Breast Reconstruction Alternatives
Some women who have had a mastectomy as part of their breast cancer treatment do not have breast reconstruction. Breast forms worn inside the bra or attached to the body are available for women who want to wear them under their clothes. Other women choose to just have a flat chest.
What if I choose not to get breast reconstruction?
Some women decide not to have any type of breast reconstruction. They might decide they don’t want to have any more surgeries than they need to treat the cancer, or that they want to be able to get back to their normal activities as soon as possible. Some women are just more comfortable with how they look and feel after the surgery to remove their cancer. Costs might also be an issue, especially for women who don’t have insurance coverage. If you change your mind later, reconstruction is usually still an option. But keep in mind that it may be easier to get the result you want if you make the decision before you have your mastectomy.
For other women, breast reconstruction might be difficult, or even not possible, because of other health issues they have. For example, you might not be able to have reconstruction if you are obese, too thin, or have blood circulation problems.
Women who don’t have breast reconstruction after surgery have two main options:
- Using a breast form or prosthesis
- Going flat (choosing no reconstruction and not wearing a breast form)
Using a breast form or prosthesis
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. Wearing a breast form is an option for women who have decided not to get reconstructive surgery but want to keep the same look under their clothes. If you haven’t decided about reconstruction, or are having reconstruction later, you might decide to use a breast form temporarily.
Most breast 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.
If you are planning to use a breast form, your doctor will tell you when you have healed enough to be fitted for a permanent breast form or prosthesis.
Choosing the right bra for your breast form
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.
If you want to wear your prosthesis under nightgowns but would like something more comfortable than a regular bra, look for a soft bra, sometimes called a leisure or night bra. These are available in most department stores.
Finding and paying for breast prostheses
Prices for breast forms 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.
Insurance coverage of breast prostheses can vary. Be sure to contact your insurance provider to find out what will be 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.
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.
Some women who do not have reconstruction decide not to wear a breast form, either. Or they might use a breast form at times while out in public but not at home. This might be because they find breast forms uncomfortable or too expensive, or just because they’re comfortable with how they look and feel without a breast form and don’t feel the need to wear one.
For most women, there aren’t likely to be any added health issues from going flat, especially if both breasts were removed. But if you’ve only had one breast removed, you might notice issues with balance, posture, or back pain, especially if you’ve always had large breasts. This is one reason some women prefer to wear a breast form – to balance out the weight on their chest. Talk to your doctor about your options if you think this might be an issue for you.
If the idea of going flat appeals to you but you’re worried about what others might think, try going without a breast form in different situations, such as at home, out with friends, or while out running errands. You might find that most people won’t notice a difference. If you find you still feel self-conscious, you can always go back to wearing a breast form.
If you decide to go flat, you may want to consider wearing clothing that might help you feel more comfortable with your appearance. Try wearing tops that are not tightly fitting and that have busy patterns, or layer sweaters or jackets over close-fitting tops. Scarves and shawls can also cover all or part of your chest.
Some women might like the idea of going flat but are uncomfortable about not having nipples. Some companies now make nipple prosthetics, which are made of silicone or other materials and look and feel like real nipples. They can be attached to the chest and then taken off when you choose to.
Finding help and support
No matter which options you choose, it’s important to know that there is advice and support out there to help you cope with the changes you’re going through. Speaking with your doctor or other members of your health care team is often a good starting point. There are also many support groups available, such as the American Cancer Society Reach To Recovery program. This program matches you up with a local volunteer who has had breast cancer. Your Reach To Recovery volunteer can answer many of your questions. She can give you suggestions, additional reading material, and advice. Remember that she’s been there and will probably understand.
Last Medical Review: June 1, 2016 Last Revised: August 18, 2016
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