Women facing surgery for breast cancer are often more likely to receive information about breast reconstruction than about the non-surgical alternative of wearing an external breast form (prosthesis).

In fact, according to Carol Kiefer, RN, although the rate of breast reconstructive surgery is increasing steadily, there are still many women for whom wearing an external breast prosthesis is a comfortable and natural-looking alternative to further surgery.

"Wearing an external breast prosthesis should be presented to the woman facing mastectomy as a viable option after surgery," wrote Kiefer in Medscape Women's Health eJournal. "The interval between a diagnosis of breast cancer and surgical intervention is sometimes a matter of days. Often, these women are making a decision they will live with for the rest of their lives. … It is imperative that women facing breast cancer surgery have all their options for regaining body symmetry presented to them in a nonbiased manner."

A Prosthesis Primer

Prostheses today come in many shapes and can approximate almost any breast size and contour. Combining layers of different densities of silicone can mimic the breast tissue of an older woman who has less elastic tissue. Firmer silicone gel can mirror the density of a younger woman's breast. The more expensive prostheses can even duplicate the motion of natural breast tissue.

Women can now attach their prosthesis directly to the skin to keep it securely in place. Postmastectomy bras have also been modernized and improved to offer support for the prosthesis and comfort for the wearer.

Prostheses may also be beneficial for women who have undergone breast-conserving surgery (lumpectomy). Depending on the extent of the surgery, a woman may still have some breast asymmetry or disfigurement. There are a variety of partial prostheses that can smooth over the missing breast tissue, resulting in a more natural appearance.

Kiefer adds that it is important for a woman to be professionally fitted for a breast prosthesis. She notes that as many as 80% of women already wear the wrong size bra, and a proper-fitting bra is important for a comfortable fitting prosthesis. She recommends that a follow-up assessment and fitting should be repeated at least every 1-2 years as breast tissue density and shape change in response to aging and weight changes.

Common Questions

Here are the answers to some common questions about breast prostheses as supplied by The Breast Cancer Site:

Q: Is there any way to make wearing my breast prosthesis cooler in warm weather?
A: Wearing the breast prosthesis inside the bra pocket keeps the prosthesis off the skin. This creates more ventilation to evaporate perspiration. Another solution is to wear a CoolPad® to block the heat transfer from the prosthesis to the chest wall. Some women claim that a lighter weight prosthesis feels cooler. It is very important to wear a bra that supports the breasts and prosthesis and keeps them from resting on the abdomen, as constant moisture in this area can create skin irritation.

Q: How do I clean my breast prosthesis?
A: Amoena® Breast Form Wash is a safe cleaner for daily use. Skin oils can break down the outer skin of a breast prosthesis and shorten the useful life of the prosthesis. It is a good idea to clean the prosthesis every night and store it in it's cradle.

Q: What is the expected lifetime of a silicone breast prosthesis?
A: Most silicone breast prostheses have warranties against manufacturer's defects for up to two years from the date of purchase. The warranty usually does not cover damage to the prosthesis from punctures, or erosion to the skin of the prosthesis from perfume or lotions. Premium breast prostheses may last longer than two years with proper care.

Q: My prosthesis feels heavy. Is it too large?
A: The first thing to evaluate in this situation is the fit of the bra. Bras have a lifespan of three to six months of constant use before they need to be replaced. If the bra doesn't adequately support the prosthesis and hold it snugly against the chest wall, then the straps of the bra end up supporting the weight of the prosthesis and pulling down on the shoulder area.

Q: Is a lighter weight breast prosthesis appropriate for me?
A: Many women who cannot tolerate a weighted silicone prosthesis find that a light weight prosthesis is much more comfortable. Some medical conditions such as lymphedema or osteoporosis of the spine warrant a light weight prosthesis.

Q: I had a lumpectomy. Is there a prosthesis for me?
A: A partial prosthesis or "shell" is available that is made of the same high quality silicone used in premium prostheses. The difference is that partial prosthesis is much thinner, and can go over a breast that just needs a little more fullness in front or on the side to provide symmetry.

SOURCES:
Medscape Women's Health eJournal; 6(5), 2001
The Breast Care Site (http://www.thebreastcaresite.com)