Breast prostheses

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A pair of breast prostheses with glued on nipples Discrene Breast forms.JPG
A pair of breast prostheses with glued on nipples

Breast prostheses are breast forms intended to look like breasts. They are often used temporarily or permanently by women after mastectomy or lumpectomy procedures, but may also be used by for aesthetic purposes. There are a number of materials and designs; although, the most common construction is gel (silicone or water-based) in a plastic film meant to feel similar to a person's skin. [1] Prostheses may be purchased at a surgical supply store, pharmacy, custom lingerie shop, or even through private services that come to a person's home. [2] There are many types of ready made breast prostheses including full or standard prostheses, partial prostheses such a shell prostheses, and stick on prostheses. [3] Customized options are also available from specialty shops, which are moulded to fit an individual's chest by taking an impression of the breast(s). [4] The areola and nipple may be replicated as part of the breast form or as separate nipple prosthesis. [5] Both custom made and off-the shelf breast prostheses come in varieties that are designed to either be held in a pocket in a specially designed mastectomy bra or attached to the skin via adhesive or other methods and worn with a standard bra. [2] There are many factors to consider when selecting breast prostheses such as different types and the care they require, insurance coverage, and psychosocial effects. [6] [7] [3]

Contents

Uses

External breast prostheses are commonly used in women who have undergone surgical treatment for breast cancer such as a mastectomy or lumpectomy. They have a variety of physical benefits including improved symmetry and balance, [8] as well as psychological benefits such as improved self-confidence. [9] Outside of post-surgical uses, prosthetics are also used by individuals to create the illusion of breasts.

Mastectomy

Breast prostheses are most commonly used after a mastectomy, usually a consequence of cancer. They are often molded to mimic the natural shape of a woman's breast and can either be used temporarily or for long-term use as an alternative to, or prior to surgical breast reconstruction. Depending on the type of mastectomy performed, progress of post-operative healing, and other various factors, surgeons will determine the time when a woman can start to use a prosthesis. A prescription may be required for breast prostheses and mastectomy bras for insurance purposes. [10]

Up to 90% of women use a prosthetic after surgery, temporarily or permanently. Over half of these women choose full weight options, while others will opt for more lightweight prosthetic devices. Some choose to make homemade prostheses, using materials such as rice and cotton.

Post-mastectomy bras

Post-mastectomy bras are similar to regular bras with the exception of containing spandex stretch pockets on the inside that help keep the breast prosthesis in place. Post-mastectomy bras can be found at specialty shops or mastectomy boutiques and some shops are also willing to stitch pockets into regular bras and swimsuits.to hold prostheses. [10]

Post-surgical camisoles

Post-surgical camisoles are convenient for women to be used immediately after their breast surgery, especially if their breasts feel sore or sensitive. They are often made with soft cotton fabric and are designed to avoid rubbing or causing irritation to the skin. The camisoles have pockets for draining and similar to post-mastectomy bras, they have stitching to help hold fiber breast prosthesis in place. Right after breast surgery, women are advised to avoid or limit their arm and shoulder movement; camisoles are ideal for this reasons because they are pulled over the hip. [11]

Attachable breast prostheses

Attachable breast prostheses can be used as an alternative to post-mastectomy bras. Attachable breast prostheses can be attached directly to the skin via adhesives and can also be worn with a regular bra. [10]

Homemade breast prostheses

Some women may choose to re-purpose the supplies found in their homes to create homemade breast prostheses. For example, shoulder pads or nylons may be used as fillers for their bras. Homemade versions can be ideal for those who prefer loose-fitting clothes where the breast shape is not as defined. [12]

Lumpectomy

After a lumpectomy or a quadrantectomy individuals may be left with an asymmetrical silhouette. Breast prostheses can help to act as an equalizer to accommodate for the missing tissue. Examples of breast prostheses after small but not total breast tissue removal include partial breast prosthesis, and attachable breast prostheses (also known as a contact prostheses). [13]

Partial breast prosthesis are available in a variety of materials such as silicone, foam, or fiber. These inserts are able to discretely fit into a regular bra or into the insert of a mastectomy bra.

