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Breast Prostheses
A breast prosthesis, also called a breast form, is worn externally to closely simulate the look of a natural breast and help restore the body's balance. This safe, non-surgical option is the choice the majority of women make following a mastectomy.
External breast forms can be made from silicone, foam or fiberfill and are usually worn in a specially designed postmastectomy bra with a pocket to hold the form in place. It has been reported that a weighted silicone breast form best helps the body maintain its balance which may prevent back, neck and posture problems.
Because no two women are alike, weighted silicone breast forms come in a variety of shapes, sizes and colors. The various styles accommodate a range of body types, breast shapes and surgeries and lifestyles.
For example, some breast forms have a soft front and are designed for women with more relaxed breast tissue. Breast forms that are soft in the back accommodate women who have had more radical surgeries and may have an uneven chest wall. There are also lightweight breast forms that are preferred by many who have lymphedema, osteoporosis and back problems. Active women may choose an attachable breast form that attaches to the body with a medical-grade, skin-friendly adhesive.
Because there is so much to consider, it is important for a woman to meet with a certified breast form fitter. A personal fitting session may last up to an hour. First, the fitter will help the woman choose the best-fitting bra, which is essential to a proper breast form fit.
She will then spend time with her discussing personal concerns and needs including body type, breast shape, surgery and lifestyle. Then together, the woman and her fitter can decide which breast form is right for her.
Breast Reconstruction
Another choice for women who have had a mastectomy is surgical breast reconstruction. The best time to consult with a plastic surgeon is before the surgery for breast cancer. While many women elect to have breast reconstruction several years following their mastectomy, it is becoming increasingly popular to have a consultation before surgery to learn about the various reconstruction possibilities.
What To Expect From Reconstruction
The goal of reconstructive surgery is to restore a breast mound which is similar to the other breast and which appears equal when a bra is worn. Every woman has different expectations. Some may be satisfied with restoring breast contour alone, while others may prefer as close a match to their natural breast as possible, including the reconstruction of a new nipple and areola.
Be aware that the sensations in the newly constructed breast are not the same as those in a woman's own breast tissue. The sensitivity to touch is diminished. In fact, many women describe a sensation of numbness in the reconstructed breast.
Breast Reconstruction Options
There are two types of procedures for breast reconstruction -- implants and tissue transfer. The type of mastectomy, cancer treatments, breast size and expectations all influence the plastic surgeon's recommendations.
Implants are silicone bags filled with salt water or silicone gel. These are surgically placed under the skin or chest muscle to recreate a breast. When the breast skin is healthy and the chest muscle is present, the surgeon makes an incision, usually through the mastectomy scar, and forms a pocket beneath the chest muscle for the implant.
The main advantage of implants is that they can be inserted quickly and easily, so operating time is relatively short. However, implants have several disadvantages: they can cause an infection and they can rupture. In addition, the salt water or silicone can leak out. Implants may also cause capsular contracture, a hardening of the scar tissue around the implant which may produce firmness, distortion or a shift in the implant. Another point to consider -- the length of time implants last before they need to be replaced is not yet known.
Tissue transfer, because it uses the patient's own tissue, has become the method of choice for breast reconstruction. In this type of reconstruction, a flap of muscle and skin (a myocutaneous flap) is taken from another part of the body and used to reconstruct a breast mound.
There are two main flaps used, each one named for the muscle it comes from. The latissimus dorsi flap is taken from the broad flat muscle of the back below the shoulder and the transverse rectus abdominis myocutaneous (TRAM) flap is taken from the abdomen. The TRAM flap is sometimes called the "tummy tuck" because the fatty tissue from the stomach is used to create a breast mound.
Following reconstruction of the breast shape, a new nipple and areola can be made. The nipple can be built by folding over skin from the newly-created breast or by grafting a piece from the other nipple. The reconstructed nipple and the areola can be tattooed with a color that matches the opposite nipple and areola. Most surgeons prefer to wait several weeks or months for the new breast to settle in and develop its normal drape before determining the proper position for the new nipple and areola.
Many women who have reconstruction still wear a silicone shell or breast pad to balance them, as the reconstructed breast may differ from the natural breast.
Information on Breast Reconstruction provided by the Society for Plastic and Reconstructive Surgeons.
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After a Mastectomy | After a Lumpectomy | After Surgery |