Breast prostheses and reconstruction

An external breast prosthesis (plural: prostheses) is a synthetic breast or part breast that replaces the shape of all or part of your breast. It is also called a breast form.

You may choose to wear a prosthesis after you have had surgery to remove the whole breast (mastectomy) or part of the breast (breast-conserving surgery, lumpectomy or wide local excision). Most breast prostheses have the shape and feel of a breast, and may weigh the same or be lighter. You can put these prostheses into specially made pockets in bras, activewear, swimwear and sleepwear or attach them directly to the skin.

A breast reconstruction is an operation to make a new breast shape. You may have a breast reconstruction at the same time as the mastectomy (immediate reconstruction) or at a later time (delayed reconstruction).

The aim of a breast reconstruction is to make a breast that looks as similar to your original breast shape or other breast as possible, but the reconstructed breast will not feel or look exactly the same.

There are 2 main types:

• implant reconstruction, using a sac filled with either silicone gel or saline
• flap or autologous reconstruction, using skin, muscle and fat from another part of your body.

Anyone with breast tissue can develop breast cancer, and may have breast reconstruction after a mastectomy.

Some of the information on these pages may be relevant to men, trans people and gender-diverse people who are considering having a breast reconstruction. For information specific to your situation, speak to your doctor.

Men with breast cancer can find information on the Cancer Australia’s website.

Breast Cancer Network Australia (BCNA) also has helpful information and personal stories about men with breast cancer.

Download our booklet ‘LGBTQI+ People and Cancer’

It is your decision whether you choose to stay flat, wear a prosthesis or have a reconstruction after surgery. Only you can choose what feels right. You do not need to decide immediately.

Unless you want to have a reconstruction at the same time as the mastectomy, there is no time limit on when you must decide. See your doctor as many times as you want before making a decision and ask questions about what to expect. You may be able to have a temporary tissue expander to give you time to decide.

Some reasons for using a breast prosthesis or having a breast reconstruction after a mastectomy include:

Replacing the weight of the removed breast – When a breast is removed, the body is no longer balanced. This can cause a slight curving of the spine and a drop of the shoulder on the affected side. Lower back and neck pain may develop over time. Regardless of your breast size, you can have issues with balance after having a mastectomy. A prosthesis or reconstruction can help with balance.

Creating symmetry when wearing clothing – Breasts are not often identical in size – the muscle and tissue on each side of the body are different. After a mastectomy on only one side, these differences are usually more noticeable. A prosthesis or breast reconstruction may help you feel and look more even on both sides (symmetrical).

Restoring self-esteem – Re-creating the shape of your breasts with a prosthesis or reconstruction may help to boost your confidence – including sexual confidence – about the way your body looks after a mastectomy. For more information about body image and sexuality issues.

Adjusting to the diagnosis and treatment – Wearing a prosthesis or having a breast reconstruction may help you cope better with the cancer diagnosis. You might feel like you are taking control of the way you look.

If you decide not to have a reconstruction or wear a prosthesis, you may consider going flat – also called staying flat or living flat. This may be because you are comfortable with how your body looks after surgery for breast cancer.

Your reasons for going flat may include:

• to avoid having more surgery and any potential complications
• for an easier, faster and less complicated physical recovery
• to return to your usual activities as soon as possible
• to avoid the possible side effects of breast reconstruction
• not liking the feeling of a reconstructed breast
• not wanting to wear a prosthesis
• to avoid the costs of surgery, new mastectomy bras or prostheses
• to avoid possible weakness in the shoulder that may make some activities, such as tennis and golf, more difficult
• not being suitable for a reconstruction.

If you decide to go flat, talk to your breast surgeon about what the finished result will look like. Ideally, the surgeon would remove extra skin, excess tissue and pockets of fat, and then smooth out the remaining tissue and skin to create an even chest wall. Your breast surgeon may work with a reconstructive (plastic) surgeon to achieve a good result.

"I chose to go flat after my double mastectomy and 2 years later, I’m happy with that decision. I felt that my breasts couldn’t be replaced, so I needed to learn to live with my new shape. It was helpful to talk to my surgeon and see photos of other people who had gone flat.” Beth

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.

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.

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

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

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

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.

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.

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.

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 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.

Breast reconstruction can be done at the same time as a mastectomy (immediate  reconstruction) or months or years later (delayed reconstruction). The timing depends on the type of breast cancer you were diagnosed with, whether you need further treatment after surgery (for example, radiation therapy or chemotherapy), the type of reconstruction, your general health, and other concerns such as cost.

Immediate reconstruction – If you have a breast reconstruction during the mastectomy, it may be possible to save most of the skin but not the nipple (skin-sparing mastectomy). Sometimes it may be possible to leave the nipple in place (nipple-sparing mastectomy). Having a skin- or nipple-sparing mastectomy often means a more natural look and fewer scars.

Delayed reconstruction – Sometimes you won’t be able to have an immediate reconstruction because of medical and cancer treatment or the surgery schedule at the hospital. You may also need to have the reconstruction in a number of stages to achieve the desired result. Talk to your surgeon about these issues.