Attachable breast prostheses anchor directly onto your body and are secured using adhesive or Velcro. Attachable prostheses can be custom made as a partial breast shape, as well as coming readily available in full sizes. These prostheses, unlike the partial prostheses, move independent of a bra and can be worn along with a regular bra. For those who do not want a bra specially designed for prostheses, an attachable option may be a consideration. [10] [14]

Breast enhancement

Transgender and Cross-dressing

Many pre or non-hormonal trans women and men who cross-dress as women use breast prostheses in order to create the illusion of feminine breasts. They are sometimes combined with cleavage enhancement techniques when used with clothing with low necklines.

Example of a man wearing a cleavage top BBCleavageTopView.JPG
Example of a man wearing a cleavage top

Full frontal cleavage tops are also available, mainly marketed to the transgender community. They incorporate a pair of breast prostheses in a one-piece skin coloured garment that is designed to provide the illusion of natural cleavage. Such garments have the disadvantage of having a visible top edge at the neck, which requires the wearing of a choker or similar necklace to hide the top edge of the garment. The edges of the breast prostheses are often distinguishable through the thin outer cover.

Psychosocial considerations

After a lumpectomy or mastectomy, both physical and psychological health of women can be affected as an outcome of tissue removal. [15] A breast prosthesis is an alternative post-surgical option to breast reconstruction to aid with these consequences. Breast tissue removal can leave women with an altered center of gravity, and could have negative impacts on posture as well as balance. [16] A prosthesis may help to correct balance and posture deficiencies caused by tissue removal. Additionally, partial or full loss of a breast can result in loss of self-esteem for some women. As a result, they may have feelings of introversion, shyness, or insecurity about their new appearance. Breast prostheses may not only add to physical appearance, it may also have psychological benefits by providing a sense of femininity for women. [17]

Types

Styles

Shapes

Non-customised prostheses are made of different shapes to suit the extent of breast tissue removal or the shape of a crossdresser's chest. Asymmetric breast forms incorporate an extension towards the armpit to replicate the shape of the tail of Spence, while symmetric "triangle" or "teardrop" prostheses do not incorporate that extension. Customised prostheses will mirror the other breast.

Weight

Silicone breasts come in a variety of weights to fit the needs of the user and are typically designed to have the same weight as natural breasts. Lightweight forms that are about 20-40% lighter than the standard form are ideal for physical activity such as sports or for sleeping. [18]

Temperature

Some users find that prostheses can get hot in warm and humid climates, though newer breast prostheses are designed to allow for better air circulation. Using a bra pocket or a prosthesis cover may also help with perspiration, however, it is important to cleanse the prosthesis often to prevent the perspiration from damaging the prosthesis. [18]

Skin tone

Many prostheses are available in colors which can suit different skin tones. Additionally, while finding an exact match for any skin tone may be difficult, companies have begun to add custom color to breast prostheses in order to match different skin tones. There may also be covers available for the prosthesis that can provide an even closer match. [3] [8]

History

Breast prostheses have a long history. In the 19th century they were made of rubber. On 27 January 1874, a U.S. patent for a "breast pad" was issued to Frederick Cox (No. US 146805). [19] His design consisted of rubber pads filled with air encased in cotton. Later in 1885, Charles L. Morehouse received US patent 326915 for his "Breast-Pad", made of natural rubber and inflatable with air at normal pressure. [20] Newer designs such as that of Laura Wolfe's in 1904 parted with the air-filled design, which was prone to punctures, in favor of down feather and silk floss filling. [21]

