External Breast Prostheses: Misinformation and False Beliefs

Irene R. Healey, B Sc

Disclosures
In This Article

"Shoulder Drop" and the Myth of the Weighted Breast Prosthesis

Women are told they must wear a "weighted" breast prosthesis to simulate the weight of the missing breast in order to "restore balance." Advertisements tell women that the consequence of not doing so may result in them developing "a problem with their balance," "spinal problems," and "shoulder drop." Women with breast cancer who are reading this material are already in a state of heightened anxiety over their health and even more vulnerable to false claims regarding their well being. Unfortunately, the claim that women will develop problems with their skeletal alignment or balance by not wearing a prosthesis that replaces the weight of the missing breast is not evidence-based. It is not supported by any scientific study of the posture of women after a mastectomy.

The clinical-sounding term "shoulder drop" is only used in the marketing of external breast prostheses. A Google search of "shoulder drop" linked with "breast prosthesis" resulted in 60 hits, all of which were selling various brands of external breast prostheses. "Shoulder drop" does not appear in the NCI cancer dictionary or in any other medical dictionary. A PubMed literature search of "shoulder drop" linked with "breast cancer" produced no results. A PubMed search of "shoulder drop" alone resulted in articles on topics unrelated to breast cancer, such as peripheral nerve injuries and lesions of the spinal accessory nerve. A Medline literature search using the key words "posture," "skeletal alignment," "balance," and "back pain" shows that these physical problems develop as a result of a variety of causes. Not one study was found that made reference to these complaints being associated with women not wearing a weighted external breast prosthesis after mastectomy. Instead, these complaints are attributed to factors, including the structure of the skeleton the woman was born with; stress; occupational factors; lifestyle choices such as wearing high heels; diseases such as osteoporosis, diabetes, or arthritis; and the loss of muscle mass, to name but a few.[27,28,29,30,31,32,33,34,35,36,37]

The majority of breast cancers are seen in women at middle age and older. These women will begin to show the general effects of aging and have physical complaints arising from life-long habits, disease, and occupational wear and tear. It stands to reason that a certain number of women, at middle age and beyond, will be found to stand at rest with one shoulder lower than the other. Some of these women will have aches in their back. A percentage of these women will also lose a breast to cancer. What is being noticed perhaps is a correlation, but there is no evidence of a causal relationship between the loss of the breast and any skeletal symptomatology.

One consequence of using the pseudo medical term "shoulder drop" as a marketing tool is that it may in fact impede a woman as she searches for the optimal adjustment to her post treatment life. "Physical activity promises to be one modifiable risk factor through which women can reduce their risk for breast cancer. Clinicians can now advise women that reducing risk for breast cancer may be one additional reason to adopt an active lifestyle."[38] Women who exercise reduce their risk of breast cancer by preventing weight gain or by lowering their weight.[38,39,40,41] It remains unclear whether exercise may also reduce the risk of a recurrence of breast cancer. Excess weight and obesity are associated with increased levels of estrogen, and physical activity decreases the exposure of breast tissue to estrogen, a growth stimulant. This could possibly also have an influence on the likelihood of a recurrence in a secondary site just as it may stimulate the growth of cancer cells in a new primary site. Added to the benefits of reducing the risk of cancer, physical activity is associated with reduced mortality in general,[42,43] including a reduced risk of heart disease,[44,45] a lower risk of diabetes,[46] and proven effectiveness at lowering stress and anxiety.[47]

Clearly, one of the most important aspects to be investigated in external breast prostheses is the impact the prosthesis has on a woman's level of physical activity after mastectomy. Physical exercise is an important contributor to a woman's quality of life, her psychological well being, her physical health, and even possibly to her survival. If women continue to wear a weighted breast, due to fear of the medical consequences of not doing so, then this false claim may well be a myth that is effectively preventing women from pursuing true healthier lifestyle options.

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