Breast reconstruction is done by a breast surgeon or a reconstructive (plastic) surgeon. If a breast surgeon is trained in plastic surgery, they are known as an oncoplastic breast surgeon.

The breast surgeon and the reconstructive (plastic) surgeon may do the breast cancer surgery and reconstruction during the same operation. A breast surgeon can do implant reconstructions and a reconstructive (plastic) surgeon can do both implant and flap reconstructions.

You can ask your surgeon:

• what the surgery will involve and the length of the recovery
• about their experience and expertise
• what risks are associated with the different types of reconstructions
• to show you photographs of their work, including how the reconstruction looks straight after surgery and several months later.

Finding a surgeon

When considering having a reconstruction, ask to be referred to an expert in breast reconstruction. Check that the breast surgeon is a member of Breast Surgeons of Australia & New Zealand (BreastSurgANZ), and the reconstructive (plastic) surgeon, a member of the Australian Society of Plastic Surgeons.

Which health professionals will I see?

In hospital, you will be cared for by a range of health professionals who specialise in different aspects of the reconstruction procedure. Specialists and other health professionals will take a team-based approach to your care as part of a multidisciplinary team (MDT).

The health professionals listed below may be in your MDT.

breast surgeon – performs breast surgery and biopsies; some breast surgeons also perform breast reconstruction

oncoplastic breast surgeon – performs breast surgery and biopsies; performs some types of breast reconstruction

reconstructive (plastic) surgeon – uses a variety of plastic surgery techniques to reconstruct the breast’s appearance after surgery

anaesthetist – assesses your health before surgery; administers anaesthesia and looks after you during the surgery; commonly plans your pain relief after surgery

breast care nurse – provides breast cancer care; provides information, support and referrals during and after treatment

radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy

medical oncologist – treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy

occupational therapist, physiotherapist – assist with physical and practical problems, including restoring movement and mobility after surgery and recommending aids and equipment; provide treatment if lymphoedema occurs

social worker – links you to support services and helps you with any emotional, practical and financial issues

counsellor, psychologist, psychiatrist – help you manage your emotional response to diagnosis and treatment

Stop smoking or vaping – If you smoke tobacco or vape, aim to quit as soon as possible. Continuing to smoke or vape can damage the blood vessels and increase the risk of complications after surgery. This can delay skin healing and recovery time. For support, talk to
your doctor or call the Quitline on 13 7848.

Exercise regularly – This will help you build up your strength to cope with recovery and reduce the risk of complications after surgery. Talk to your doctor, physiotherapist or exercise physiologist about the amount and type of exercise that is right for you.

Talk to someone – It’s natural to feel anxious before surgery. Talk to your treatment team, or call Cancer Council 13 11 20 to arrange to speak to a trained Cancer Connect volunteer who has had reconstruction surgery and can offer you support.

There are different ways to reconstruct a breast shape:

• using implants
• using a flap of your own skin, fat or muscle (also called autologous)
• using a breast implant and your own tissue.

Most breast reconstructions involve 2 or more operations. Talk to your surgeon about how long you may have to wait between operations. Your surgeon will discuss the different techniques and suggest the most suitable type of reconstruction for you. They can also tell you what to expect after surgery.

Your reconstruction options will depend on several factors, including:

• your preference
• your body shape and build, and whether you have a body mass index (BMI) over 30
• your general health
• the surgeon’s experience
• how much breast tissue has already been removed
• any scars or previous operations to the area of your body where tissue will be taken
• the quality of the remaining skin and muscle
• the breast size you would like
• whether one or both breasts are affected
• whether you need radiation therapy or have already had it
• whether you smoke or vape or have recently quit – smoking and vaping affect the type and timing of the reconstruction you can have.

An implant reconstruction uses a sac filled with silicone gel or saline to create a breast shape. You may have an implant reconstruction as a one-stage or two-stage operation.

In the one-stage operation, the surgeon puts in a permanent implant during the mastectomy. In the two-stage operation a tissue expander is used to inflate and stretch the skin so there is room for the implant. A tissue expander is used for some people whose skin may need this expansion step in the process, or if you want to significantly increase the size of the reconstructed breast compared to the breast size before.

There are benefits and drawbacks to having an implant.

Types of implants

All implants are made with an outer layer (shell) of silicone. They can be filled with silicone gel or saline (salt water).

Silicone gel implants – These are used in almost all implant reconstructions. Implants are now made with a soft, semi-solid filling called cohesive gel. This gel is quite firm and holds its shape like jelly. A softer, honey-like type of gel was previously used.

The surface of these implants can feel smooth or have a rough (textured) surface. The rougher textured implants are called macro textured; the less textured implants are called micro textured. Textured implants grip to tissue better and are less likely to move position than
smooth implants. Some textured implants have been removed from sale because of a rare side effect called BIA–ALCL.

