Breast prostheses

When can I start wearing a prosthesis?

In the first weeks after surgery, you may want to wear a temporary breast prosthesis called a soft prosthesis (or soft form). The soft prosthesis is light and made from a smooth material such as polyester. It can be worn in a bra that has a pocket (post-surgical bra). Choose a bra with a front opening to avoid stretching your arms behind your back, as this can be uncomfortable. If the bra feels too tight or rubs against your scar, you can wear a crop top or camisole with a pocket in it. You can also wear a soft prosthesis while your skin is tender from radiation therapy.

You can be fitted for a permanent prosthesis when the skin and other tissue has healed. This may be up to 2 months after surgery and 6 weeks after radiation therapy. Check with your surgeon or breast care nurse about how long you need to wait.

My Care Kit

Breast Cancer Network Australia (BCNA) provides a free bra and temporary soft form for use after breast cancer surgery. The bra is designed to be worn immediately after surgery. It has seams that avoid pressure on scars, and extra hooks and eyes to adjust the bra for any swelling. It can also be done up from the front or back, making fastening easier. To order a My Care Kit, speak to your breast care nurse.

What to consider

Benefits

• Can give you the look of 2 breasts under clothes.
• Avoids the risks of surgery and extending the recovery time, which makes it possible to return to daily activities faster.
• Can be worn with different clothes, including during sports such as swimming.
• Medicare covers part of the cost of new or replacement prostheses.
• Can be replaced if it wears out or is damaged.
• Can be worn while you’re waiting for a reconstruction or during treatment such as radiation
  therapy or chemotherapy.
• Can be matched to your breast size to correct weight imbalance.
• Easy to change size (e.g. if the size of your other breast changes).

Drawbacks

• You may not like the idea of having an artificial breast.
• You may need to wear a special bra to keep the prosthesis in place.
• Requires special washing and storage.
• You may need to make changes to your clothes or use accessories so the prosthesis stays in place.
• May be uncomfortable at times (e.g. heavy, hot or irritating), especially when playing sport or on hot days.
• You may be concerned the prosthesis will move or fall out.
• You may feel self-conscious when naked and not wearing the prosthesis.
• Needs to be replaced every few years.

Material used in prostheses

Temporary soft prostheses – These tend to be made with foam, fibre fill or fleece. In the first couple of weeks or months after surgery, you will be given a temporary prosthesis to wear while you heal. Another option is to use the temporary soft prosthesis with a knitted cotton cover called a knitted knocker, which often includes the shape of a nipple. To order a knitted knocker, visit Knitted Knockers Australia. You may find some temporary prostheses are more comfortable than others. Your breast care nurse can organise a temporary soft prosthesis for you. Once the area has healed, you can continue to wear the soft prosthesis at night-time.

Permanent breast prostheses – These are usually used long term and are mostly made from medical grade silicone gel. Silicone is a non-toxic manufactured substance that is heat-resistant and rubbery. If a prosthesis tears or punctures, the silicone can’t be absorbed by the skin.

The silicone is moulded into the shape of a breast or part of a breast. The front surface feels soft and smooth. The back surface, which rests against the body, varies depending on whether the prosthesis is designed to go into a bra pocket or attach directly to your skin. It can be firm and smooth; flat or hollow; have ridges that are soft and flexible; have a thin film that clings gently to the skin; or be made of fabric. A new type of prosthesis has an inflatable back that you can adjust for comfort.

Most permanent prostheses are weighted to feel similar to your remaining breast (if only one breast has been removed), but lightweight styles are also available. Some prostheses include a nipple outline, or you can buy a nipple that attaches to the prosthesis.

Breast forms are very well designed these days. Anyone pressing up against you would not know the difference – not like the days when they were filled with bird seed or rice.” JAN

Types of prostheses

As everyone is different, prostheses are available in a variety of:

• shapes (triangles, circles or teardrops)
• cup sizes (shallow, average or full)
• skin tones.