While breast forms were mainly sold for post-surgical purposes, over time the aesthetic potential of these prosthetics was explored. Breast form development increased in the mid 20th century as more companies began to sell and market a variety of breast forms with new materials made possible by chemical engineering advancements. Eventually, marketing for breast prosthetics expanded to target people other than cisgender women looking for a surgical prosthetic or cosmetic enhancement. Companies like NearlyMe created branded products for trans and non-binary individuals. [22]

Other Considerations

Insurance

Breast prostheses or mastectomy bras are covered by most insurances. To get these covered one should obtain a prescription from their physician with the diagnosis and a documentation of need. [23] External breast prostheses are covered under Medicare part B following mastectomy; surgeries in the outpatient setting are also covered under Part B while Part A covers mastectomy surgeries in the inpatient setting. [24] Custom-made prostheses are not usually covered by insurances due to their high costs. [25]

Care

Although breast prostheses specific for swimming exist, extra care should be given to immediately rinse them after swimming to avoid damage from chlorine or saltwater. [26] In general, a silicone breast prosthesis should be treated like one's own skin; it should be washed daily with soap and water and dried after. Some prosthesis may require additional or more specific care to keep it clean. Sharp objects such as brooches or pins should be avoided as they may puncture silicone breasts and cause leaking. [27]

Related Research Articles

<span class="mw-page-title-main">Breast reconstruction</span> Surgical rebuilding of a breast

Breast reconstruction is the surgical process of rebuilding the shape and look of a breast, most commonly in women who have had surgery to treat breast cancer. It involves using autologous tissue, prosthetic implants, or a combination of both with the goal of reconstructing a natural-looking breast. This process often also includes the rebuilding of the nipple and areola, known as nipple-areola complex (NAC) reconstruction, as one of the final stages.

<span class="mw-page-title-main">Mastectomy</span> Surgical removal of one or both breasts

Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operation as a preventive measure. Alternatively, some women can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.

<span class="mw-page-title-main">Prosthesis</span> Artificial device that replaces a missing body part

In medicine, a prosthesis, or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trauma, disease, or a condition present at birth. Prostheses are intended to restore the normal functions of the missing body part. Amputee rehabilitation is primarily coordinated by a physiatrist as part of an inter-disciplinary team consisting of physiatrists, prosthetists, nurses, physical therapists, and occupational therapists. Prostheses can be created by hand or with computer-aided design (CAD), a software interface that helps creators design and analyze the creation with computer-generated 2-D and 3-D graphics as well as analysis and optimization tools.

Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement.

Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

<span class="mw-page-title-main">Breast augmentation</span> Surgical procedure

Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall. As an elective cosmetic surgery, primary augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.

<span class="mw-page-title-main">Lumpectomy</span> Limited surgical removal of breast tissue

Lumpectomy is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or breast cancer. It is considered a viable breast conservation therapy, as the amount of tissue removed is limited compared to a full-breast mastectomy, and thus may have physical and emotional advantages over more disfiguring treatment. Sometimes a lumpectomy may be used to either confirm or rule out that cancer has actually been detected. A lumpectomy is usually recommended to patients whose cancer has been detected early and who do not have enlarged tumors. Although a lumpectomy is used to allow for most of the breast to remain intact, the procedure may result in adverse affects that can include sensitivity and result in scar tissue, pain, and possible disfiguration of the breast if the lump taken out is significant. According to National Comprehensive Cancer Network guidelines, lumpectomy may be performed for ductal carcinoma in situ (DCIS), invasive ductal carcinoma, or other conditions.

<span class="mw-page-title-main">Seroma</span> Pocket of fluid that sometimes develops after surgery

A seroma is a pocket of clear serous fluid. They may sometimes develop in the body after surgery, particularly after breast surgery, abdominal surgery, and reconstructive surgery. They can be diagnosed by physical signs, and with a CT scan.