Saline implants – These are no longer commonly used in breast reconstruction. Saline breast implants don’t look and feel as natural as silicone implants. They may wrinkle under the skin and may leak. If the saline leaks, the implant deflates and needs to be replaced.

Reconstruction with an implant

After the reconstruction you will have a scar on your breast. The type of scar will depend on the type of cut (incision) that your breast and reconstructive (plastic) surgeons choose.

What to consider

Benefits

• The operation takes only a few hours and you usually stay in hospital for only a few days.
• Creates the breast shape without moving tissue (muscle, skin or fat) from another place in the body, so these parts aren’t affected.
• There is only a scar in the breast area from the mastectomy and no scar elsewhere on the body.
• Recovery time at home is shorter than for a flap reconstruction. Although the chest area will be swollen and sensitive, you may be able to return to most activities after 4 weeks. Heavy lifting should be avoided for 6–8 weeks.
• Implants come in a range of shapes and sizes. You can choose to change your original breast size.
• The operation doesn’t usually cause muscle weakness, only temporary discomfort and pressure.
• Having a reconstruction may make you more confident when naked.

Drawbacks

• May not be suitable if you plan to have radiation therapy.
• Two or more operations may be needed. If you have an expander first, the expander is gradually filled every couple of weeks. The whole process may take 3–6 months.
• A breast reconstructed with a tissue expander usually feels firm and doesn’t move like the original breast, but it usually looks the same in a bra.
• If your other breast changes in shape and size, you may need more surgery to match the 2 breasts.
• Hardened scar tissue (capsule) may form around the implant. This can change the shape of
  the breast and may be painful.
• There is a risk of infection, which may mean removing the implant.
• Implants may eventually need to be replaced.
• There are some rare side effects.
• There may be an increased risk of lymphoedema (swelling in the soft tissue under the skin).

One-stage operation

This operation is sometimes called a direct-to-implant reconstruction. It is usually done at the same time as a skin- or nipple-sparing mastectomy, when there is enough tissue left on the chest to cover the implant. The surgeon can place the implant above or under the chest (pectoralis) muscle.

Subpectoral implant reconstruction

The breast implant is placed under the chest muscle. This is called a subpectoral implant reconstruction. The lower and outer part of the implant is often covered by a material called dermal matrix or mesh to hold the implant in place.

Prepectoral implant reconstruction

The breast implant is placed in front of the chest muscle, directly under the skin and the layer of tissue just under the skin. This is called a prepectoral implant reconstruction. The whole outer part of the implant is covered by a dermal matrix or mesh to hold the implant in place.

Two-stage operation with a tissue expander

Tissue expansion is a process that stretches the remaining chest skin and soft tissue to fit the breast implant. This is done in two stages. The two-stage approach is often used when radiation therapy is given after a mastectomy and before the implant is put in.

First stage

Implanting the tissue expander – In the first operation, a balloon-like bag called a tissue expander is placed under the chest muscle. In some cases, it is placed in front of the chest
muscle. Every couple of weeks, the balloon is injected with saline through a port (a thin tube). You may be given 1–6 injections depending on how much the skin and muscle need to stretch.
The stretched tissue creates a pocket for the breast implant. The saline injections are usually not painful.

Second stage

Expanding the tissue expander – The tissue stretches and expands each time saline is added.  You may feel discomfort for a few days. When the expander has stretched the tissue enough, you have a second operation to remove the temporary expander and insert the implant in its place. You may need to stay in hospital overnight after this second operation.

Risks of having an implant reconstruction

Before the operation, the surgeon will discuss the risks of an implant reconstruction with you. Some of these risks are covered below.

Infection – You’ll be given antibiotics at the time of the operation to reduce the risk of infection. If you do get an infection, the implant may have to be removed until the infection clears. The implant can then be replaced with a new one.

Implant rupture – Implants can leak or break (rupture) because the silicone gradually weakens over time. If a saline implant ruptures, salty water will leak into your body. The salty water is not harmful, but you will need to have surgery to remove the empty silicone envelope and replace the implant.

Implants may need to be changed every 10–15 years, or earlier if there are any problems.  Regularly examine your breasts, armpit and implant for any changes. See your surgeon or GP every year for check-ups, which will include scans.

Hardening of the implant – A fibrous covering can form around a breast implant. If this hardens over time, it may make the reconstructed breast feel firm. This is called capsular contracture, and it is more common after radiation therapy. Capsular contracture can be uncomfortable or painful and may change the shape of the breast. You may need to have additional surgery to remove or replace the implant. A new surgical procedure called capsulotomy can be done to loosen the scar tissue surrounding the implant.

Movement – The position of the implant in the body may change slightly over time. This is called implant malposition, displacement, descent or rotation. In a small number of cases, the implant shifts a lot and changes the shape of the breast. Further surgery can restore the implant to its original position.

Visible rippling – Sometimes implants adhere to the surface of the skin and this can affect how smooth the breast is. This can often be corrected with minor surgery, which injects fat from another part of the body under the skin. This is called lipomodelling.