If you have breast-conserving surgery, you can wear a partial breast prosthesis (triangle, oval, curve or shell) to regain breast symmetry. These are also called balance shapers.

Different prostheses have different amounts or layers of silicone. This allows you to match the breast prosthesis to the structure and movement of your remaining breast.

Symmetrical prostheses are even on both sides and can be worn on either the left or right side of the body. Asymmetrical prostheses are designed specifically for the left or right side.

The type of prosthesis you can wear will depend on the amount and location of tissue removed during surgery. You should be able to find one that is close to your original breast shape and suits your lifestyle. Your fitter will be able to guide you through the range of prostheses that are suitable for you.

Different breast prostheses and their features

Soft prosthesis

When used – immediately after surgery; during leisure time or sleeping
How used – worn in a pocketed bra
Material – polyester front cover and cotton back cover
Weight – lightweight
Special features – breathable cotton back layer to maintain ideal body temperature
Other considerations – not a suitable substitute for a weighted silicone form that provides the
body with balance

Three-layer prosthesis

When used – everyday use
How used – worn in a pocketed bra
Material – 3 layers of silicone to help the prosthesis drape and move more realistically for the type of breast it is matching, such as a younger or an older breast
Weight – regular weighted silicone
Special features – may include technology to maintain ideal body temperature
Other considerations – symmetrical shape – can be worn on either the left or right side

Partial prosthesis

When used – after breast-conserving surgery or if breast changes shape after radiation therapy
How used – can be worn in your usual bra cup
Material – 2 layers of silicone
Weight – regular weighted silicone
Special features – extra soft silicone, covered with a thin film to cling gently to the breast; includes temperature-regulating technology
Other considerations – available in a variety of shapes and sizes to replace the missing breast tissue and to achieve symmetry

Lightweight prosthesis

When used – everyday use
How used – worn in a pocketed bra
Material – slightly firmer lightweight silicone in the back layer helps keep the prosthesis in place when worn in a bra pocket
Weight – weighs 40% less than a standard silicone prosthesis
Special features – back layer includes temperature-regulating material; available in different colours
Other considerations – designed to drape like a natural breast; moves with the body and flattens when you lie down

Attachable or contact prosthesis

When used – everyday use
How used – attachable; adheres to the chest wall
Material – standard silicone layer with super soft film
Weight – lightweight
Special features – designed with a low-cut inside edge for use when surgery has conserved a
small area of cleavage
Other considerations – follows body movements naturally; suits figure-hugging clothes

Adjustable prosthesis

When used – everyday use
How used – worn in a pocketed bra
Material – lightweight or ultralightweight silicone
Weight – weighs up to 40% less than a standard silicone prosthesis
Special features – has a built-in air chamber that you can adjust to ensure a close fit and good skin contact
Other considerations – provides comfort if your chest wall is uneven

Swim form

When used – when swimming
How used – worn inside the pocket of a swimsuit
Material – lightweight pale blue silicone
Weight – 30% lighter than a standard prosthesis
Special features – resistant to salt water and chlorine; quick drying
Other considerations – water moves behind the prosthesis to make it more comfortable

It’s like buying anything valuable. You need to take your time and make sure it’s right.” MARY-ANNE

Buying a breast prosthesis

You can visit a store to buy your prosthesis, or you may feel more comfortable organising a home fitting.

To find a prosthesis that suits your body shape and frame, it is recommended that you see a trained fitter who can help you choose the right prosthesis, as well as a pocketed bra if necessary. It is best to make an appointment with a fitter so you have uninterrupted time with them. When you go to the fitting, you might like to bring along someone for support – the other person doesn’t have to come into the dressing room with you.

Before your appointment (or even before your operation), you may find it helpful to see samples of breast prostheses to give you an idea of what to expect. Your breast care nurse can show you various types of breast prostheses and bras.

