External Breast Prostheses: Misinformation and False Beliefs

Irene R. Healey, B Sc

Disclosures
In This Article

Do Gels Really "Move and Feel" Like Breast Tissue? Are There Better Materials?

Are there other reasons to wear a "weighted" external breast prosthesis? The most common filler material used today in external breast prostheses, meant for long-term wear, is gel. Most of the variation and choice in contemporary external breast prostheses appears to be in the design of the prosthesis. Dow Corning, one of the developers of silicone, held the patent on silicone gel and introduced gel-filled breast prostheses as an implantable device in the early 1960s. In the late 1960s, Dow Corning collaborated with a large prosthetic company to market gel-filled external breast prostheses.[48]

Advertisements for breast prostheses claim that gel "moves and feels like breast tissue." How a real breast moves or feels may be subjective and will probably vary depending on the age of the woman, whether she has had children, and other factors such as having dense breast tissue. Moreover, when trying to simulate a breast, one must take into consideration that the breast, real or prosthetic, will most likely be contained within a bra. The type of bra a woman chooses to wear will also contribute to the feel of the breast that the prosthesis is intended to simulate.

The weight of a gel is similar to breast tissue (tissue being mostly water and the weight of gel being close to that of water). This single similarity, however, does not mean that gels mimic the breast in all regards, and it has not been demonstrated that weight is the feature that women benefit from most. An implanted gel-filled breast prosthesis may indeed feel like a real breast, but the implant is held in place behind skin and/or muscle. In fact, with capsular contraction, it may be too well held in place. External breast prostheses must be secured in place with adhesives and Velcro attachments or by a sticky-back surface. However, many wearers have a skin reaction to the glues -- particularly after radiation therapy -- and they do not work well in hot weather or with menopausal symptoms.[49,50]

Given the negative attributes of gel-filled prostheses, such as noise and displacement as a result of its weight, one can question whether gel really is the most appropriate material. Gel may be too literal a translation of the concept of breast tissue. In fact, a conviction that a weighted gel-filled prosthesis is necessary for medical reasons may curtail the development and application of new materials and different designs.

Studies on the satisfaction levels of women who wear a breast prosthesis compared with those who chose surgical reconstruction never define the physical characteristics of the prosthesis the women were wearing.[18,19,11] This implies that contemporary breast prosthesis manufacturers can only employ 1 type of design and use only 1 type of material, which is not the case. Could it be that women who are dissatisfied with breast prostheses are in fact dissatisfied with only certain properties of the prosthesis that could be altered?

As of June 1999, the US Patent Office listed 178 patents for the design and manufacturing of external breast prostheses.[51] The first patent for the design and manufacture of a breast prosthesis was granted in 1874. In the past century, breast prostheses have been available through mail order, as a store-bought stock item, and as a custom-made device. The basic design of a prosthesis with an outer casing forming the skin of the prosthesis with an inside filling was patented early in the past century. Down, cotton, and different types of foam and fiber have been used in the past to create the missing breast. This demonstrates that there are, in fact, many choices in materials and options in the design and delivery systems.

In light of the cost of surgical reconstruction and the risks involved for what is essentially an elective surgery, women who desire to wear an external breast prosthesis should have options that are just as complex, variable, and well researched as their surgical alternatives. There should be an option for women that is not as invasive as surgery but is as individualized as the surgical options. Given the cost of surgical reconstruction to the public healthcare system and to private insurers, better prostheses that satisfy the needs of women could ultimately result in savings. More important, however, is that women need choices in all aspects of their cancer care and this extends to the design, weight, and material used to create a prosthetic breast which is meant to replace a part of their own body.

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