Lymphoma – There have been reports of a link between a type of non-Hodgkin lymphoma and textured breast implants. This is known as breast implant associated anaplastic large cell lymphoma, or BIA–ALCL, and it is rare. BIA–ALCL is a cancer that grows in the fluid and scar
tissue that forms around a breast implant. Implants that have a smooth surface have not been linked to BIA–ALCL. The Therapeutic Goods Administration (TGA) recommends monitoring your breasts for any changes such as swelling, a lump or pain.

For more information about BIA–ALCL, visit the TGA’s website. The TGA also has an online breast implant hub, where information and support related to breast implants and their safety are updated as new evidence becomes available. If you are concerned, talk to your surgeon.

Other health problems – Research has not established that silicone breast implants cause autoimmune disorders such as scleroderma, rheumatoid arthritis or lupus. There is also no evidence that implants cause breast cancer.

How to keep up to date about the safety of your breast implants

While implants are generally considered to be safe, there have been some concerns about risks.

Some silicone implants were voluntarily taken off the market in the 1990s due to safety concerns. Since then, regulatory authorities such as the Therapeutic Goods Administration (TGA) must approve brands that are used in Australia.

In April 2010, the French breast implant brand Poly Implant Prothèse (PIP) was withdrawn due  to safety concerns and a possible increased likelihood of ruptures. About 5000 Australians had a PIP implant between 2000 and 2010, most of which were cosmetic procedures.

In late 2019, the TGA removed from sale some textured breast implants. The TGA also imposed
extra conditions on other implants due to concerns over BIA–ALCL.

The Australian Breast Device Registry (ABDR) is a national clinical quality registry for all people having breast implant surgery. Its aim is to provide a way to track the long-term safety and performance of breast implants. This can help identify early signs of problems with a device.

ABDR is supported by the Australian Society of Plastic Surgeons, Breast Surgeons of Australia and New Zealand, and the Australasian College of Cosmetic Surgery and Medicine. Your surgeon will provide you with printed information about the registry and you’ll be contacted by ABDR after the surgery with more information.

For updated safety information, visit the TGA breast implant hub.

Discuss any concerns you have about the safety of your implant with your surgeon.

The shape of a breast can be built using your own muscle, fat and skin, which is taken from another area of the body. This is called a flap or autologous reconstruction.

There are different types of flap reconstructions. Most use a flap of tissue from the tummy (abdomen). But tissue can also be taken from the back, bottom and thighs.

Your surgeon will discuss the type of flap reconstruction that is most suitable for you. This may depend on if you:

• have large breasts
• don’t have enough skin to cover an implant
• have had radiation therapy.

A flap reconstruction may not be suitable for you if you smoke; have diabetes, connective tissue disease or vascular disease; have had previous major abdominal surgery; or have a higher BMI.

There are benefits and drawbacks to having a flap reconstruction. You need to discuss these with your surgeon. They can also tell you how long the operation will take and the expected length of your recovery.

Because I’d had extensive radiation therapy to the chest area, I was only suitable for a flap reconstruction. My reconstructed breast is absolutely amazing. It’s very symmetrical and even.” LESLEY

Location of flap reconstructions

The tissue for reconstructing your breast can come from different places. Your doctor will discuss the best location with you.

DIEP flap – Takes skin and fat, but no muscle, from the lower abdomen.
TRAM flap – Takes skin, fat and muscle from the lower abdomen.

LD flap – Takes skin, fat and muscle from the back.

Less common flap reconstructions

SGAP or IGAP flap – Takes fat and skin from the upper or lower bottom.

TMG or TUG flap – Takes skin, fat and a small amount of muscle from the upper inner thigh.

PAP flap – Takes fat, skin and muscle from the back of the upper thigh.

What to consider

Benefits

• Flap reconstruction is permanent once the breast has healed.
• Most methods use only your own living tissue to create the breast. This often gives a better match to the other breast. This may be important to you, especially when you are naked.
• The flap maintains its look and feel over the long term and generally adjusts if your body’s  weight changes.
• Using your own tissue means there is no risk of possible rupture.
• There is less chance of long-term complications.
• If you have a flap reconstruction, you are less likely to need further surgery in the future than you would if you have an implant reconstruction.
• Having a reconstruction may make you more confident when naked.

Drawbacks

• Flap reconstruction is more extensive than implant reconstruction. Additional treatment or follow-up surgeries are sometimes needed. The operation will take several hours and you may need to stay in hospital for about a week.
• Recovery takes longer than after an implant reconstruction as there are 2 wounds that have to heal – a wound at the site where the flap was taken and a wound on the breast that was reconstructed.
• Risks include infection and the flap not healing properly.
• Surgery usually causes more than one scar (but these fade).
• Depending on the type of flap, you may also need an implant.
• DIEP and TRAM procedures can be done only once.
• There is a small risk of hernia with abdominal flaps.

Flap from the lower abdomen (DIEP or TRAM flap reconstruction)

Tissue from the lower abdomen (tummy) is used to reconstruct the breast shape. There are 2 main types of abdominal flaps: free deep inferior epigastric perforator (DIEP) flap, and free transverse rectus abdominis myocutaneous (TRAM) flap.

