Breast Prosthesis vs. Breast Reconstruction After a Mastectomy

Losing a breast to breast cancer can be an extremely difficult experience, both emotionally and physically.

After having a mastectomy (removal of the breast), women have two main options to help restore the appearance of the breast that was removed: breast prosthesis or breast reconstruction. Both options have pros and cons to consider.

Let's go over these options in detail so you can make the most informed decision for yourself.

What is a Breast Prosthesis?

A breast prosthesis is an artificial breast form that is worn inside your bra to recreate the natural shape of the removed breast. Breast prostheses come in many shapes, sizes, and materials to suit each person’s needs and preferences.

Breast prostheses are considered “external” because they are removable. You insert them into pockets of mastectomy bras or use special adhesive strips to hold them in place.

Breast prostheses allow you to regain a balanced appearance when dressed. Some women use them as a temporary option, while others continue using breast prostheses for many years as an alternative to getting reconstructive surgery.

What are Breast Prostheses Made Of?

Today, breast prostheses are very natural-looking and made from soft, comfortable materials.

Common materials used include:

• Silicone gel - This gives the most realistic weight, drape, and feel. Silicone is soft and smooth and resembles natural breast tissue.
• Foam or fiberfill - Lightweight materials that have a comparable appearance to natural breasts. They are a more affordable option.
• Lightweight silicone - Has the drape and feel of silicone gel with less weight.
• Partial prostheses - Smaller shapes to fill gaps from breast-conserving surgery like lumpectomy.

The outer shell can be made of silicone, polyurethane, or nylon. A permanent adhesive called tape can also be applied to the backside to stick directly to your skin if desired.

Breast prostheses come in many different shapes, sizes, and skin tones to closely match your natural look before mastectomy. There are also customization options whereby custom breast prostheses can be specially made from a mold to perfectly match your other breasts.

Prices for breast prostheses range from $50-$500+, depending on the materials used and whether custom shaping is needed.

It is always advisable that you make sure to get properly fitted by a trained mastectomy fit specialist to ensure the best comfort and positioning. Most prostheses today last 1-2 years with proper care.

What is Breast Reconstruction?

Breast reconstruction is surgery that rebuilds the shape and appearance of a breast after mastectomy. It involves using a breast implant or utilizing tissue from another part of your body, like the back, abdomen, or buttocks.

Breast reconstruction creates a "new" breast shape without having to wear an external breast prosthesis in your bra. The reconstructed area can also be tattooed to recreate an areola and nipple for the most natural result possible after losing a breast.

There are two main approaches to breast reconstruction:

• Implant-based - This places a round silicone or saline breast implant to build breast volume. It often requires stretching of chest skin using a tissue expander device.
• Autologous or “flap” reconstruction - This transplants fat, skin, and sometimes muscle from areas like the tummy, back, or buttocks to reconstruct the breast shape. Common donor sites are TRAM, DIEP, and Latissimus Dorsi flaps.

Breast reconstruction often requires multiple surgeries spaced weeks or months apart for the full result. It also leaves visible scars at the breast and donor sites.

However, the major advantage is you do not have to deal with wearing an external prosthesis again once healed. For many women, permanently reconstructing and recreating their breasts can help restore femininity and body confidence after breast cancer surgery.

Deciding Between Breast Prosthesis and Reconstruction

Now that we’ve covered the basics let’s compare these two options — breast prosthesis vs breast reconstruction — in more detail. We’ll look at the differences in terms of:

• Recovery time
• Appearance
• Cost
• Process
• Risks
• Comfort

This information should help you make the best personal choice based on your needs, preferences, cancer treatment, and body type.

Recovery Time

Breast Prosthesis

Breast prostheses have little to no recovery time. You simply get fit for a bra and breast form once bandages are removed a few weeks after mastectomy surgery.

You may experience some skin irritation as tissues heal and sensitivities decrease over 2-3 months. But a breast prosthesis itself does not require any surgery so you avoid major procedures and downtime.

Breast Reconstruction

Breast reconstruction requires multiple major surgeries spaced weeks or months apart. You can expect:

• 1-week hospital stay and 4-6-week recovery period for initial tissue flap or implant procedure.
• A few months of healing until second stage surgery if the nipple and areola reconstruction is also desired.
• Limited arm movement and activity for the first few weeks after surgery.
• Possible revisions or corrections to be done months later.

So, breast reconstruction requires a much longer total recovery period compared to simply using a breast prosthesis after mastectomy.

