External Breast Prostheses: Misinformation and False Beliefs

Irene R. Healey, B Sc

Disclosures
In This Article

Would All Women Benefit From Surgical Reconstruction?

There will always be a need for external breast prostheses. Articles that look at why women decide to delay or not have surgical reconstruction list that they are anxious about additional surgery, do not want anything foreign in their body, are dissatisfied with the expected cosmetic results, or feel they are too old.[18,56] Additionally, the majority of breast cancers occur in older women who may have other age-related circumstances and comorbidities that prevent them from having surgical reconstruction. Women with metastatic disease and those who smoke or are obese may be excluded from surgery. Some women will have failed attempts at surgical reconstruction, and others may wish to delay their decision to have surgical reconstruction and want to wear a breast prosthesis in the interim.

Plastic surgeons looking at the results of their work seek to quantify the benefits women obtain from the different types of surgical reconstruction. Studies have compared the psychological benefits between delayed versus immediate reconstruction and compared the physical and psychological outcomes between the different types of reconstructive surgery.[57,58,59] There has been a tendency in this literature to extrapolate the results and assume that since the majority of women with surgical reconstruction benefit from it, then all women with a mastectomy will benefit. For obvious ethical reasons it is impossible to test many of the assumptions regarding the benefits of surgical reconstruction after mastectomy through a double-blind clinical trial with a control group. However, women who decide to have surgical reconstruction are self-selecting. Many could have reported satisfaction with their surgery either because they had a prior psychological necessity to receive the benefits resulting from the surgery (some of which cannot be achieved through other means) or, if not fully pleased with the results, could have been motivated in retrospect to rationalize and justify their decision to undergo the surgery.

In general, breast reconstruction is intended to provide psychological benefits, but evidence suggests that the question of who benefits from reconstructive surgery is far more complex than surgeons have supposed. A review of the literature concerning the psychological aspects of breast reconstruction found, "...methodological flaws with much of the existing research in this area, in particular the reliance on retrospective designs and the inappropriate use of randomized controlled trials." It concludes that, "...the widespread assumptions regarding the psychological benefits of reconstructive surgery remain largely unsupported by sound research evidence."[60]

Whether a woman undergoes surgical reconstruction is influenced by such factors as her age, her tumor type and characteristics, stage of disease, family income, insurance status, ethnicity, geographic location, and type of hospital where she received treatment.[61]

Additionally, a woman's use of coping styles, such as positive problem solving, escape/avoidance, and seeking social support, shape her behavior and ultimately the decisions she makes. Other important influences are the opinions of the oncologist and healthcare team members and the quality of the patient/doctor communication.[6]

In plastic surgery literature, breast reconstruction is claimed to be a viable option for the majority of women with breast cancer. The rate of surgical reconstruction is considered to be too low and reconstruction is seen as an underused option. Articles call for the need for greater physician and patient education on the benefits of surgical reconstruction.[16,61]

A call for better advocacy in relation to external breast prostheses was not found in the literature. In fact, an article in a clinical psychology journal states that "...women with reconstruction do , indeed, experience what many report as the main benefits of reconstruction -- greater ease in clothing style and convenience -- and the escape from wearing a prosthesis."[62]

In a study of women with lumpectomy, mastectomy alone, and mastectomy with reconstruction, a majority of women in both mastectomy groups -- those wearing a prosthesis and those with reconstruction -- were satisfied with their method of restoring their premastectomy appearance. It seems that women in both groups made choices based on their individual needs and were, as a result, content with those choices.[14] However, in another study, more of the women who had chosen surgical reconstruction after mastectomy felt cancer had had a negative impact on their sex life.[63] Additionally, another study established that although some studies report a mastectomy having a negative impact on measurements of body image, quality of life encompasses more than body image, and studies of quality of life have shown that women who have a mastectomy alone report a greater quality of life.[64]

Literature on breast cancer demonstrates that the experience of breast cancer is multidimensional. A woman's response to the loss of a breast is individual and predicated by many factors. No one method of restoring the missing breast is suitable for all women. Accordingly, it is incumbent on researchers to subject women's experience of external breast prostheses to the same rigorous and detailed examination that occurs in surgical reconstruction and other breast cancer-related fields. It is unfortunate that -- due to the absence of sound, applied research and development -- an external breast prosthesis is currently viewed by many in the medical community as an inferior choice or an option that women choose despite its many shortcomings.

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