INTRODUCTION:

Breast cancer is a global health issue and a leading cause of death among women internationally, is the disease women fear most. Breast cancer is caused by uncontrolled growth of abnormal cells in the breast. Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer to present further spread of infection.¹Therefore rehabilitation after mastectomy is integral to women’s health promotion. Most of the women select breast restoration and symmetry through breast reconstruction or external breast prosthesis (EBP).²

Definition:

External breast prosthesis is an artificial breast that is worn under clothing to imitate the shape of the breast. It fits in a bra cup with or without a bra pocket.³

History:

Breast prostheses have a long history. In the 19^th century they were made of rubber. On the 27 January 1874, a U.S. patent for a “breast pad” was issued to Frederik Cox (No. US 146805).

His design consisted of rubber pads filled with air encased in cotton. Later in 1885, Charles L. Morehouse received US patent 326915 for his “Breast pads”, made of natural rubber and inflatable with air at normal pressure. Newer designs such as that of Laura Wolfe’s in 1904 parted with the air filled design, which was prone to punctures, in favor of down feather and silk floss filling. Mastectomies are known since1861, then women all around the world try to replace the volume of their breast, it’s due to breast cancer treatment.⁴

Purposes:

· To recreate the appearance of the breast

· To improve symmetry and balance

· To protect the posture

· To improve self-confidence

· To prevent shoulder drop

· To prevent problems with curvature of the spine and muscular pain in the neck and back

· Ptosis of the contra lateral breast.

· To improve quality of life.^4,5,7,10

Reasons for Choose to wear the External Breast Prosthesis:

1. Replacing the weight of the lost breast:

When a breast is removed, the body is no longer balanced. This can cause a slight curving of the spine and a drop of the shoulder on the affected side. Lower back and neck pain may develop over time. Issues with balance after having a mastectomy can affect women of any breast size. An external breast prosthesis can help with balance.

2. Creating symmetry when wearing clothing:

Most women don’t have identical breasts – the muscle and tissue on each side of the body are different. After a mastectomy, these differences are usually more noticeable. A external breast prosthesis may help to feel and look more even on both sides (symmetrical).

3. Restoring self-esteem:

Re-creating a more natural appearance with a external breast prosthesis may help to boost the confidence – including sexual confidence – about the way of body looks after a mastectomy.

4. Adjusting to the diagnosis and treatment:

Using a external breast prosthesis may help your cope better with the experience of cancer.⁶

Psychological Consideration:

After a lumpectomy or mastectomy, both physical and psychological health of women can be affected as an outcome of tissue removal. It can leave women with an altered center of gravity, and could have negative impacts on posture as well as balance. A prostheses may help to correct balance and posture deficiencies caused by tissue removal. Breast prostheses also have psychological benefits by providing a sense of femininity for women.⁴

Indications:

· It replaces the natural breast after a complete mastectomy

· It improves their body image, posture and self esteem.

· It provide only after mastectomy wound healing women

· Autofocus Reconstruction

· Contra lateral symmetry procedure

· It improve the physical and psychological health of mastectomy women

Contra Indications:

· Expander-implant reconstruction

· Insufficient skin soft tissue and muscle to cover the prosthesis

· Incomplete mastectomy wound healing women.^4,5,7,10

Types of External Breast Prosthesis:

Prostheses come in a wide variety of shapes, sizes and skin tones and are made from materials that are designed to move, feel and weight as similar to a mutual breast as possible.

i) Full or standard prosthesis:

This prosthesis has various backings designed to go straight against the chest wall where all breast tissue has been removed. It’s matched in size, shape and skin tone to other breast.

ii) Partial or shaped prosthesis:

A partial prosthesis is for women who have had part of their breast removed. It’s worn inside a bra and is shaped to fill out the breast outline. It’s made of the same silicone material as most full prosthesis.

iii) Shell prosthesis:

A soft shell of made of silicon is placed around the smaller breast to help match the size of the large one. They are typically made to have a polyester front with a breathable cotton backing and are lightweight.

iv) Stick-on prosthesis:

Stick on prosthesis (Full or partial) sticks directly into the skin. These can suit women who are active or who want to wear a less supportive bra, as not all of the weight is taken by the bra. They can also be worn with strapless dresses and tops if the clothing is supportive enough.

Contra-indication of stick-on prosthesis:

Most women will be advised not to wear a stick- on prosthesis for 12 months after surgery or during (and sometimes after) radiotherapy as it may damage the skin. They can be worn either by attaching it directly to the chest wall or as a regular prosthesis with a protective backing over the stick-on part.

v) custom - made prosthesis:

Some shops can customize prosthetics to match natural color, size of other breast, and the bodies natural contour. Silicon and latex materials are normally used.^4,6,8,9,10

Shapes of External Breast Prosthesis:

Breast prostheses come in symmetrical, teardrop and asymmetrical shape.

i) Symmetrical:

The symmetrical form is usually an oval or triangular shape that can be worn on either the left or right side.

ii) Asymmetrical or pear-shaped:

Asymmetrical or pear-shaped are generally more suitable for women who have had more extensive surgery as they have extensions to fit under the arm or upper chest wall. However, they can also be used by women who have not had extensive surgery. They are specifically designed for either the left or right side.

iii) Teardrop:

The teardrop shape is often more suitable for women whose breasts are fuller in the lower and outer area and less full above the nipple. These can also be worn on either the right or left side.^7,8,9,10

Weights of External Breast Prosthesis

i) Full weight prosthesis:

Full weight silicone breast prosthesis will help to balance better. A large sized silicone breast prosthesis would make it more uncomfortable and result in pain in shoulder and back.

ii) Light weight prosthesis:

Women are allowed to wear a temporary light fiber-filled breast form after a few days of surgery. It can restore shape and also prevents irritation to sensitive issues. After six to eight weeks of surgery, the permanent silicone fiber can be worn.

iii) Temperature and skin tone:

· Newer breast prostheses are designed to allow for better air circulation.