These flaps are called free flaps because the flap is cut completely away from the blood supply in the abdomen. The surgeon then reconnects the flap to the blood vessels in the chest area using microsurgery (surgery using miniature instruments and viewed through a microscope).

DIEP flap reconstruction – This is called DIEP because it uses deep blood vessels called deep inferior epigastric perforators (DIEP). It is now done more often than TRAM flap procedures.

In a DIEP flap procedure, the surgeon uses only the skin and fat to reconstruct the breast. The abdominal muscle is left in place. This means the strength of your abdomen muscle is less affected and the risk of abdominal problems after surgery is reduced.

Reconstruction with a DIEP flap

After the reconstruction you will have a scar on your breast and a scar across your abdomen from one hip to the other (seen only faintly below).

TRAM flap reconstruction – In this procedure, all or some of the muscle in the lower abdomen and a flap of skin and fat are used to reconstruct the breast shape. The muscle in the lower abdomen that runs from the breastbone to the pubic bone is the rectus abdominis muscle, or “six pack” muscle.

A type of TRAM flap reconstruction that is not often done anymore is called a pedicle TRAM flap. In this procedure, the flap remains attached to its original blood supply and is tunnelled under the skin of the upper abdomen to the breast. A pedicle TRAM flap has a high risk of hernia.

How the abdomen will look after reconstruction

After a DIEP or TRAM flap reconstruction, your abdomen is tighter and flatter. This is because the reconstructed breast is formed from tissue taken from the abdominal area.

You will have a long scar across the lower abdomen from one hip to the other, a scar around your bellybutton and a scar on the reconstructed breast. While everyone heals differently, the appearance of the scars will improve with time.

Both types of flap reconstructions can make the abdominal area weaker, and you will have little to no feeling in the skin over the breast and the scar over the abdomen. You may be advised to wear a garment called an abdominal binder to protect and support the wound. Ask your surgeon how long you will have to wear the binder.

Flap from the back (LD flap reconstruction)

The latissimus dorsi (LD) is a muscle on the upper back that controls shoulder movement. This muscle and some skin and fat can be moved from the back around to the chest to reconstruct the breast shape.

This reconstruction can be completed in one operation, but the surgeon will usually place an implant under the flap to create a breast that is similar in size to your remaining breast. If you have a tissue expander, the surgeon will begin the expansion process after the flap has healed. Unless you have a nipple-sparing mastectomy, the areola and nipple are created in a separate operation.

The size of the scar on the back will depend on the surgeon – most times it can be hidden by a bra strap. The scar on the breast will vary depending on the type of mastectomy you had.

A new technique avoids a scar on the back by reopening the mastectomy scar and then special instruments are inserted to bring the latissimus dorsi muscle forward towards the breast. This surgery is now widely available. Ask your surgeon if this is suitable for you.

Reconstruction with an LD flap

After the reconstruction you will have a scar on your breast. You may also have a scar on your back, depending on the technique used.

Less common types of flap procedures

If a DIEP, TRAM or LD flap is not suitable, you may be offered reconstruction techniques that  use fat and a blood supply from another area of the body. These include:

• superior gluteal artery perforator (SGAP) flap or inferior gluteal artery perforator (IGAP) flap using tissue from the bottom
• transverse myocutaneous gracilis (TMG) flap, transverse upper gracilis (TUG) flap or profunda artery perforator (PAP) flap using tissue from the inner thigh.

To help reconstruct a small breast shape, the surgeon may remove fat from another part of the body (liposuction), then inject it into the breast to create or improve the shape and contour.

Risks of having a flap reconstruction

Before the operation, the surgeon will discuss the risks of a flap reconstruction with you. Some of these risks include:

Loss of the flap – Blood vessels supplying the flap may kink or get clots, leading to bleeding  and a loss of circulation. If there are signs of problems with the blood supply, you might need another operation. If the blood supply is not good enough, this may cause the tissue to die, leading to a partial o complete loss of the flap. Problems with blood supply are more likely to happen if you smoke or have recently quit or are carrying extra weight. If the flap dies, you usually have to wait 6–12 months before having a reconstruction again.

Hardening of the flap – In rare cases, the fat used to make a TRAM or DIEP flap doesn’t get enough blood supply and dies. This is known as fat necrosis. Because it causes the affected area in the reconstructed breast to feel hard, fat necrosis can easily be seen and diagnosed on a mammogram. It can be left in place or surgically removed. Fat necrosis is more likely to happen if you smoke or have had radiation therapy.

Problems with the donor site – After an abdominal flap reconstruction, it may take time for the wound to heal, and fluid can collect (seroma) in the abdominal region. After an LD flap
reconstruction, it’s common for fluid to build up (seroma) in the back where the muscle was taken from.

