Breast prostheses and reconstruction

Treatment for early or locally advanced breast cancer will usually include surgery. The type of surgery you are recommended will depend on the type and stage of cancer, where it is in the breast, the size of your breast and your personal preferences.

There are two types of surgery, breast-conserving surgery and mastectomy.

Breast-conserving surgery, also known as a lumpectomy or wide local excision, removes part of the breast. Your surgeon will remove the tumour and some of the healthy tissue around it in order to keep as much of your breast as possible. This may change the shape and size of your breast and the position of the nipple.

A mastectomy involves the removal of the whole breast. A mastectomy may be recommended if there is cancer in more than one area of your breast; if the cancer is large in comparison to the size of your breast; it is difficult to get a clear margin around the tumour or if you have had radiation therapy to the same breast before and can’t have it again.

Before or after a mastectomy you may think about how to restore your breast shape and you may consider a breast prosthesis or reconstruction.

What is a breast prosthesis?

A breast prosthesis is a synthetic breast or part of a breast worn under clothing or in a bra to replace all or part of your breast. A breast prosthesis is worn after breast-conserving surgery or a mastectomy.

Most breast prostheses have the shape and feel of a natural breast. They may weight the same or be lighter. Breast prostheses can be attached directly to the skin or inserted into specially made pockets in bras, sleepwear and activewear.

What is breast reconstruction?

Breast reconstruction is an operation to make a new breast shape called a breast mound. You can choose to have a breast reconstruction when you have a mastectomy or at a later time. If your nipple is removed during the mastectomy, one can be created with surgery or tattooing. Alternatively, you can use stick-on nipples.

Breast reconstruction aims to make a breast that looks as similar to your original breast shape other breast as possible. However, it will not look or feel exactly the same.

There are two main types of breast reconstruction:

• implant reconstruction which uses a sac fille with silicone gel or saline
• flap reconstruction which uses skin, muscle and fat from another part of your body.

Breast reconstruction in men and gender diverse people

All people have breast tissue and can develop breast cancer. Breast reconstruction is not common in men but is sometimes possible and will typically use tissue from the back, abdomen or buttocks. Reconstruction using breast implants is not possible for men at the moment as breast implants are specifically designed to recreate the look of a woman’s breast.

Do I need to have a prosthesis or reconstruction?

It is up to you whether or not you have a reconstruction or wear a prosthesis after surgery. Everyone responds in their own way to the loss of a breast or breasts and only you can choose what feels right for you.

You don’t need to make a decision immediately. There is no time limit on when you have to decide unless you are considering having breast reconstruction at the same time as the mastectomy.

Approximately one in five women in Australia has breast reconstruction after a mastectomy, although this number is increasing. If you don’t have a reconstruction you can choose to either use a prostheses, or live with the changes in your body. Talk to your doctor and take as much time as you need to make a decision.

There are many reasons women choose a breast prosthesis or reconstruction after a mastectomy including:

• wanting to replace the weight of the lost breast
• creating symmetry when wearing clothing
• helping to restore self-esteem and confidence
• helping to cope with the experience of cancer
• taking control of your appearance.

When can I start wearing a prosthesis?

Following surgery, the breast area will be tender, but you can still choose to wear a light temporary breast prosthesis (soft prosthesis or soft form) straight away.

Once you have recovered from treatment, you can be fitted for a permanent prosthesis. In order to give your skin and other tissue time to heal, you may have to wait for six weeks after radiation therapy and up to two months after surgery. Talk to you doctor or breast care nurse about how long you will need to wait.

When can I have a reconstruction?

You can have breast reconstruction when you have a mastectomy (immediate reconstruction) or months or even years later (delayed reconstruction). The timing will depend on the type of breast cancer you had, whether you need further treatment, if your surgery needs to be done in stages your overall health and concerns such as the surgery schedule at the hospital and cost.

Talk to your surgeon about these issues and your options.

What are the risks of a reconstruction?

Your surgeon will discuss potential risks before your surgery.

Some of the risks with an implant reconstruction include:

• infection
• implant rupture
• hardening of the implant
• change of the p0osition of the implant over time
• visible rippling of the skin of the breast.

Some of the risks associated with flap reconstruction include:

• loss of the flap
• problems with the donor site
• hernia.

What are my options?

Understanding the available options, possible costs and complications can help you make a well-informed decision. Remember you don’t necessarily have to choose between options. You can start off with a prosthesis and decide later to have a breast reconstruction.

Talk to your doctor about what is possible for you as not all options are suitable for all people.

What are the costs?

The cost of a breast prosthesis and bra will vary depending on the type. The cost of a new or replacement breast prosthesis can be claimed through Medicare.

Rebates for breast prostheses and related products will vary from provider to provider. Talk to your health fund about what is covered.

You should find out how much it will cost to have a breast reconstruction before you have surgery. Check with the hospital, your surgeon, Medicare and your private health fund, if you have one, before you decide to go ahead to find out what is covered and what extras you may need to pay for. These can include, post-surgical bras, medical check-ups and pain medication.

There is a Medicare rebate for a nipple tattoo if it is done by a health professional with a Medicare provider number. Your private health fund may also cover this.

Where can I get reliable information and support?

Call Cancer Council 13 11 20 for information and support. If you are thinking about have breast reconstruction ask to speak to trained Cancer Connect volunteers who have had reconstruction surgery.

Visit Breast Cancer Network Australia to read personal stories about breast reconstruction. You can also use their support and services to find a specialist prosthesis fitter in your area.

Sources

• Understanding Breast Prostheses and Reconstruction, Cancer Council Australia © 2023. Last medical review of source booklet: November 2023.
• Understanding Breast Cancer, Cancer Council Australia © 2020. Last medical review of source booklet: July 2020.
• Breast Cancer Network Australia