You may also find it useful to talk to someone who is using a breast prosthesis – call Cancer Council 13 11 20 to arrange to speak to a Cancer Connect volunteer.

You might find getting fitted for a prosthesis to be an emotional experience, especially the first time. You may feel embarrassed at the thought of having someone else see the site of the surgery. Professional fitters regularly see women who have had similar surgery and will take a sensitive approach.

How to find a specialist fitter

Ask your breast care nurse to recommend fitters in your local area. You can also use Breast Cancer Network Australia’s local service directory.

Where to buy a breast prosthesis

You can buy a breast prosthesis from specialist stores that sell only breast prostheses and related products, the lingerie section of some major department stores, and some lingerie boutiques. There may also be a free home service available in your area.

Visit multiple stores – If you live in a rural area, you might have fewer options for where you can shop and what you can buy. Making a trip to a shop in a large town or city may be worthwhile. This might also appeal if you don’t want to shop where people know you.

Browse before you buy – You can browse what’s available in stores online or ask retailers to send catalogues so you can look at the full range of bras and breast prostheses available. If you see something you like, you may be able to order the prosthesis, or a fitter can order it in for you. However, it is a good idea to be measured in person by an experienced fitter, especially if you are buying a breast prosthesis for the first time.

Ask about a store’s returns policy – You may be able to exchange the breast prosthesis for a different style or size if the one you buy feels uncomfortable. This is not always possible, particularly for attachable breast prostheses.

Call Cancer Council 13 11 20 – They may be able to help you find out more about buying breast prostheses and related products.

What to expect at the fitting

A fitting usually takes 40–60 minutes. You will have privacy when being measured and getting changed. Most fitters carry out the fitting in a similar way.

What to bring to the fitting – Take the bras you wore before surgery to the fitting. The fitter will check whether these bras are suitable to use with a prosthesis.

Discuss what you want – If you’ve had a double (bilateral) mastectomy, the fitter will ask you what breast size you were and what size you would like to be. You might like to keep your original size or go up or down a size. The fitter will ask you about what type of bras you like and how active you are.

Check bra size – The fitter will probably check your existing bra size with a tape measure.

Select from a variety of sizes and styles – The fitter will bring you a selection of pocketed bras to choose from. When you’ve chosen your bra, the fitter will help you try on several different types of breast prostheses until you find a good fit.

Choose a bra – Wearing a well-fitting bra will ensure your breast prosthesis is comfortable and sits well.

While you may find that your regular bra, sports bra or sports crop top adequately supports your permanent prosthesis, pocketed bras are specially designed for this purpose.

Features of a pocketed bra include:

• soft seams
• wide underband that sits flat on your chest between the cups
• deep front and side panels
• full cups
• wide, elasticised, adjustable straps
• no underwire.

Check fit – The fitter will often have a slip-on T-shirt (like a smock) for you to try over the bra and prosthesis to check that the prosthesis is the right size and gives you a good shape. The
fitter will show you how to check that the breast prosthesis is sitting properly in the pocketed
bra and will discuss how to take care of it.

The external appearance of my breast form is great. People often say that you’d never know I was wearing a breast form.” RUTH

Wearing a breast prosthesis

It may take time to get used to having a prosthesis. You may feel nervous about wearing it, or it may feel different depending on the weather, your clothes or what you’re doing. You may have some concerns, including those outlined below.

Temperature

You may find that wearing the prosthesis feels too hot in warm and humid weather. This is more common if you have larger breasts. New models of breast prostheses are designed with air ventilation and drying methods to help manage temperature and increase comfort.

How to control the temperature

• Wear a correctly fitting bra to hold the prosthesis in the right place and help keep you cool.
• Buy a breast prosthesis that uses temperature-regulating technology. This helps absorb body heat and helps maintain your body temperature.
• Wear a lightweight prosthesis in warmer weather, which may keep you cooler.
• Use a bra pocket or a breast prosthesis cover with a regular bra to help absorb sweat perspiration) and keep you cool on hot days. Check whether your fitter sells covers.
• Wear a bra made with fast-drying or sweat-wicking fabric, such as a sports bra, which may be more comfortable if you perspire a lot.
• Wash your prosthesis well at the end of the day to stop any perspiration from damaging the prosthesis.
• Choose clothing made with cool, comfortable fabric, such as linen, silk or a synthetic fabric that is breathable.