<span class="mw-page-title-main">Palatal lift prosthesis</span>

A palatal lift prosthesis is a prosthesis that addresses a condition referred to as palatopharyngeal incompetence. Palatopharyngeal incompetence broadly refers to a muscular inability to sufficiently close the port between the nasopharynx and oropharynx during speech and/or swallowing. An inability to adequately close the palatopharyngeal port during speech results in hypernasalance that, depending upon its severity, can render speakers difficult to understand or unintelligible. The potential for compromised intelligibility secondary to hypernasalance is underscored when consideration is given to the fact that only three English language phonemes – /m/, /n/, and /ng/ – are pronounced with an open palatopharyngeal port. Furthermore, an impaired ability to effect a closure of the palatopharyngeal port while swallowing can result in the nasopharyngeal regurgitation of liquid or solid boluses.

<span class="mw-page-title-main">Breast implant</span> Prosthesis used to change the size, shape, and contour of a persons breast

A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenital defects and deformities of the chest wall or, cosmetically, to enlarge the appearance of the breast through breast augmentation surgery.

<span class="mw-page-title-main">Ductal carcinoma in situ</span> Pre-cancerous breast lesion

Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the breast. DCIS is classified as Stage 0. It rarely produces symptoms or a breast lump one can feel, typically being detected through screening mammography. It has been diagnosed in a significant percentage of men.

<span class="mw-page-title-main">Penile implant</span> Medical device

A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.

Breast cancer management takes different approaches depending on physical and biological characteristics of the disease, as well as the age, over-all health and personal preferences of the patient. Treatment types can be classified into local therapy and systemic treatment. Local therapy is most efficacious in early stage breast cancer, while systemic therapy is generally justified in advanced and metastatic disease, or in diseases with specific phenotypes.

<span class="mw-page-title-main">Breast-conserving surgery</span> Surgical operation

Breast-conserving surgery refers to an operation that aims to remove breast cancer while avoiding a mastectomy. Different forms of this operation include: lumpectomy (tylectomy), wide local excision, segmental resection, and quadrantectomy. Breast-conserving surgery has been increasingly accepted as an alternative to mastectomy in specific patients, as it provides tumor removal while maintaining an acceptable cosmetic outcome. This page reviews the history of this operation, important considerations in decision making and patient selection, and the emerging field of oncoplastic breast conservation surgery.

A DIEP flap is type of breast reconstruction where blood vessels, fat, and skin from the lower belly are relocated to the chest to rebuild breasts after mastectomy. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. This is a type of autologous reconstruction, meaning one's own tissue is used.

<span class="mw-page-title-main">Nose prosthesis</span>

A nose prosthesis is a craniofacial prosthesis for someone who no longer has their original nose. Nose prostheses are designed by anaplastologists who have their patients referred to them by ear, nose, and throat doctors and plastic surgeons.

<span class="mw-page-title-main">Nipple prosthesis</span>

Nipple/Areola prostheses are made of silicone by breast prosthesis manufacturers and anaplastologists for breast cancer survivors who were treated for breast cancer with a mastectomy. Prostheses can be worn weeks after a mastectomy, breast reconstruction, or even nipple reconstruction. As an inexpensive and convenient alternative to surgery, patients may choose to wear them anytime during treatment. Patients who ultimately find nipple prostheses thought that they should be informed of them during the consultation prior to mastectomy.

Beryl Tsang is a Canadian fibre artist and founder of Tits-Bits: Hand Knitted Breasts. She is original creator of the knitted breast prosthetic.

Anne Louise Rosenberg is an American surgical oncologist retired from practice in Cherry Hill, New Jersey.

Aesthetic flat closure after mastectomy is contouring of the chest wall after mastectomy without traditional breast reconstruction. Vernacular synonyms and related vernacular and technical terms include "going flat", "flat closure", "optimal flat closure", "nonreconstructive mastectomy", "oncoplastic mastectomy", "non-skin sparing mastectomy", "mastectomy without reconstruction", and "aesthetic primary closure post-mastectomy".

