External Breast Prostheses: Misinformation and False Beliefs

Irene R. Healey, B Sc

Disclosures
In This Article

Abstract and Introduction

This article discusses common myths associated with the use of external breast prostheses and the impact this misinformation may have on the quality of life of women after mastectomy. A review of the literature reveals that very little research has been conducted on this subject. The majority of information on breast prostheses is provided by the manufacturers and tacitly accepted by healthcare providers and the media in general. Claims regarding the medical necessity of a weighted prosthesis and the suitability of gel fillings are examined and found wanting. Widespread acceptance of these myths may be preventing women from pursuing healthy lifestyle options and restricting the development of more suitable prosthetic products. The article concludes that a rigorous, evidence-based approach to the evaluation of external breast prostheses would enhance both the development of this noninvasive and cost-effective sector of post-mastectomy care, as well as the adjustment, well being and quality of life of breast cancer survivors.

False beliefs and myths exist in the practice of medicine, extending as well to the treatment of breast cancer.[1,2,3] Over time, misconceptions should be subjected to critical evaluation so misinformation can be corrected. This article discusses misinformation associated with the use of external breast prostheses and the impact this misinformation may be having on the quality of life of women after mastectomy.

With the diagnosis of breast cancer, a woman must make many decisions regarding the treatment she will receive. Even if she chooses to defer the decision making to medical practitioners or other authority figures, she cannot escape the necessity of taking actions that will determine her course of treatment and her quality of life afterwards. The need to give consent to treatment requires adequate access to information upon which to make an informed decision. The process of arriving at decisions will be influenced by many factors, including the woman's personality, her use of coping mechanisms, and, importantly, the attitude of the medical team and their attitude toward her choices.[4,5,6,7,8]

The Internet has facilitated the search for information on which to base such life-altering decisions.[9] A woman with high information needs can find detailed information concerning her surgical reconstruction options through a variety of sources -- for example, the Web site for the US Food and Drug Administration. Such Web sites clearly outline the risks involved with surgical reconstruction either by implantation or with autologous tissue. It has been noted that women who are well informed adjust better to their treatment outcomes, and a well-informed person is more likely to engage in discussions with her surgeon about her treatment options.[10]

Having a mastectomy, however, leads to a tier of decision making regarding whether to have surgical reconstruction, wear an external breast prosthesis, or not wear anything at all to replace the amputated breast. Almost nothing is known about women who decide not to have surgical reconstruction and not wear a prosthesis, and little research has been done regarding external breast prostheses and their influence on a woman's quality of life after mastectomy.[11] "It is estimated that up to 90% of women who have had a mastectomy use breast prostheses. At present little is known about how women access information about breast prostheses.... their patterns of prosthesis use, satisfaction levels, and how the prosthesis impacts on their quality of life."[12]

The majority of information on breast prostheses is provided by the manufacturers. Women are often referred to "certified fitters" to answer their questions regarding external breast prostheses. Certified fitters are retail staff that breast prosthesis manufacturers have trained to fit and sell their products. Some, however, may not have adequate education in healthcare or oncology. "However well-intentioned fitters may be, they may not have the necessary training to adequately deal with the psychological and emotional issues many women experience."[12,13]

Women may not know the attitudes their primary care givers have towards external breast prostheses. Women may not be able to gather adequate information regarding external breast prostheses in an unbiased manner either from the manufactures, retailers, or their healthcare providers, in order to make an informed decision regarding their cancer care. Although the majority of women who have a mastectomy will go on to wear an external breast prosthesis,[14,15] it is an area of a woman's post mastectomy treatment that has the least amount of objective information available to her and that has been subject to the least amount of scientific inquiry.[11]

External breast prosthesis manufacturers claim they have studied the weight and movement of breast tissue and that they can provide women with what they need.[16] Some reference books on breast care, written for the lay public, mirror this optimism and tell women that, "....there is a good prosthesis for every woman who has had a mastectomy."[17] Yet studies show that when researchers ask specific questions of women who wear a breast prosthesis, there is a list of complaints.

Objective and open discussion of the complications arising from surgical reconstruction provides an impetus for further research and improvement in surgical outcomes. This type of objective measurement and critique of practice does not occur in the breast prosthetic industry. One could argue that this is not necessary, because wearing an external breast prosthesis is not invasive and does not have the same attendant health risks associated with autologous tissue reconstruction or prosthesis implantation and therefore does not merit the same scrutiny. However, surgical articles state that the most common reason for choosing reconstruction is to not wear the external prosthesis.[18] Given the continuum of choices a woman must navigate throughout her cancer treatment, one could argue that there is a hypothetical link between her dissatisfaction with external breast prostheses and the physical consequences she encounters with surgical reconstruction -- if she chooses to have the surgery out of dissatisfaction with her external breast prosthesis. Therefore, the lack of evidence-based information concerning external breast prostheses, and the problems arising from wearing a prosthesis, may well have more of an impact on women's health than believed at first glance.

Over 30% of women are dissatisfied with their external breast prosthesis.[12] Journal articles note that many women find breast prostheses to be hot and heavy, to limit a woman's choice in clothing, and to become displaced with movement.[18,19,20,21] Many women wear the prosthesis only when they are outside the home, and many continue to wear the lightweight foam shells, meant to serve as a temporary prosthesis, many years after their mastectomy.[22] In addition to the physical discomfort associated with wearing a prosthesis, a gel-filled prosthesis may emit a noise when struck.[23] Many gel-filled prostheses are designed with a hollow cavity in the back to decrease the weight and minimize contact with the uneven contours of the chest wall. Suction can form when the prosthesis is pressed against the chest by the bra. When this suction is broken with physical activity, a sound can be created. Adhesive-retained prostheses attempt to mitigate the creation of noise in prostheses.[20]

Because information on external breast prostheses is largely presented to women by the manufacturers and vendors of these prostheses, it is understandable that they may overstate the virtues of their product and not refer to difficulties that some women experience with them. Additionally, some of the Web sites that women access for general information on breast cancer and its treatment are, in fact, maintained by external breast prosthesis manufacturers. It stands to reason, therefore, that misinformation and false beliefs regarding external breast prostheses are reinforced and perpetuated.

The National Cancer Institute (NCI) estimates that about 1 in 8 women in the United States (approximately 13.3%) will develop breast cancer during her lifetime. According to the National Alliance of Breast Cancer Organizations, more than 200,000 new breast cancer cases are diagnosed each year in the United States; there are more than 2 million breast cancer survivors. One report has estimated that the number in the United States may increase to 400,000[24] annually due to the increased number of people born after 1945 entering the age group when cancer is most likely to occur. Forty-eight percent of the cases of breast cancer occur in women older than 65 years, and 30% occur in those older than age 70.[25] Older women are more likely to choose a breast prosthesis over surgical reconstruction after a mastectomy.[18] Therefore, the number of women seeking an external breast prosthesis for their nonsurgical restoration after mastectomy can be expected to increase as the incidence of breast cancer increases in the aging population.

The impact of breast cancer on a woman's physical, social, and psychological well being is undeniable. When adapting to life after cancer, a woman may want to re-engage in previous behavior and seek to re-establish the life she led before having become a "breast cancer patient." Alternatively, the occurrence of cancer may spur the individual to make positive changes in her life,[26] such as changing jobs or being more attentive to good nutrition and exercise.

Have we identified the features in external breast prostheses that facilitate an optimal quality of life after mastectomy? Conversely, do we know enough about those features that have a negative impact on a woman's life after mastectomy?

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