My breast form gets sweaty after I’ve been playing tennis. I have 2 forms, so after a shower I swap.” PAM

Weight

Silicone prostheses are available in different weights to suit a variety of needs. A standard silicone breast prosthesis is designed to be about the same weight as the other breast.  Lightweight and ultra-lightweight breast prostheses are about 20–40% lighter than a standard prosthesis. You may prefer to wear a lightweight prosthesis when playing sport, or a soft prosthesis to bed.

If you’ve had a single mastectomy, a prosthesis that is correctly fitted and properly supported in a bra can make you feel balanced and will usually not feel too heavy, even if it feels heavy in your hands. If you’ve had a double mastectomy, you can choose the weight you feel most
comfortable with. A fitter can help you pick a prosthesis with a weight that feels right.

Swimwear

While you can swim with your prosthesis occasionally, if you swim regularly, it’s better to buy a swim breast prosthesis. Swim breast prostheses are made of clear, water-resistant silicone. They are lightweight and dry quickly. You may also want to wear special pocketed swimwear, which includes a bra pocket for a swim breast prosthesis, wide straps, and higher neck and arm lines.

Mastectomy swimwear comes in a wide range of styles, patterns and colours. These can be bought from your fitter, some department stores, direct from some manufacturers or online.

Clothes

It’s common to worry about what you can wear with a prosthesis. You may find that you don’t need to change your clothes, but you might need to make some adjustments. For example, you may no longer feel comfortable wearing low-cut tops.

Your fitter may stock a range of products designed specifically to be worn with a breast prosthesis. The range of mastectomy wear is constantly expanding and includes lingerie, sleepwear, swimwear, sports bras, activewear and camisettes (material that attaches to your bra straps to make low necklines more modest).

How to adapt clothing or use accessories

• Use scarves or jewellery for extra coverage or to draw the emphasis away from your chest area.
• Alter your clothing yourself or use a dressmaker.
• Try a strapless pocketed bra or use a prosthesis you can attach to your skin.
• Wear a camisole or singlet under a V-neck top or buy a pocketed camisole bra.
• Reduce pressure from bra straps by using small shoulder cushions (check that the pressure is not from a poorly fitting bra).
• Add extra hooks on the back of the bra to make it more adjustable.
• Sew a pocket into your bra, sleepwear, activewear or swimsuit. You can find various patterns and instructions on how to make pockets online. Some lingerie stores sell ready-made pockets or they can order them for you.

Caring for a breast prosthesis

Your fitter will tell you how to care for your prosthesis. Prostheses usually need to be replaced every 2 years, but this will depend on how often they are worn, how well they’re looked after and your lifestyle.

Check that your bra fits correctly every 12 months. You will probably need a new bra and breast prosthesis if your weight changes. If the prosthesis splits or cracks at the seams, it should be replaced. You can throw away your old or damaged prostheses in your general rubbish collection. Silicone cannot be recycled. You can donate old ill-fitting prostheses to local op shops or to your breast care nurse.

How to care for your breast prosthesis

• Handwash the prosthesis after every wear. Use warm water and a mild unscented soap or a cleanser supplied by the prosthesis manufacturer. Rinse the prosthesis thoroughly and pat it dry with a towel.
• Store your prosthesis in the box it came in to help keep its shape and protect it from sunlight and heat.
• Take care when placing brooches or badges onto your clothing.
• Take care when handling pets so their claws don’t damage the prosthesis.
• If you use a regular prosthesis when swimming, rinse it in clean water soon after swimming to remove chlorine or salt water.
• Use a soft, fibre-filled prosthesis in a sauna – a silicone prosthesis may heat up against your skin.
• Avoid using body lotions, perfumed deodorant, sunscreen or tanning lotion near your prosthesis. These products can damage it.
• Be careful when gardening, especially if you are gardening near shrubs or plants with thorns.