Hernia (abdominal bulge) – If you have had a DIEP or TRAM flap, you have a small risk of developing a hernia. A hernia occurs when part of the bowel sticks through a weak point in the abdominal wall. The risk of an abdominal hernia is greater with a TRAM flap than with a DIEP flap reconstruction because removing the TRAM flap can weaken the abdominal wall and cause a hernia. If you have any signs of a hernia, see your doctor.

You may want only the shape of the breast reconstructed without a nipple, or you may choose to have the look of a nipple. The appearance of a nipple and areola (the brown or pink rim of tissue around the nipple) can be created in several ways.

Adhesive nipples – These stick to the skin or breast prosthesis and stay in place for several days. They are made from soft silicone and are available in a variety of colours. You can buy them from breast prostheses suppliers.

Nipple made from your own body tissue – A small operation can reconstruct a nipple and the areola. This operation is generally done a number of months after a reconstruction to give your body time to heal from the original operation and because the reconstructed breast may drop slightly after surgery.

The nipple is made from tissue on your reconstructed breast. It is folded to create a nipple shape. The new nipple won’t have nerves, so it will not feel any sensation or become erect to touch. Sometimes the nipple can flatten out and sometimes it can be permanently erect.

Nipple tattoo – The new nipple can be tattooed to match the colour of the other nipple. The tattoo can be done by a reconstructive (plastic) surgeon, trained nurse, professional medical tattooist or specially trained cosmetic therapist. Initially, the tattoo will look darker than the remaining nipple, but it will fade with time to match in colour.

A new technique called 3D nipple tattoos uses different shading to create the appearance of a nipple. Your breast care nurse can give you more information about this new procedure.

Reconstructed breast and nipple (no tattoo)

After the reconstruction you will have a new nipple.

Often the difference between the remaining breast and the reconstructed breast is small and not noticeable when wearing a bra. But if the difference in breast size is more obvious, you may decide to have the remaining breast made smaller or larger by surgery to match the reconstructed breast and improve balance and posture.

Bilateral mastectomy

You may be advised or choose to have a bilateral mastectomy – also called a double mastectomy. This means both breasts are removed at the same time. You may have a bilateral mastectomy for several reasons:

• the type of breast cancer you have
• your risks and/or anxiety about developing another breast cancer
• family history or a gene fault that increases your breast cancer risk
• the amount of surgery required to achieve a symmetrical result with the breast reconstruction
• choosing an abdominal flap reconstruction – because surgery on the abdomen can only be done once, the flap procedure can’t be repeated at a later date if cancer develops in the other breast.

You can consider reconstructing both breasts or going flat. Discuss your options with your doctor and get a second opinion if you wish.

Therapeutic mammaplasty

This procedure combines surgery to treat breast cancer (breast-conserving surgery or wide local excision) with surgery to reduce the size of the breast (breast reduction).

It is often used as an alternative to mastectomy in suitable cases. Sometimes a breast reduction is done on the other breast at the same time, or at a later date.

Everyone reacts to surgery differently. The type of side effects you have will be influenced by the type of surgery you’ve had.

Short-term side effects

Appearance of the breast – It’s common to feel nervous when the bandages and dressings are first removed. It will take time for the bruising and swelling to fade, and the appearance of a breast reconstruction using a tissue flap may take longer to settle. If you’re disappointed with the appearance of the breast, you may have other operations or procedures to improve the look and shape of the breast.

Pain relief – After any type of operation, you will be given pain medicines to ease your discomfort. You will also probably have small tubes (drains) inserted into the operation site to remove excess fluid, and may go home with them. If you have had a flap reconstruction, you will be sore in the area where the other tissue and/or muscle were taken, as well as in the breast area.

Healing problems – Sometimes the area will not heal well within the first week or so after surgery. This can be caused by infection, poor blood supply or problems with an implant or flap.
Any infection must be treated to reduce the possibility of further complications. If an implant has been used, it might need to be taken out. It may be possible to have a new implant put in at a later date.

Bleeding – Blood may build up in or under the wound. This is called a haematoma, and it causes swelling and pain. A large haematoma may need to be removed by surgery.

Seroma – In some cases, when drains have been removed, extra fluid collects in or under the wound. This is called a seroma, and it causes swelling and pain. It may need to be removed by a health professional using a needle. You can wear a special bra called a compression bra to help relieve the pain.

Scars – All types of breast reconstruction will leave a scar. Everyone heals differently, and the final appearance of a scar will vary, even if the surgery is the same. Most scars have a thickened, red appearance at first, but they will usually fade after about 3 months.

Sometimes the scar stays thick and becomes itchy and uncomfortable. Before the surgery, let your surgeon know if you have other raised, irregular scars (sometimes called keloid scars), as this may show that you are prone to getting these types of scars. Your surgeon or breast care nurse can advise you about treatments to reduce the discomfort. You may be able to have further surgery to improve the scar’s appearance.

Long-term considerations

Pregnancy – Breast reconstruction doesn’t affect your ability to become pregnant or carry a baby. There is a small risk of having a hernia during pregnancy if you had an abdominal flap reconstruction. Your doctor will talk to you about any risks you may have and how to manage them.

