Breast forms and bras vs. breast reconstruction

Breast forms and bras vs. breast reconstruction

Following a mastectomy (or breast-conserving surgery in some cases), a woman may
consider having the breast mound rebuilt, or reconstructed. This is usually something that
is discussed before surgery to treat the cancer. Decisions about the type of reconstruction
and when it will be done depend on each woman's medical situation and personal
preferences. There are several types of reconstructive surgery available. Some use saline
(salt water) or silicone implants, while others use tissues from other parts of your body.
For a discussion of the different breast reconstruction options, see our document, Breast
Reconstruction After Mastectomy.
A breast form is a prosthesis (artificial body part) worn either inside a bra or attached to
the body to simulate the appearance and feel of a natural breast. For women who have
had a mastectomy, breast forms can be an important alternative to breast reconstruction.
Some women may not want further surgery, knowing that breast reconstruction can
sometimes require several procedures to complete.
If you are planning on using a breast form, your doctor will tell you when you have
healed enough to be fitted for a permanent breast form or prosthesis. Most of these forms
are made from materials that mimic the movement, feel, and weight of natural tissue. A
properly weighted form provides the balance your body needs for correct posture and
anchors your bra, keeping it from riding up.
At first, these forms may feel too heavy, but in time they will feel natural. Prices vary
considerably. High price doesn't necessarily mean that the product is the best for you.
Take time to shop for a good fit, comfort, and an attractive, natural appearance in the bra
and under clothing. Your clothes should fit the way they did before surgery.
The right bra for you may very well be the one you have always worn. It may or may not
need adjustments. If there is tenderness during healing, a bra extender can help by
increasing the circumference of the bra so that it does not bind the chest too tightly.
Heavy-breasted women can relieve pressure on shoulder straps by slipping a bra shoulder
pad under one or both straps.
If you decide to wear your breast form in a pocket in your bra, you can have your regular
bra adapted. There are also special mastectomy bras with the pockets already sewn in. If
the breast form causes any kind of skin irritation, use a bra with a pocket. If your bra has
underwires, you may be able to wear it, but be sure to clear this with your doctor.
You might want to wear your prosthesis under nightgowns but would like something
more comfortable than a regular bra. Most department stores carry a soft bra, sometimes
called a leisure or night bra.
For a list of companies that sell breast prostheses and other accessories, see our
document, Breast Prostheses and Hair Loss Accessories List.
Insurance coverage of breast prostheses can vary. Be sure to read your insurance policy
to see what is covered and how you must submit claims. Also, ask your doctor to write
prescriptions for your prosthesis and for any special mastectomy bras. When purchasing
bras or breast forms, mark the bills and any checks you write "surgical." Medicare and
Medicaid can be used to pay for some of these expenses if you are eligible. The cost of
breast forms and bras with pockets may be tax deductible, as may the cost if you have a
bra altered. Keep careful records of all related expenses.
Be aware that some insurance companies will not cover both a breast prosthesis and
reconstructive surgery. That can mean that if you submit a claim for a prosthesis or bra to
your insurance company, in some cases the company will not cover reconstruction,
should you choose this procedure in the future. Make sure you get all the facts before
submitting any insurance claims.
Be sure to call your local ACS Reach To Recovery volunteer about any questions you
have. She will give you suggestions, additional reading material, and advice. Remember
that she's been there and will probably understand.
Sexuality after breast cancer
Concerns about sexuality are often very worrisome to a woman with breast cancer.
Several factors may place a woman at higher risk for sexual problems after breast cancer.
Physical changes (such as those after surgery) may make a woman less comfortable with
her body. Some treatments for breast cancer, such as chemotherapy, can change a
woman's hormone levels and may negatively affect sexual interest and/or response. A
diagnosis of breast cancer when a woman is in her 20s or 30s can be especially difficult
because choosing a partner and childbearing are often very important during this period.
Suggestions that may help a woman adjust to changes in her body image include looking
at and touching herself; seeking the support of others, preferably before surgery;
involving her partner as soon as possible after surgery; and openly communicating
feelings, needs, and wants created by her changed image.
Sexual impact of surgery and radiation
The most common sexual side effects stem from damage to a woman's feelings of
attractiveness. In our culture, we are taught to view breasts as a basic part of beauty and
femininity. If her breast has been removed, a woman may be insecure about whether her
partner will accept her and find her sexually pleasing.
The breasts and nipples are also sources of sexual pleasure for many women. Touching
the breasts is a common part of foreplay in our culture. For many women, breast
stimulation adds to sexual excitement.
Treatment for breast cancer can interfere with pleasure from breast caressing. After a
mastectomy, the whole breast is gone. Some women still enjoy being stroked around the
area of the healed scar. Others dislike being touched there and may no longer even enjoy
being touched on the remaining breast and nipple. Some women who have had a
mastectomy may feel self-conscious in sex positions where the area of the missing breast
is more visible.
Breast surgery or radiation to the breasts does not physically decrease a woman's sexual
