Using a breast prosthesis

A breast prosthesis is an artificial breast form you can wear under your clothes after mastectomy or lumpectomy. Some prostheses attach directly to the skin. Others are worn inside a pocketed bra that is designed to hold a prosthesis.

Women may choose to wear a prosthesis for many reasons. Examples include:

• They’ve decided to go flat after mastectomy but want the appearance of a breast shape under clothes.
• They are delaying reconstruction after mastectomy but want the appearance of a breast shape in the meantime.
• They want to add the appearance of volume after lumpectomy, for a more of a balanced look.

If you're interested in using a prosthesis, there are many different options to consider, ranging from foam pads to silicone forms that are custom-made to fit your body.

Deciding whether to use a prosthesis

Many women decide not to have reconstruction after mastectomy. This is called going flat. A woman may decide to go flat on just one side of the chest, or on both sides.

There are different reasons for going flat and deciding to wear a breast prosthesis. Here are some specific examples:

• Some women choose to go flat after having an implant removed (a procedure called explant surgery) due to complications such as painful scar tissue or implant rupture. Going flat and using a breast prosthesis can bring peace of mind for people who are no longer comfortable having an implant. It can also restore the body’s pre-mastectomy appearance when worn under clothing.
• Other women may choose to go flat if a tissue reconstruction fails. If the tissue used to create a new breast does not get enough blood supply, the tissue may die. In this case, surgeons remove the dead tissue and perform flat closure. This allows the body to heal before trying another reconstruction. While healing, a woman may decide to wear a breast prosthesis to create the appearance of a breast under clothes.
• If a woman feels unsure about undergoing breast reconstruction, she may choose to go flat after mastectomy to allow more time to decide. Delayed reconstruction is usually an option in this case. This means reconstruction can happen months or years later. Trying out a breast prosthesis can help someone see how they might look with reconstruction.

Some people who have had a lumpectomy decide to use a partial prosthesis to restore balance. Reasons include:

• If a large area of tissue is removed during lumpectomy, making the breast look smaller after surgery
• If radiation therapy after lumpectomy makes the breast look smaller than the other healthy breast

Feelings about wearing a breast prosthesis are different for everyone:

• Some women feel comfortable living flat all the time.
• Other women who go flat decide they want to have the appearance of breasts all the time. Breast prostheses can be a good option in this case.
• Some women who go flat want the appearance of breasts just part of the time—at work, in public, or at special events, for example. Breast prostheses allow for this flexibility.

Whether to use a prosthesis is a personal decision. Unlike reconstruction, breast prostheses are temporary, so you can change your mind at any time. If you find you don’t like wearing a prosthesis, you can live flat or you can choose to have delayed reconstruction surgery weeks, months, or even years later.

Benefits of breast prostheses

Besides being temporary, and allowing people to avoid reconstruction surgery, prostheses have some other advantages:

• They can create the natural look of breasts under a bra or clothes.
• They help the upper body look and feel more balanced—especially if only one breast was removed.
• They can make wearing a bra more comfortable if you choose to wear one after mastectomy.
• They allow you to wear clothes you already have that fit your chest before breast cancer.

Disadvantages of breast prostheses

Breast prostheses also have some disadvantages:

• They need to be washed regularly and stored properly. Different materials (foam vs. silicone, for example) have different requirements.
• Breast forms usually need to be replaced every 6 months or every few years, depending on which type you choose.
• There is always some risk that a prosthesis will shift out of place, especially during exercise or other strenuous activities.
• Some people find that silicone breast forms make their chest feel too warm, especially in hot weather. However, today’s silicone forms are much lighter that past versions. They are often filled with small pockets of air to keep the chest cooler.
• For prostheses that attach directly to the skin, the adhesive may cause some skin irritation or redness.
• Prostheses do not mimic the look and feel of a natural breast as well as breast reconstruction does. Some people want the look of a breast even when they’re not wearing clothes.

Talk with your care team and weigh the pros and cons. If you join an in-person or online breast cancer support group, you can ask others who have worn a prosthesis what it is like for them.

If you decide to try a prosthesis, your care team can tell you how long to wait after mastectomy to try one. Waiting gives the skin time to heal.

How to find prostheses shops and fitters

You can buy a breast prosthesis at a medical supply store, some pharmacies, or even online.

Still, you’ll get the best results if you go to a shop that carries post-surgical breast prostheses and bras. Most have certified mastectomy fitters on staff.

