Breast Forms and Other Reconstruction Alternatives

If you don't get breast reconstruction after a mastectomy, you have the option to wear a breast form inside a bra or attached to your body. This is also called a breast prosthesis.

You can also choose not to wear a breast form. This is sometimes called “going flat.” People who go flat often have a procedure known as an aesthetic flat closure to tighten and smooth out the chest wall.

Why do some people choose not to get breast reconstruction?

There are many reasons why you might choose not to get reconstruction after a mastectomy.

You might decide you don’t want any surgery other than what you need to treat your cancer. Or you might want to get back to your normal activities as soon as possible. Some people are just more comfortable with how they look and feel after a mastectomy. Cost might also be an issue, especially for people without insurance coverage.

For other people, breast reconstruction might be difficult or impossible because of health issues. For example, reconstruction might not be an option if you have obesity or if you have blood circulation problems from continued smoking or poorly controlled diabetes.

What if I change my mind later?

If you change your mind later, reconstruction is usually still an option. But keep in mind that it may be easier to get the results you want if you make the decision before you have breast cancer surgery.

Using a breast form (prosthesis)

A breast form (prosthesis) is worn either inside a bra or attached to your body to simulate the look and feel of a natural breast. 

Wearing a breast form is an option for people who decide not to get reconstructive surgery but want to keep the same look under their clothes. If you haven’t decided about reconstruction, or if you are having reconstruction later, you might choose to use a breast form for a while.

Your healthcare team will tell you when you've healed enough to be fitted for a breast form.

What do breast forms feel like?

Most breast forms are made from materials that try to copy the movement, feel, and weight of natural breast tissue. A properly weighted form provides the balance your body needs for correct posture. It also anchors your bra, keeping it from riding up. At first, these forms may feel too heavy, but in time they should begin to feel natural.

Choosing the right bra for your breast form

The right bra for you may very well be the one you’ve always worn. You may be able to wear an underwire bra, but clear this with your healthcare team first.

You can also add adjustments or wear a bra with pockets.

Your regular bra

If you wear a breast form with your regular bra, it may or may not need adjustments, such as a:

• Bra extender. If you have tenderness while you heal, a bra extender can help by increasing the width of your bra so that it does not wrap around your chest too tightly. This is done with small pieces of fabric that attach to your bra fastener.
• Bra shoulder pad. If you have large, heavy breasts, you can relieve pressure on your shoulder straps by sliding a bra shoulder pad under one or both straps.

A bra with pockets

If you decide to wear your breast form in a pocket in your bra, you can have your regular bra altered. You can also use a special mastectomy bra with the pockets already sewn in. If the breast form irritates your skin, use a bra with a pocket.

A leisure or night bra

If you want to wear your breast form under sleepwear but would like something more comfortable than a regular bra, look for a soft bra. This is sometimes called a leisure or night bra. These can be found online or in most department stores.

Finding and paying for breast forms

Several online retailers sell breast forms. You might also have a specialty store near you. Ask your breast surgeon for suggestions or use the American Cancer Society Resource Search to get started.

Prices for breast forms vary considerably.

A high price does not necessarily mean that the product is the best for you. Take time to shop for a good fit, comfort, and a natural appearance in the bra and under clothing. Your clothes should fit the way they did before surgery.

Insurance coverage

Your insurance may cover some or all of the cost of a breast form, but coverage varies. Medicare and Medicaid can be used to pay for some of these expenses if you are eligible. Contact your health insurance company to find out what will be covered and how you must submit claims.

The cost of breast forms and bras with pockets and the cost of having a bra altered might also be tax deductible.

To help with your insurance claims:

• Ask your surgeon to write prescriptions for your breast form and for any special mastectomy bras.
• When you buy bras or breast forms, mark the bills and any checks you write "surgical."
• Keep careful records of all related expenses.

Some insurance companies will not cover both a breast form and reconstructive surgery.

That can mean that if you submit a claim for a breast form or bra to your insurance company, in some cases the company will not cover reconstruction if you decide to have the surgery in the future.

Make sure you get all the facts before submitting any insurance claims.

Aesthetic flat closure and “going flat”

Some people choose to “go flat” after having a mastectomy, meaning they do not have reconstruction and they also do not wear a breast form. This might be because they find breast forms uncomfortable or too expensive, or because they’re comfortable with how they look and feel without a breast form and don’t feel the need to wear one.  Some people use a breast form when they are out, but not when they are at home.

People who go flat often have a procedure called aesthetic flat closure (AFC). This involves removing extra fat, skin, and other tissue in the breast area during surgery. The leftover tissue is tightened and smoothed out to flatten the chest wall.

Balance and posture

Most people do not have any added health issues from going flat, especially if both breasts were removed. But if only one of your breasts is removed, you might notice issues with balance, posture, or back pain, especially if you have large breasts. This is one reason some people prefer to wear a breast form to balance out the weight on their chest.

If you think this might be an issue for you, talk to your healthcare team about your options.

Making the decision to go flat

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 running errands. You might find that most people won’t notice a difference. If you still feel self-conscious, you can always go back to wearing a breast form.

Clothing choices

Some people who go flat use certain types of clothing to help them feel more comfortable with the way their chest looks.

For example:

• Wearing loose-fitting tops with busy patterns.
• Layering sweaters or jackets over close-fitting tops.
• Using scarves and shawls to cover all or part of your chest.

Adding nipple prosthetics

Some people like the idea of going flat but are uncomfortable about not having nipples. Several companies now make nipple prosthetics. These are made of silicone or other materials and look and feel much like real nipples. They can be attached to your chest and then taken off when you choose. You can learn more about this in Reconstructing the Nipple and Areola After Breast Surgery.