Breastfeeding – It will not be possible to breastfeed with the reconstructed breast. You may be able to breastfeed successfully with the other breast, although this may be difficult if you have had reduction surgery in this breast. You can ask a breast care nurse or lactation consultant any questions you have about breastfeeding after a reconstruction.

How long your recovery takes will depend on your age, general health and the type of surgery you had.

Rest – When you get home from hospital, you will need to take things easy for the first few weeks. Ask family and friends to help you with chores so you can rest.

Lifting – Avoid repetitive arm movements (e.g. hanging out washing, vacuuming), heavy lifting (more than 5 kg, so this may include shopping bags) and activities that strain your arm. You can gradually return to your usual activities after 4–8 weeks.

Driving – You will probably need to avoid driving for 4–6 weeks after surgery. Discuss this timing with your breast surgeon.

Tummy problems – After abdominal flap surgery, you may have weaker abdominal muscles.  Get up from a low chair or sit up in bed carefully. Wearing supportive underwear will help. If the weakness continues after 6 weeks, ask your doctor for a referral to a physiotherapist or an exercise physiologist for an exercise program.

Loose clothing – Until the area is healed, wear loose-fitting comfortable clothing.

Follow-up appointments – Continue to see the specialist who performed the reconstruction until your body has healed.

Before you have surgery, find out how much it will cost to have a breast reconstruction. Check with your surgeon, the hospital, Medicare and your private health fund, if you have one, before deciding to go ahead. Ask about likely out-of-pocket costs. These may include pain medicines, post-surgical bras and check-ups with your breast surgeon.

Services to help with the costs of a reconstruction include:

If you live in a regional or rural area – Every state and territory has a government scheme that provides financial help to people who need to travel long distances for specialist medical treatment that is not available in their local area. Many schemes also assist with the cost of accommodation. Ask the hospital social worker about services you are eligible to receive.

If you need legal or financial advice – Talk to a qualified professional about your situation. Cancer Council offers free legal and financial services in some states and territories for people who can’t afford to pay – call 13 11 20 to ask if you are eligible.

If you have your nipple tattooed – There is a Medicare rebate if the tattooing is done by a health professional with a Medicare provider number. If you have private health insurance, it may cover the cost of the tattooing.

What to consider – reconstruction costs

Public hospital

• Reconstruction after a mastectomy is a medical procedure, not a cosmetic one, so the costs are covered through Medicare for a public patient in a public hospital.
• There may be some extra charges if an implant is used.
• There may be some extra charges for private patients who have a reconstruction in a public hospital.
• If you choose to have a delayed reconstruction, you will be put on the hospital’s elective surgery waiting list. Ask your surgeon how long you might have to wait.
• You can change your mind and decide not to proceed with the reconstruction even if you are on a waiting list.

Private hospital

• Private patients may be covered by their private health insurance or may have to pay the cost themselves.
• In a private hospital, Medicare will cover some of the surgeon’s and anaesthetist’s fees. Your health fund may cover some or all of the remaining costs, but you may need to pay a gap fee or a hospital admission fee.
• Part of or the entire cost of an inflatable tissue expander and any permanent implant may
  also be covered by your health insurance provider.
• If you decide to join a health fund before your operation, you will have to wait the qualifying period before you can make a claim. This may be up to 12 months. Check with the different health funds.

With my private insurance, I was significantly out of pocket. However, the advantage gained with the reconstruction was well worth the cost.” GWEN

Download our booklet ‘Cancer and Your Finances’

You will probably find it helpful to stay active. Light exercise after surgery, such as walking, can help people recover and improve their energy levels.

The amount and type of exercise you do will depend on what you are used to, how well you feel and your doctor’s advice. It is important that you wear a supportive bra to protect your breasts when you exercise.

If you have a breast reconstruction, it will be a while before you can return to vigorous exercise and you may need to modify the exercise that you do. For example, if you have an abdominal flap reconstruction, you will need to be gentle with abdominal exercises. You will also be encouraged to wear supportive underwear. Ask your doctor, breast care nurse, physiotherapist or exercise physiologist about exercises you can try.

Exercise and breast reconstruction

Exercise is important before and after breast reconstruction surgery to help get your arm and shoulder moving again. Exercise before surgery can help you feel better and recover your strength faster.

For a guide to some simple exercises that you can do after a breast reconstruction, see our ‘Arm & shoulder exercises after surgery poster’.

Breast Cancer Network Australia has videos and a podcast to help you start your recovery before you have surgery, as well as afterwards.

Download our booklet ‘Exercise for People Living with Cancer’

Complementary therapies are designed to be used alongside conventional medical treatments. Therapies such as massage, relaxation and acupuncture can increase your sense of control, decrease stress and anxiety, and improve your mood. Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.

Alternative therapies are therapies used instead of conventional medical treatments. Many alternative therapies have not been scientifically tested, so there is no proof they stop cancer growing or spreading. Others have been tested and shown to be harmful to people with cancer or not to work. Cancer Council does not recommend the use of alternative therapies as a cancer treatment.