A certified mastectomy fitter is a health professional who has trained in how to fit women for breast forms and mastectomy bras. To be certified, they are required to pass a certification exam.

Many cancer centers have specialty shops where you can purchase breast prostheses. These shops often have mastectomy fitters on site. If your cancer center does not have a shop, ask your care team for recommendations.

Some independent bra shops and major retailers offer fitting services for breast forms. Nordstrom is one example.

You also can browse the websites of companies that make prostheses to get a better idea of what’s available. Makers include Amoena, American Breast Care, Anita, and NearlyMe.

Many prosthesis manufacturers do not sell direct-to-customer and sell only through retail shops, but websites often have information on where you can buy their prostheses. Amoena and Anita feature online directories of retailers you can search by location.

Check with your care team to see how long you should wait after surgery and radiation (if radiation has been recommended) to get fitted for a prosthesis. Ask your doctor to write you a prescription for a breast form and mastectomy bra before visiting a fitter.

Working with a certified mastectomy fitter

When you make an appointment for a breast prosthesis fitting, ask the staff what you should bring with you. Typically, they will need:

• A doctor’s prescription for the breast form and bra
• Your health insurance card
• One or two of your favorite bras from before your breast surgery, and some shirts and tops you like to wear (in different styles)

You can expect your fitter to:

• Examine your skin at the mastectomy/lumpectomy site
• Measure you for a mastectomy bra
• Show you bra style options
• Show you options for pocketed athletic tops, bathing suit tops, and/or lingerie tops
• Ask about your daily routines (work and leisure), exercise, and activity levels
• Ask if you plan to wear a prosthesis all the time or just some of the time, and whether you want to wear it inside a bra or directly on the chest skin
• Ask about your preferences for look and feel, weight, shape, skin tone, and comfort
• Have you try on different options so you can decide what type of prosthesis you prefer
• Consult with you about adding a prosthesis pocket to bras or bathing suit tops you already own
• Explain what the return policy is, and if you can try the prosthesis for a week or two to make sure it’s right for you
• Instruct you on how to care for the prosthesis
• Tell you how often the prosthesis will need to be replaced

If you decide to have a silicone prosthesis custom made, expect to have a longer visit so that the fitter can capture digital images and measurements of your upper body and chest area. Your fitter also will show you the options available.

Often, staff members can help with questions about what your insurance plan will cover. Some plans do not cover custom-made prostheses, for example. Staff can also let you know if they can bill your insurance directly or if you’ll have to submit the claim yourself.

If you can’t find a certified fitter or shop near you, ask your care team for help.

Shopping for prostheses online

If you are shopping for a breast prosthesis online, it can sometimes be challenging to find the best options for you—especially if you had a single mastectomy and are trying to match your other breast. If you had a double mastectomy, it may be easier because you are buying two matching breast forms.

Be sure to check the return policy at online stores to see if there is an option to get help on a phone or video call.

Paying for breast prostheses

Medicare, Medicaid, and commercial health insurance plans offer coverage for breast prostheses and mastectomy bras. However, coverage can vary. Some tips:

• Check with your insurance plan to find out what is covered, what your copay and/or deductible will be, and how the claim should be submitted.
• Ask if there is specific language your doctor should use when writing the prescription for your prosthesis and mastectomy bra.
• Find out if you are required to purchase the prosthesis and bra from specific shops or suppliers approved by your insurance plan.

Other things to keep in mind:

• Your plan might not cover a custom-made silicone breast form, which is more expensive than other options.
• Your plan may limit you to one type of prosthesis per year. So, if you want more than one style—nonsilicone and silicone, or a prosthesis made for swimming—you might need to pay out of pocket.
• Plans vary in how many mastectomy bras they will cover each year, and how frequently they will cover a replacement prosthesis.
• Insurance plans generally don’t cover other mastectomy garments, such as pocketed bathing suit tops and athletic tops.
• If you submit a claim for a prosthesis and mastectomy bra and then decide to have breast reconstruction, your insurance plan might not pay for it.
• You will need a prescription from your doctor every time you need to replace a prosthesis or mastectomy bra.

Keep organized records of your purchases and insurance details so you can review them if you need to.

If you can’t afford the out-of-pocket costs, or you want a second prosthesis that your insurance plan won’t cover, there are lower-cost/no-cost options such as The Busted Tank and Knitted Knockers. For example, you might have your insurance plan cover a more realistic silicone prosthesis, but then order a lighter form for when you’re relaxing at home.

Visit Financial matters to learn more about managing the costs of care.