Appearance

Breast Prosthesis

You must replace the breast prosthesis every 1-2 years to keep a natural shape and position in clothing. Prostheses may show obvious edges or shifts in position requiring periodic adjustment.

Since it is removable, you still have the single mastectomy scar visible when not wearing the prosthesis. Skin can also become retracted over time without the normal filling of breast tissue. This gives an indented, concaved appearance on the surgery side.

Breast Reconstruction

Reconstructed breasts aim to be permanent, without the need to replace implants or flaps over time. The tissue fills clothing for a seamless, balanced look. Nipple/areola tattooing creates the most realistic result possible.

However, reconstructed breasts do leave mastectomy scars and may have visible flap donor site scars on other areas of the body. Skin flap death, capsular contracture, and implant shifting can also distort the breast shape.

Up to 25% of women may require revision surgeries to fix issues with the reconstructed breast or achieve desired cosmetic outcomes.

Cost

Breast Prosthesis

Out-of-pocket costs for breast prostheses usually range from $50 - $500+. Higher-end prostheses made from premium silicone materials tend to cost more but have a more realistic look and feel.

Custom shaping and realistic nipple molding also increase prosthesis pricing. Mastectomy bras specifically designed with prosthetic pockets usually run $50+ each.

These costs are often fully or partially covered by provincial and private medical insurance plans in Canada. Government assistance programs can also help low-income patients access affordable breast prostheses.

Breast Reconstruction

Breast reconstruction costs widely vary by technique, hospital fees, plastic surgeon, and required stages. It ranges from roughly $5,000 - $50,000+ in total. Common reconstruction costs are:

• Implant reconstruction: $10,000 - $15,000
• Flap procedures using own tissue: $15,000 - $50,000+

These costs often fall under provincial healthcare if deemed medically necessary after mastectomy. Some exceptions may apply depending on whether certain revisions or procedures to optimize aesthetic outcomes are considered cosmetic vs required. Make sure to check your coverage specifics.

Many private medical insurance plans also cover 80%+ of reconstruction costs. However, out-of-pocket fees must be paid by the patient if uninsured.

Process

Breast Prosthesis

Being fit for a breast prosthesis involves:

• Getting measured weeks after mastectomy once bandages are removed
• Trying different shapes and materials for the best individual fit
• Learning how to properly insert and remove prosthesis
• Having pocket sewn into your mastectomy bras

It’s a simple process completed in one or two appointments after recovery from breast cancer surgery. And it’s easy to switch styles whenever needed.

Breast Reconstruction Process

The breast reconstruction process varies greatly depending on the technique chosen but includes multiple phases:

• Phase 1 - Initial reconstruction surgery using implants and expanders or autologous tissue flap
• Phase 2 - Second surgery to adjust implants or flap; nipple/areola reconstruction
• Phase 3 - Tattooing surgery to pigment areola/nipple; any revision surgeries

You must wait weeks or months between each major procedure as tissues heal. For autologous flaps, restoring sensation or the ability to breastfeed requires specialized procedures

The entire process commonly takes 12-24 months or longer from initial mastectomy to final revisions. It is much more involved than using prostheses.

Risks

Breast Prosthesis Risks

Minimal risks are involved with wearing a breast prosthesis after mastectomy. One may experience:

• Skin irritation or rashes
• Discomfort from poorly fitted prosthesis or bra
• Shoulder/back pain if too heavy model used
• Shifting of prosthesis - Requires periodic readjustment
• Noticeable edges of the prosthesis under clothing

This is easily resolved by seeing your fit specialist for a new style or size. You can also compare the pros/cons of adhesive options if shifting is an issue for active women.

Breast Reconstruction Risks

Higher risks due to extensive surgery involved with breast reconstruction:

• Bleeding, infections
• Loss of transplanted flap - Often requires repeat reconstruction
• Implant rejection or rupture
• Scarring problems - Raised, visible scars needing revision
• Fat necrosis - Hard lumps under the skin near the flap
• Loss of reconstruction - If a failed procedure or recurrent cancer
• Asymmetry in size/shape requiring additional surgery
• Limited arm mobility - Months of stiffness, tightness
• Chronic pain - Nerve damage, tissue adhesion

Revisional surgeries are often needed down the line for ideal breast symmetry or to fix post-op complications. Talk to your surgeons about this likelihood.

Comfort

Breast Prosthesis Comfort

Modern breast prostheses use very soft, comfortable materials like silicone or lightweight fiberfill. New vacuum seal methods allow one-piece breast forms to lay smoothly against the chest wall without gapping or shifting.