Download our booklet ‘Understanding Complementary Therapies’

Listen to our podcast ‘Finding Calm During Cancer’

Any change to your appearance after breast cancer surgery may affect the way you think and feel about yourself, including your confidence and self-esteem. It is normal to experience sadness and grief after breast surgery. You may find that your sense of identity or femininity has been affected.

It may take some time to get used to seeing and feeling the differences in your body. You may find that having a breast reconstruction or wearing a breast prosthesis improves your self-confidence. However, you may prefer to concentrate on accepting the changes in your body without wearing a prosthesis or having breast reconstruction.

Changing your clothing and using accessories might make you feel more confident when wearing a breast prosthesis. If you have a reconstruction, it will take time to adjust to the different way a reconstructed breast looks, feels and moves. The appearance of the breast will improve with time as scars heal and fade. It may take some time for you to adjust to the  changes to your body image after reconstruction.

You may also be concerned about how others perceive the changes to your body, and this may affect your relationships and interest in sex.

Talking to health professionals such as psychologists, counsellors or psychiatrists may be helpful. Don’t be embarrassed to ask for a referral. These health professionals may help you find strategies to help with your recovery. It may also help to talk to someone who has had a similar experience. Call Cancer Council 13 11 20 for information on support services.

Having treatment for breast cancer may affect your sexuality. It may take time for you to feel like resuming sexual activity after treatment for cancer – you may need to recover from the operation and get used to wearing a prosthesis, going flat or having a reconstructed breast.

Things that improve your overall wellbeing, such as eating well, exercising and relaxing, may help to boost your sexual confidence.

If you have a partner, you may be concerned about how they will react to your new body shape. You may feel nervous about a partner seeing you naked or worry that they’ll find you  unattractive. You may want to talk to your partner about the changes while you’re in the hospital rather than the more intimate environment of your home.

It will take time to get used to how your body has changed. You may miss the pleasure you felt from the breast or nipple being stroked or kissed during sex. This may be the case even if you have a reconstruction. If breast stimulation was important to arousal before surgery, you may need to explore other ways of becoming aroused.

While you’re recovering, try to touch and stroke your mastectomy scar or your reconstructed breast regularly to help you become familiar with the new sensation, so that when you are touched by your partner, your brain has adjusted to the “new normal”.

Changes to your body may mean you avoid sexual contact. This may not be satisfying for you and your partner. Although it may be difficult, share your fears and needs with them.

What if I don’t have a partner?

If you don’t have a partner, you might be anxious or uncertain about forming new relationships. If you meet someone new, you might worry about when and how to tell them that you’re wearing a breast prosthesis, have scars or have a reconstructed breast – and you may worry about how they may react.

It isn’t easy to decide when to tell a potential partner about any changes to your body. It’s natural to be worried about their reaction to seeing you naked for the first time.

Take your time and let a new partner know about the changes to your body when you feel ready. Practising what to say, before you talk to them, may help. You might want to show the other person how your body has changed before any sexual activity so that you can both get used to how that makes you feel. Do what feels right for you.

If a new relationship doesn’t work out, don’t automatically blame the cancer or how your body has changed. Relationships can end for a variety of reasons.

You might find it helpful to talk through any concerns you have about meeting someone new. Call Cancer Council 13 11 20 for information on support services. You can also talk to a counsellor or psychologist, your breast care nurse or your GP about your feelings.

We’ve become more intimate on other non-sexual levels. Cancer has opened up a whole lot of things, quite surprisingly.” KERRY

How to manage changes in body image and sexuality

Body image

• Wear clothes that make you feel good.
• Focus on yourself as a whole person (body, mind and personality) and not just the part of you that has changed.
• Draw attention to other parts of your body by using colours, clothing, make-up or accessories.
• Do activities that you enjoy or things that make you feel good about yourself, such as walking, listening to music, working or studying, having a massage, relaxing outside or volunteering.
• Consider having a decorative tattoo. This may make you feel more confident by acknowledging what you’ve been through or disguising a scar.
• Take part in a photo shoot.
• Register for a free Look Good Feel Better workshop, which offers tips and techniques to help restore appearance and self-esteem for people during or after cancer treatment. Visit Look Good Feel Better or call them on 1800 650 960.

Sexuality and intimacy

• If you are using a prosthesis, wear it in an attractive bra or camisole.
• Wear lingerie or a camisole, or drape a scarf or sarong over your scars, if you are self-conscious.
• Touch, hold, hug, massage and caress your partner to reassure each other of your love and
  attraction.
• Be open about what you are comfortable with. You might not be ready for your breast area to be touched, or you may want your partner to specifically touch this area.
• Dim or turn off the lights if you prefer.
• Talk to your doctor, your breast care nurse or a counsellor about any ongoing problems.

Download our booklet ‘Sexuality, Intimacy and Cancer’

Download our booklet ‘LGBTQI+ People and Cancer’