External Prosthesis (External Breast Prosthesis or Breast Forms)
Even though this is not a “true” reconstruction option, it is a simple alternative if you do not wish to have surgery. There are many different types and styles to choose from. The breast form may be built into a special bra or can be custom made to fit into a regular bra. Partial breast forms can be used to fill the space after a lumpectomy/partial mastectomy.
When it is used
- If you have serious health problems and are not healthy enough for surgery
- If you are still having cancer treatment
- If you do not want to have surgery
When it is not used
- If your skin does not react well to the external prosthesis
- No risk of problems from a general anesthetic or surgery
- No extra scars
- Easy to use and take care of
- No natural tissue or breast mound
- Need to hide under clothing and may slip out
- May limit clothing choice
- May feel bulky and heavy
- Uncomfortable and hot in warmer temperatures
- Costs a few hundred dollars and is only partially covered by government programs
- Where can I get one?
Contact your local Breast Cancer Support Network or your Regional Breast Cancer Action group. They can put you in contact.
Special Considerations: Surgery to Balance the Other Breast
The main goal of breast reconstruction is to create a breast that looks nice and matches the other one. It is hard to make them match perfectly. Every effort is made to make them match as closely as possible. Surgery to correct the shape and size of the other breast is often done to help match the new breast. This type of surgery can also be used in women who had only a part of their breast removed (lumpectomy, partial mastectomy) to improve the shape of the partial breast defect.
Breast Lift (Balancing mastopexy)
The nipple and breast tissue are placed in a higher position with some skin removal to match the reconstructed breast. The overall effect is a higher and firmer breast mound. Fat and breast tissue are not removed; therefore there is very little change in size.
Breast Reduction (Balancing reduction mammoplasty)
Through the same incisions as a mastopexy, skin, fat, and breast tissue are removed in order to match the size of the other breast or the size desired by the patient.
Balancing augment mammoplasty “Breast Implants”
In women with small breasts, putting an implant in the other breast can help to create balance. This can be done at the same time as the reconstruction or at a later date. This should not interfere with cancer treatment or follow-up.
Special Considerations: Nipple and Areola Reconstruction
Nipple and areola reconstruction are the last steps of breast reconstruction. This is done after the breast mound reconstruction is finished and the woman is happy with the way it looks. This is usually done six months to one year after the breast mound reconstruction.
There are generally two parts:
- Making the nipple mound
- Adding colour
For women who do not want any more surgery, tattooing alone is an option to add color and shading.
In certain cases, at the time of the mastectomy, the nipple and areola can be saved. This should be discussed with the breast cancer surgeon.
Nipple Mound Reconstruction
There are many techniques that can be used. Most commonly, the tissue in the breast mound is raised and folded to create the nipple. This is a small surgery. It can be done in an operating room but is often done in the clinic using local freezing. Some examples are shown below.
The nipple is created using only the skin and fat over the breast mound. Examples of flaps may include the “C-V” flap, and the “Double Opposing Tab” flap.
- Easy to do. Done under local anesthetic.
- No skin grafts are needed
- Smaller nipple mound long-term, may flatten over time
- Coloring needed to match the natural areola
Local Flaps with Skin Grafting
Skin and fat are taken from the breast mound to make the nipple. A skin graft is needed to cover the area taken. This is usually taken from an area where a scar already exists such as the abdomen or other breast. It is also used to reconstruct the areola. An example is the “Skate” flap.
- Nipple is more visible and lasts longer over time.
- Skin graft needed, possibly creating a new scar
- Often needs to be done in the operating room under a general anesthetic.
- Risk of graft loss
- Bulky dressings that cover the area
- Coloring often needed to match the natural areola
Free nipple graft
In certain cases, a part of the nipple on the other breast may be taken to create a new nipple on the reconstructed breast.
- Better match to the natural areola
- Small scar on the nipple donor site
- Risk of graft loss
- Donor nipple may lose some sensation
The areola may be reconstructed using the skin from the other nipple. The goal is to get both areolas to match as closely as possible. A skin graft from the abdomen may also be used to create the new areola. Tattooing may be needed to match the color.
The nipple/areola color is added as a tattoo on the flap skin to match the natural color. Tattooing can be done with or without a nipple mound creation. Usually a local anesthetic is used before the tattooing starts. Touch-up tattooing may be needed to reach or maintain the desired color.
- Tattoo time: 20–30 minutes each nipple
- Recovery time: 1–2 days, Moisturizing ointment and dressings are applied for several days