desire. Nor does it decrease her ability to have vaginal lubrication or normal genital
feelings, or to reach orgasm. Some good news from recent research is that within a year
after their surgery, most women with early stage breast cancer have good emotional
adjustment and sexual satisfaction. They report a quality of life similar to women who
never had cancer.
A few women have chronic pain in their chests and shoulders after radical mastectomy.
During intercourse, supporting these areas with pillows and avoiding positions where
your weight rests on your chest or arms may help.
If you had breast-conserving surgery followed by radiation therapy, the breast may be
scarred. It also may be a different shape or size. During radiation therapy, the skin may
become red and swollen. The breast also may be a little tender. Feeling in the breast and
nipple, however, should return to normal.
Sexual impact of breast reconstruction
Breast reconstruction restores the shape of the breast, but it cannot restore normal breast
sensation. The nerve that supplies feeling to the nipple runs through the deep breast
tissue, and it gets disconnected during surgery. In a reconstructed breast, the feeling of
pleasure from touching the nipple is lost. A rebuilt nipple has much less feeling.
In time, the skin on the reconstructed breast will regain some sensitivity but probably will
not give the same kind of pleasure as before mastectomy. Breast reconstruction often
makes women more comfortable with their bodies, however, and helps them feel more
attractive.
Effect on your partner
Relationship issues are also important because the cancer diagnosis can be very
distressing for the partner, as well as the patient. Partners are usually concerned about
how to express their love physically and emotionally after treatment, especially surgery.
Breast cancer can be a growth experience for couples under certain circumstances. The
relationship may be enhanced if the partner takes part in decision-making and goes with
the woman to surgery and other treatments.
Pregnancy after breast cancer
Because many breast cancers are sensitive to estrogen, there has been concern that if a
woman has been treated for breast cancer, high hormone levels during pregnancy might
increase the chance of recurrence. Studies have shown, however, that pregnancy doesn’t
increase the risk of recurrence after successful treatment of breast cancer. Still, many
doctors advise breast cancer survivors not to become pregnant for at least 2 years after
treatment. This would allow any early return of the cancer to be diagnosed, which in turn
could affect a woman's decision to become pregnant. But this 2-year wait period is not
based on strong scientific evidence, and earlier pregnancy may not be harmful. Still,
chemotherapy and hormone therapy drugs can affect the fetus, so it isn’t safe to get
pregnant until all treatment is complete.
Women are advised to discuss their risk of recurrence with their doctors. In some cases,
counseling can help women with the complex issues and uncertainties about motherhood
and breast cancer survivorship.
Post-menopausal hormone therapy after breast cancer
The known link between estrogen levels and breast cancer growth has discouraged many
women and their doctors from choosing or recommending post-menopausal hormone
therapy (PHT), also called hormone replacement therapy (HRT), to help relieve
menopausal symptoms. Unfortunately, many women experience menopausal symptoms
after treatment for breast cancer. This can occur naturally, as a result of post-menopausal
women stopping PHT, or in pre-menopausal women as a result of chemotherapy or
ovarian ablation. Tamoxifen and aromatase inhibitors can also cause menopausal
symptoms such as hot flashes.
In the past, doctors have offered PHT after breast cancer treatment to women suffering
from severe symptoms because early studies had shown no harm. But a well-designed
clinical trial (the HABITS study) found that breast cancer survivors taking PHT were
much more likely to develop a new or recurrent breast cancer than women who were not
taking the drugs. This is why most doctors now feel that for women previously treated for
breast cancer, taking PHT would be unwise.
Women may want to discuss with their doctors alternatives to PHT to help with specific
menopausal symptoms. Some doctors have suggested that phytoestrogens (estrogen-like
substances from certain plant sources, such as soy products) may be safer than the
estrogens used in PHT. However, although eating soy foods seems to be safe for breast
cancer survivors, there is not enough information available on phytoestrogen supplements
to fully evaluate their safety.
Drugs without hormonal properties that may be somewhat effective in treating hot flashes
include the antidepressant venlafaxine (Effexor®), the blood pressure drug clonidine, and
the nerve drug gabapentin (Neurontin®). Acupuncture also seems to be helpful in treating
hot flashes. For women taking tamoxifen, it's important to note that some antidepressants,
known as SSRIs, may interact with tamoxifen and could make it less effective. Ask your
doctor about any possible interactions between tamoxifen and any drugs you may be
taking.
Seeing a new doctor after breast cancer treatment
At some point after your cancer diagnosis and treatment, you may find yourself seeing a
new doctor who does not know anything about your medical history. It is important that
you be able to give your new doctor the details of your diagnosis and treatment. Make
sure you have the following information handy:
· A copy of your pathology report(s) from any biopsies or surgeries
· If you had surgery, a copy of your operative report(s)
· If you were in the hospital, a copy of the discharge summary that doctors prepare
when patients are sent home
· If you had radiation therapy, a copy of your treatment summary
· If you had systemic therapy (hormone therapy, chemotherapy, or targeted therapies),
a list of your drugs, drug doses, and when you took them

The doctor may want copies of this information for his records, but always keep copies
for yourself.