· Many prostheses are available in colors which can suit different skin tones.^3,6,9,10

External Breast Prosthesis Available Materials In The Market:

i) Silicone gel:

Silicone gel is a non-toxic, synthetically made substance. Most breast prostheses are made from soft silicone gel encased in a thin film. They are moulded to resemble the natural shape of a women’s breast, or part of a breast. The outer surface feels soft and smooth, and may include a nipple outline. Silicone prosthesis can’t be absorbed through the skin.

ii) Foam prosthesis:

Foam prosthesis is lighter and cooler. It may be more suitable if you are particularly active or if may find this style more comfortable in warmer weather.

iii) Polypropylene beads prosthesis:

Some prosthesis are filled with polypropylene beads. These mould into the shape of the bra and, as air is able to circulate, they are cooler.

iv) Camisoles:

Camisoles that have soft attachable prostheses can be worn immediately after surgery until the surgical site in healed.

v) Swim prosthesis:

Swim prosthesis are made especially for use when swimming and don’t get damaged by salt water or chlorine.

vi) Breast prosthesis backings:

The backing of most prostheses is made of the same material as the front.

· Some may have a different backing, such as fabric or a panel of gel, designed to make them more comfortable.

· Backing that can be moulded to fit an uneven chest wall are also available. Some prostheses have backing that allow more air flow and may be cooler.

vii) Prosthetic nipples:

Prosthetic or ‘artificial’ nipples are made of soft silicone that can be worn on a reconstructed breast or prosthesis.

· They are either self-sticking or come with special skin glue that can hold the prosthetic nipple in place for several days.

^·Prosthetic nipples come in different sizes and skin colors but some hospitals custom- make them so they match the nipple on your other breast.^5,6,7,8,10

Made to Measure:

This technique uses a 3D scanner to produce a computerized 3D image of the chest area, which can then be used to create a customized prosthesis shape. It is made to give a good match to the chest wall, which stops the prostheses moving, and is matched to your skin tone.^5,8,10

External Breast Prosthesis Fitting:

It is important to take a well-fitting bra to the external breast prosthesis.^8,10

Utilization of External Breast Prosthesis:

· Once your scar area is fully healed and swelling has gone down ( usually within six to eight weeks ) can be fitted for permanent silicone prosthesis, if choose.

· External breast prosthesis can be utilized 1 to 2 years.^4,5,8

Cost of External Breast Prosthesis:

· For a pre-made silicone prosthesis the average cost is about RS.4000 to 5000/-

· For custom made prosthesis the cost could be up to RS.25000 and more.^6,8

Other Considerations:

1. Insurance Of The External Breast Prosthesis:

Breast prostheses or mastectomy bras are covered by most insurance. To get these covered one should obtain a prescription from their physician. Custom-made prostheses are not usually covered by insurances due to their high costs.

2. Care Of The External Breast Prosthesis:

· Hand washes the prosthesis after every wear.

· Wash it daily in warm soapy water and dry it with a towel.

· Rinse the breast form well in clean water soon after swimming to remove any chlorine or Saltwater.

· Use a soft, fiber-filled from in a sauna or spa-silicone prosthesis may heat up against your skin.

· Avoid using perfumed deodorant, as this can damage the breast form.

· Take care not be to catch the prosthesis with sharp objects such as rights or brooches as these may damage it, causing the silicone to leak. If it does get damaged, you can usually seal the year temporarily with a sticking plaster.^4,5,6,8,10

CONCLUSION:

External breast prosthesis usage is highlights the worldwide breast cancer. It’s also improved women’s physical, psychological, social, spiritual and sexual health after mastectomy. Using external breast prosthesis can help them to improve their body image, self confidence and body posture. External breast prosthesis is a valuable method of post-mastectomy women, which improves quality of life.

REFERENCE:

1. Mastectomy form Wikipedia, the free encyclopedia. Available from https://en.m.wikipedia.org/wiki/Mastectomy

2. Jetha Z.A et al (2017) Women experience of using external breast prosthesis after mastectomy. Asio-Pasific Journal of Oncology Nursing. Vol 4. Issue 3.

3. External Breast Prostheses, from Cancer Australia. Available from https://www.canceraustralia.gov.au/affected-cancer-types/breast-cancer/external-breast-prostheses

4. Breast Prostheses from Wikipedia, the free encyclopedia. Available from https://en.m.wikipedia.org/wiki/Breast-Prosthese

5. The importance of wearing Breast Prosthesis, from medisiamedic. Available from https://medisiamedic.com/importance-wearing-breast-prosthesis/

6. Breast Prostheses. From Cancer Council Victoria. Available from https://www.cancer Vic.org.au/living-with-Cancer/common-side-effects/breast-prostheses-and-reconstruction/ breast-prosthesis-froms.html

7. Choosing a Prosthesis After Breast Cancer Surgery. From HealthlinkBC. Available from https://www.healthlinkbc.ca/health-topics/abk42220

8. Prosthesis styles. From breast cancer now. Available from https://breastcancernow.org/information-support/facing-cancer/living-beyond-breast-Cancer/your-body/breast-prosthesis/types-breast-prosthesis

9. Breast Prosthestics, from scheckandsiress. Available from https://www.scheckandsiress.com/products-services/post-mastectomy-care/

10. Balance your body with Breast Prosthesis, from artificial eye co. Available from http://www.artificaleyeco.com/breast-prosthesis.php

Received on 10.10.2020 Modified on 14.01.2021

Asian J. Nursing Education and Research. 2021; 11(3):427-430.

DOI: 10.52711/2349-2996.2021.00103