References

  1. ↑ ,"External breast prosthesis",issued 2005-09-08
  2. 1 2 3 "Prosthetics: An Alternative to Reconstruction". Breastcancer.org. 2019-03-07. Retrieved 2020-07-31.
  3. 1 2 3 4 5 6 "Prosthesis styles". Breast Cancer Now. 2015-06-09. Retrieved 2020-08-05.
  4. ↑ "Choosing a Prosthesis After Breast Cancer Surgery | Michigan Medicine". www.uofmhealth.org. Retrieved 2020-07-31.
  5. ↑ "Prostheses". www.cancer.org. Retrieved 2020-07-31.
  6. ↑ Jetha (2017). "Women experiences of using external breast prosthesis after mastectomy". Asia-Pacific Journal of Oncology Nursing. 4 (3): 250–258. doi: 10.4103/apjon.apjon_25_17 . PMC   5473097 . PMID   28695172.
  7. ↑ "What to Know About Mastectomy Clothing: Bras, Swimsuits and Insurance". Dana-Farber Cancer Institute. 2014-12-05. Retrieved 2020-08-05.
  8. 1 2 "Breast Prosthetics & Mastectomy Bra FAQ | Seattle Cancer Care Alliance". www.seattlecca.org. Retrieved 2020-07-31.
  9. ↑ Lu, Zhenqi (February 2019). "Physical and Psychological Effects of Different Temperature-controlled Breast Prostheses on Patients With Breast Cancer - Full Text View - ClinicalTrials.gov". clinicaltrials.gov. Retrieved 2020-07-31.
  10. 1 2 3 4 5 "Post-Mastectomy Prosthesis". www.hopkinsmedicine.org. 19 November 2019. Retrieved 2020-07-31.
  11. ↑ "Your Guide to: Bras and Breast Prostheses After Breast Surgery with Drains" (PDF). University Health Network. Retrieved August 4, 2020.
  12. ↑ "Choosing a Prosthesis After Breast Cancer Surgery | Michigan Medicine". www.uofmhealth.org. Retrieved 2020-08-05.
  13. ↑ "TLC: Hair Loss and Mastectomy Products". www.cancer.org. Retrieved 2020-07-31.
  14. ↑ "Choosing a Prosthesis After Breast Cancer Surgery | Cigna". www.cigna.com. Retrieved 2020-08-04.
  15. ↑ Jetha (2017). "Women experiences of using external breast prosthesis after mastectomy". Asia-Pacific Journal of Oncology Nursing. 4 (3): 250–258. doi: 10.4103/apjon.apjon_25_17 . PMC   5473097 . PMID   28695172.
  16. ↑ "Breast Prosthesis". Jay Ann Intimates. Archived from the original on 2020-08-04. Retrieved 2020-08-03.
  17. ↑ "Psychological Effects of Mastectomy – Breast Cancer". Cope with Cancer. 2016-05-05. Retrieved 2020-08-03.
  18. 1 2 3 4 "Breast prostheses". Cancer Council Victoria. June 1, 2017. Retrieved August 3, 2020.
  19. ↑ ,"Improvement in breast-pads",issued 1874-01-27
  20. ↑ "Patent Images".[ permanent dead link ]
  21. ↑ ,"Artificial breast.",issued 1904-11-04
  22. ↑ "A Brief History of Breast Forms". Trans Tool Shed. 23 December 2019. Retrieved 2020-08-03.
  23. ↑ "What to Know About Mastectomy Clothing: Bras, Swimsuits and Insurance". Dana-Farber Cancer Institute. 2014-12-05. Retrieved 2020-07-31.
  24. ↑ "Breast Prosthesis Coverage". www.medicare.gov. Retrieved 2020-07-31.
  25. ↑ "Prosthetics: An Alternative to Reconstruction". Breastcancer.org. 2019-03-07. Retrieved 2020-07-31.
  26. ↑ "Wearing a Breast Prosthesis". Cancer Council NSW. Retrieved 2020-08-05.
  27. ↑ "Breast prosthesis". Breast Cancer Now. 2015-06-09. Retrieved 2020-08-05.
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