Also, adhesive options can be worn for weeks comfortably before removal for cleansing. And there is also easy to customize comfort level by adjusting materials and support features used.

Generally, well-fitted prostheses do not cause pain. Although trial and error is what usually helps determine the ideal placement and styles that lay best against a woman’s unique chest shape after a mastectomy.

You can also consider using partial prostheses if less filling is needed.

Breast Reconstruction Comfort

Reconstructed breasts require months of surgery recovery for sensation to return and swelling to subside. As a result, initial discomfort is very common. Many women also report feeling pain, tightness, or difficulty moving the affected arm normally for a year or more before they fully heal.

If enough native skin remains after mastectomy, expanders can be placed under healthy tissue with less discomfort. But flap techniques can sometimes cause injury to additional areas like the abdomen, back, or buttocks donor sites— multiplying discomfort.

Some women reject expanders/implants causing repeated removal attempts. Others undergo years of surgery to correct asymmetry or fix capsular contracture causing breast distortion

And so comfort highly depends on the type and extent of reconstruction, complications, and needed revisions.

Key Factors Impacting Your Choice

As seen above, breast prosthesis and breast reconstruction differ in terms of procedures, appearance, risks, and recovery involved. There’s no “right” option for everyone. It's an individual choice based on your:

• Breast cancer specifics - Stage, treatment type, need for radiation
• Body type and quality of native skin/tissue remaining
• Personal priorities - Quicker recovery vs. most natural result achieved
• Procedure factors - Flap donor sites, number of expansions for implants, revisions
• Cost and health insurance coverage for breast products and surgeries
• Overall health and surgical risks due to age or medical conditions

Ask your plastic surgeon these key questions below during consultations to determine if a prosthesis or reconstruction may be better for your unique situation:

• How will my chest look with a breast prosthesis vs breast reconstruction surgical result?
• Am I healthy enough to undergo major reconstruction plus revision surgeries?
• What areas would tissue need to be taken from if a flap is used?
• Will implants likely need replacing within 10-15 years?
• What percentage of your reconstruction patients require revisions?
• Does my cancer treatment plan impact options for reconstruction timing?
• What specific pros and cons do you see for my body and goals?

You should get personalized input from both your general breast surgeon performing the mastectomy procedure plus surgeons specializing in reconstruction choices. This is because some patients’ tissues are ill-suited for flap success, and also, other medical histories can make implants too high risk.

Listen to all professional opinions then do additional research before deciding on using a prosthesis or reconstructive surgery. Choose the path that feels most comfortable, physically and emotionally. You should also compare cost quotes, pre vs post-op, once insurance impacts are known.

Finding Outside Support for Decision-Making

Do not feel rushed or overwhelmed making choices about breast restoration methods before or after your mastectomy surgery. Take time to actively research all options presented, then call patient hotlines for unbiased information on what surgery, recovery and long-term prosthesis use is really like:

• Canadian Cancer Society - Trained specialists provide personalized reconstruction guidance and financial assistance resources.
• CancerCare – Free counseling, second opinions, and prosthesis/reconstruction information for US patients.
• Breast Cancer Network Australia – Aussie volunteer sharing surgery journeys.

Connect online or in person with women who’ve faced the same crossroads of prostheses, reconstruction, or going flat. Hearing others’ experiences can provide much-needed comfort when making big post-mastectomy decisions.

Focus groups also exist for “previvors” considering preventative mastectomy. You can use them to prepare your list of personal pros/cons using discussion topics and experiences shared in these groups.

Temporary Options During the Mastectomy Healing Period

Once you’ve weighed all the information and decided on your eventual breast restoration route, a lightweight breast prosthesis can provide comfort those first 2-3 months after a mastectomy while your tissues heal.

During this time, you can ask your nurse about accessing a free or low-cost temporary prosthesis from area clinics and cancer charities until when you feel ready for a more permanent option. These easy solutions can help clothes drape as you focus your energy on recovery.

In summary, take your time exploring breast prosthesis vs breast reconstruction choices post-mastectomy. Set up consultations with qualified surgeons to learn all the benefits and drawbacks of your unique case. And speak to supportive women who’ve worn prostheses for years or gone through the flap/implant breast reconstruction process—gain insight on life post-surgery.

Also, stay confident weighing options by utilizing second opinions, insurance guidance, and temporary prostheses until the right decision comes. Your doctors and breast care nurses will be there to help guide each step of your cancer journey, including achieving your goals for restoring appearance and feminine comfort after breast cancer surgery.