Air travel with a prosthesis

It’s safe to wear a prosthesis on an aeroplane or pack it as carry-on luggage – the change in altitude and air pressure won’t affect the prosthesis. The rules about liquids, gels and aerosols don’t apply to silicone gel breast prostheses because they are considered to be a medical device.

Most international airports use security systems and full-body scanners that pick up items worn under clothing such as a prosthesis. To confirm that the prosthesis isn’t a threat, airport security staff may organise another imaging scan or a pat down, which will happen in a private area by a staff member of the same gender. They should not ask you to lift your clothing or remove the prosthesis, or touch the prosthesis.

How to fly with a prosthesis

• Let the airport security officer know that you are wearing a prosthesis, if you feel comfortable  to do so.
• Ask your treatment team for a letter stating that you wear a prosthesis and have it with you.
• Request to be screened in a private area and by a security officer of the same gender.
• If you think you haven’t been treated with dignity or respect, let the screening supervisor know. You can also complain in writing to airport management.
• Pack your prosthesis or mastectomy bra in your carry-on bag if you don’t want to wear it.
• Visit the Department of Home Affairs website for more information about flying with a prosthesis.

Paying for a breast prosthesis

The cost of a breast prosthesis and bra varies depending on the type. If the cost of the prosthesis is an issue, you may choose not to replace the prosthesis regularly because of the cost.

Guide to the average cost of each prosthesis and bra

Silicone breast prosthesis – $300–$500
Partial breast prosthesis – $150–$200
Silicone swim prosthesis – $150–$200
Foam prosthesis – about $70
Mastectomy bra – $40–$100
Bra pocket that you can sew into a regular bra – $10–$15

Reimbursement from Medicare

The cost of a new or replacement breast prosthesis can be claimed through Medicare. You can claim for a new prosthesis every 2 years if you’re a permanent resident of Australia, are eligible for Medicare, and have had a full or partial mastectomy as a result of breast cancer.

At the time of last review (November 2023), Medicare’s External Breast Prostheses Reimbursement Program provides up to $400 for each new or replacement breast prosthesis.  If you’ve had a double (bilateral) mastectomy, you are eligible for reimbursement for 2 breast prostheses of up to $400 each. Visit Services Australia to check the latest information.

Steps for making a claim for a replacement prosthesis:

• Allow 2 years or more between the purchase dates of the prostheses. In some cases, you may be able to make additional claims but you will need to provide a letter from your doctor or surgeon.
• Claim any refund from your private health insurance first if you’re eligible.
• Obtain a claim form from any Medicare office, download it from Services Australia or call Medicare on 132 011 to request it in the mail.
• Scan the original receipt, attach it to the claim form and return this by email, post or in person at a Medicare Service Centre. You cannot make a claim online (as at 2023). The payment will be made by electronic funds transfer into your bank account.

Private health insurance

If you have private health insurance, check with your fund about what they cover. Rebates for breast prostheses and related products such as mastectomy bras vary between private health funds. Some rebates only apply to members with extras cover. Most health funds have waiting periods and other terms and conditions. They may also require a letter from your surgeon or breast care nurse explaining why you need a prosthesis. Before buying a prosthesis, check with your health fund about what is covered and what information they need from you.

Even if you have made a claim through private health insurance, you may be able to claim a reimbursement from Medicare. If the full price of the prosthesis wasn’t covered by your private health insurer, you can claim through Medicare, but this reimbursement will be adjusted according to the $400 limit. For example, if you buy a prosthesis for $500, and get a $200 refund from your private health fund, your Medicare reimbursement would be $200.