for Recovery would like to thank Gretha Aalbers for compiling this pamphlet, and the Ralph Nussbaum Foundation for sponsoring the printing.