Breast prostheses

Temporary soft prostheses 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. Some women continue wearing a soft prosthesis at night-time. 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 request a knitted knocker, visit  Knitted Knockers Australia. You may find some temporary prostheses more comfortable than others. Talk to your breast care nurse or fitter.

Permanent breast prostheses for long-term use 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 natural shape of a breast or part of a breast. The front surface feels soft and smooth. The back surface that 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. 

As every woman’s body is different, prostheses are available in a variety of shapes (triangles, circles or teardrops), cup sizes (shallow, average or full) and skin colours. There are also partial breast prostheses (triangles, ovals, curves and shells) for women who have had breast-conserving surgery and want 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. Asymmetric prostheses are designed specifically for the right or left 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 breast prosthesis

when used – Immediately after surgery; 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 with temperature-regulating technology

other considerations – Not a suitable substitute for a weighted silicone form that provides body with balance

Three-layer breast prosthesis

when used – Everyday use

how used – Worn in a pocketed bra

material – Three 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 temperature regulating technology

other considerations – Symmetrical shape – can be worn on either the left or right side

Partial breast 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 – Two layers of silicone

weight – Regular weighted silicone

special features – Extra soft silicone, covered with a thin film to cling gently to the breast with temperature-regulating technology

other considerations – Available in a variety of shapes and sizes to replace the missing breast tissue and to achieve symmetry

Lightweight breast prosthesis

when used – Everyday use

how used – Worn in a pocketed bra

material – Ultra-lightweight silicone; slightly firmer lightweight silicone in the back layer helps keep the prosthesis in place when worn in a bra pocket

weight – 40% less than a standard silicone prosthesis of the same shape and size

special features – Back layer includes temperature regulating material

other considerations – Designed to drape like a natural breast so that it moves with the body and flattens when a woman lies down

Attachable or contact breast 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 lower-cut inside edge for use when surgery has conserved a small area of cleavage

other considerations – Follows body movements naturally; ideal for wearing with figure-hugging clothes

Adjustable breast prosthesis

when used – Everyday use

how used – Worn in a pocketed bra

material – Lightweight or ultralightweight silicone

weight – Up to 40% less than same-sized 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 –  Comfortable for women with an uneven chest wall

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.

For some women, having a fitting for a prosthesis can be an emotional or distressing experience, especially the first time. You may be embarrassed at the thought of having someone else see the site of the surgery or feel upset about needing a breast prosthesis. Professional fitters regularly see women who have had similar surgery and will take a sensitive approach.

You can visit a store to buy your prosthesis, or you may feel more comfortable organising a home fitting. It’s advisable to make an appointment with a fitter. This allows you to have uninterrupted time with them. When you go to the fitting, you might like to take a friend with you for support. The other person doesn’t have to come into the dressing room with you.

You may also find it helpful to see some breast prostheses before your appointment (or even before your operation), to give you an idea of what to expect. Ask your breast care nurse to show you samples of breast prostheses and bras. You may also find it useful to talk to a woman who is using a breast prosthesis – call Cancer Council 13 11 20 to arrange to speak to a Cancer Connect volunteer.

Where to buy a breast prosthesis

You can buy a breast prosthesis from a variety of retail outlets, including 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.

If you live in a rural area, you might have fewer options for what you can buy and where you can shop. 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.

You can also browse 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 it, or a fitter can order it in for you. However, it is a good idea to be measured in person by a fitter, particularly if you are buying a breast prosthesis for the first time.

Ask the store about its 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.

You can use Breast Cancer Network Australia’s local service directory to find a specialist prosthesis fitter in your area. Cancer Council 13 11 20 may also be able to help you find out more about buying breast prostheses and related products.

At the fitting

A fitting usually takes 40–60 minutes. You will have privacy when being measured and getting changed. For a list of questions you might like to ask your breast care nurse or a breast prosthesis fitter. Most fitters carry out the fitting in a similar way:

• The fitter will probably check your bra size with a tape measure.
• The fitter will ask you about what type of bras you like and how active you are.
• Take the bras you wore before surgery to the fitter. The fitter will check whether these bras are suitable to use with a prosthesis.
• If you’ve had a double 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 brings 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.
• The fitter often has 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 looks symmetrical under clothing.
• The fitter shows you how to check the breast prosthesis sits properly in the pocketed bra and will discuss how to take care of it.

Choosing a bra

Wearing a well-fitting bra will ensure your breast prosthesis is comfortable and sits well. While you may find that your ordinary bra, sports bra or sports crop top adequately supports your prosthesis, pocketed bras are specially designed for this purpose. Features of a pocketed bra include:

Straps – Elasticised, adjustable, comfortable straps. Wide straps can help distribute the weight of the breasts on the shoulders.

Cups – Full cups with firm, elasticised edges

Pockets – Hold breast prosthesis securely in place and protect it from damage.

Band – Thick sides that don’t cut into the skin and help minimise slipping or movement of the prosthesis. Should sit close to your chest wall between the cups and have a high front at the centre.

