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Some women who have breast cancer surgery as part of their breast cancer treatment decide not to have breast reconstruction.

They might decide they don’t want to have any more surgery than they need to treat the cancer, or that they want to be able to get back to their normal activities as soon as possible. Some women are just more comfortable with how they look and feel after the surgery to remove their cancer. Cost might also be an issue, especially for women who don’t have insurance coverage.

If a woman changes her mind later, reconstruction is usually still an option. But keep in mind that it may be easier to get the result you want if you make the decision before you have the breast cancer surgery.

For other women, breast reconstruction might be difficult, or even not possible, because of other health issues they have. For example, you might not be able to have reconstruction if you are obese or have blood circulation problems, such as from continued smoking or poorly controlled diabetes.

Women who don’t want breast reconstruction after surgery have two options:

• Using a breast form or prosthesis (inside the bra or attached to the body to wear under their clothes)
• Going flat (not wearing a breast form)

Using a breast form or prosthesis

A breast form is a prosthesis (artificial body part) worn either inside a bra or attached to the body to simulate the look and feel of a natural breast. Wearing a breast form is an option for women who have decided not to get reconstructive surgery but want to keep the same look under their clothes. If you haven’t decided about reconstruction, or are having reconstruction later, you might decide to use a breast form for a while.

Most breast forms are made from materials that try to copy the movement, feel, and weight of natural breast tissue. A properly weighted form provides the balance your body needs for correct posture and anchors your bra, keeping it from riding up. At first, these forms may feel too heavy, but in time they should begin to feel natural.

If you are planning to use a breast form, your doctor will tell you when you have healed enough to be fitted for a permanent breast form or prosthesis.

Choosing the right bra for your breast form

The right bra for you may very well be the one you have always worn. It may or may not need adjustments. If there is tenderness during healing, a bra extender (small pieces of fabric that attach to your bra fastener) can help by increasing the width of the bra so that it does not wrap around the chest too tightly. Women with large, heavy breasts can lessen pressure on shoulder straps by sliding a bra shoulder pad under one or both straps.

If you decide to wear your breast form in a pocket in your bra, you can have your regular bra altered. There are also special mastectomy bras with the pockets already sewn in. If the breast form causes any kind of skin irritation, use a bra with a pocket. If your bra has underwires, you may be able to wear it, but be sure to clear this with your doctor.

If you want to wear your prosthesis under sleepwear but would like something more comfortable than a regular bra, look for a soft bra, sometimes called a leisure or night bra. These are in most department stores.

Finding and paying for breast prostheses

Prices for breast forms vary considerably. High price doesn't necessarily mean that the product is the best for you. Take time to shop for a good fit, comfort, and an attractive, natural appearance in the bra and under clothing. Your clothes should fit the way they did before surgery.

Insurance coverage of breast prostheses is not all the same. Be sure to contact your health insurance company to find out what will be covered and how you must submit claims. Also, ask your doctor to write prescriptions for your prosthesis and for any special mastectomy bras. When purchasing bras or breast forms, mark the bills and any checks you write "surgical." Medicare and Medicaid can be used to pay for some of these expenses if you are eligible. The cost of breast forms and bras with pockets and the cost of having a bra altered might be tax deductible. Keep careful records of all related expenses.

Some insurance companies will not cover both a breast prosthesis and reconstructive surgery. That can mean that if you submit a claim for a prosthesis or bra to your insurance company, in some cases the company will not cover reconstruction, should you choose this procedure in the future. Make sure you get all the facts before submitting any insurance claims.

Going flat

Some women, who do not have reconstruction surgery, decide not to wear a breast form, either.

For most women, there aren’t likely to be any added health issues from going flat, especially if both breasts were removed. But if you’ve only had one breast removed, you might notice issues with balance, posture, or back pain, especially if you have large breasts. This is one reason some women prefer to wear a breast form – to balance out the weight on their chest. Talk to your doctor about your options if you think this might be an issue for you.

Some women might use a breast form when they are out, but not when at home. This might be because they find breast forms uncomfortable or too expensive, or just because they’re comfortable with how they look and feel without a breast form and don’t feel the need to wear one?.

If the idea of going flat appeals to you but you’re worried about what others might think, try going without a breast form in different situations, such as at home, out with friends, or while out running errands. You might find that most people won’t notice a difference. If you find you still feel self-conscious, you can always go back to wearing a breast form.

If you decide to go flat, you might want to consider wearing clothing that might help you feel more comfortable with your appearance. Try wearing tops that are not tight fitting and that have busy patterns, or layer sweaters or jackets over close-fitting tops. Scarves and shawls can also cover all or part of your chest.

Some women might like the idea of going flat but are uncomfortable about not having nipples. Some companies now make nipple prosthetics, which are made of silicone or other materials and look and feel like real nipples. They can be attached to the chest and then taken off when you choose.