Getting the right fit

The key to a well-fitting breast prosthesis is getting it to match your natural breast in shape and size as closely as possible. With a correctly fitting bra, it is unlikely that a prosthesis will be noticeable to others or fall out.

You can bring your own bras (the ones you wore before surgery, or your post-surgical or pocketed bras) to the fitting or your fitter can suggest a bra from their stock. Getting the right fit will help give you a natural shape under your clothes. Many women say this makes them feel whole again.

Aim for a fit that looks natural and feels comfortable. The various styles and materials used in making prostheses may feel quite different on your skin or in the bra. The fitter will also check that the breast prothesis fits correctly. A breast prosthesis that fits well will not block the flow of lymph fluid in your body nor cause swelling in the arm (lymphoedema).

Most women find they get used to wearing the breast prosthesis, although this may take some time. If you find the breast prosthesis continues to feel uncomfortable or looks obvious, the fit is probably not right. Ask the fitter if you can be refitted. 

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.

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 a natural breast. Lightweight and ultra-lightweight breast prostheses are about 20–40% lighter than the standard prosthesis.

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. It may take a bit of time to get used to the weight, particularly if it has been a while since the mastectomy. You may prefer to wear a lightweight prosthesis when playing sport or a soft prosthesis to bed.

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.
• Wear a lightweight prosthesis in warmer weather, which may keep you cooler.
• Wear clothing made with cool, comfortable fabric, such as linen, silk or a synthetic fabric that is breathable.
• Use a bra pocket or a breast prosthesis cover with a regular bra to help absorb sweat (perspiration). Check whether your fitter supplies 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.

Clothes and swimwear

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 also stock a range of products designed specifically to be worn with a breast prosthesis. These include lingerie, sleepwear, swimwear, sports bras, activewear and camisettes (material that attaches to your bra straps to make low necklines more modest).

The range of mastectomy wear is constantly expanding and many attractive options are available. You may prefer to swim without your breast prosthesis, but if you swim regularly, there are advantages to buying a swim breast prosthesis.

Swim breast prostheses are made of clear, water-resistant silicone. They are lightweight and dry quickly. You should rinse the prosthesis after  swimming to avoid chlorine or saltwater damage. 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.

Australian and international brands offer a wide range of styles, patterns and colours of suitable swimwear. These can be bought from your fitter, some department stores, direct from some manufacturers or online.

How to adapt clothing or use accessories

• Use scarves or jewellery for extra coverage.
• Alter your clothing yourself or use a dressmaker.
• Try a strapless pocketed bra or use an attachable prosthesis.
• Wear a camisole or singlet under a V-necked 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 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.

Prostheses usually last around two years, but they may last a shorter or longer time depending 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.

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.
• Rinse the prosthesis in clean water soon after swimming to remove chlorine or saltwater.
• Use a soft, fibre-filled prosthesis in a sauna – a silicone prosthesis may heat up against your skin.
• Avoid using body lotions, perfumed deodorant or tanning lotion around your prosthesis as these products can damage it.
• 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 onto your clothing.
• Take care when gardening, especially if you are gardening near shrubs or plants with thorns.
• Take care when handling pets so their claws don’t damage the prosthesis.

You may be concerned about travelling with your breast prosthesis. It’s safe to wear or carry a prosthesis on an aeroplane – the change in altitude and air pressure doesn’t affect the prosthesis.

Most international airports have full-body scanners, which will detect the prosthesis. Airport security staff may organise another imaging scan or a pat down to confirm that the prosthesis isn’t a threat. They should not ask you to lift your clothing or remove the prosthesis.

How to travel with a prosthesis

• Let the airport security officer know that you are wearing a prosthesis, if you feel comfortable to do so.
• Ask your doctor or breast surgeon for a letter stating that you have a prosthesis and are wearing or carrying it with you.
• Request to be screened in a private area and by a female security officer.
• The security screening officer should never touch the prosthesis you are wearing.
• 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.
• The rules about liquids, gels and aerosols don’t apply to silicone or gel-filled breast prostheses.
• Visit TravelSECURE for more information about travelling with a prosthesis.

The cost of a breast prosthesis and bra varies depending on the type, which may influence your choice. Some women 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. Women who are permanent residents of Australia, are eligible for Medicare, and have had a full or partial mastectomy as a result of breast cancer can claim for a new prosthesis every two years.

At the time of last review (July 2020), Medicare’s External Breast Prostheses Reimbursement Program provides up to $400 for each new or replacement breast prosthesis. If you’ve had a bilateral mastectomy, you are eligible for reimbursement for two breast prostheses of up to $400 each. As policies change, check what assistance is available before you buy prostheses or bras.

How to make a claim for a replacement prosthesis:

• Allow two 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. The payment will be made by electronic funds transfer into your bank account.

Private health insurance

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 stating why you need a prosthesis. Ask your health fund what is covered and what information they need from you.

If you have private health insurance, you may also 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.