Development of Architected Materials for External Breast Prostheses

After mastectomy, the provision of an appropriate breast prosthesis can help to improve body image and quality of life and reduce associated emotional distress. Although up to 90% of women use an external breast prosthesis after mastectomy, little is known about their experiences and satisfaction with breast prosthesis use. Focus groups were conducted with women who had been fitted with an external breast prosthesis, breast care nurses, and prosthesis fitters to explore women's experiences of prosthesis use. Qualitative thematic content analysis of focus group transcripts indicated that whereas women's initial reaction to the prosthesis generally was negative, this improved over time. Provision of adequate information and support, characteristics of the fitter and the fitting experience, and relationships with breast care nurses and prosthesis fitters were important to women's acceptance and satisfaction with their prosthesis. The study results highlighted the key role that breast care nurses play and the underestimation of the prosthesis fitter's role. Common themes concerning the impact of prosthesis use included body image, appearance, and feminine identity. These findings have important implications for professionals involved in the delivery of breast prostheses services.

After total mastectomy, many women choose to wear external breast prosthesis rather than undergo breast reconstruction. The purpose of this study was to evaluate long-term satisfaction among external breast prosthesis wearers and the impact of satisfaction on prosthesis use. A questionnaire was designed to assess demographic information, prosthesis information provision, prosthesis use, and satisfaction with prosthesis. Fifty-nine women who had undergone total mastectomy without breast reconstruction completed the questionnaire. The majority of women (68%) were at least 5 years out from mastectomy. Approximately half (49%) of the women had received information about breast prostheses prior to mastectomy; 29% received information from the surgeon performing the operation. Frequent and prolonged prosthesis use was prevalent with 64% of participants reporting prosthesis use all the time, 6-7 days/week. Participants showed high rates (83%) of overall satisfaction. However, women who wore their prosthesis out in public only were less satisfied than more frequent wearers (50% versus 89%, chi(2) = 8.83, d.f. = 1, alpha = 0.05). Satisfaction increased over time, as women who were greater than 5 years out from mastectomy were more satisfied than women less that 5 years post-mastectomy (90% versus 67%, chi(2) = 4.43, d.f. = 1, alpha = 0.05). The vast majority of women are satisfied with their external breast prosthesis several years after mastectomy. Most women used their prosthesis all the time and overall satisfaction contributed to higher levels of prosthesis use. Given the long-term importance of external breast prostheses for women who have undergone mastectomy, a greater effort to inform patients about external breast prostheses prior to surgery is needed.

Breast loss has a negative effect on women physically, psychologically and socially. External breast prostheses can improve patients' figure physically, increase their self-confidence, and thus improve quality of life. Little is known about the knowledge of medical professionals on the use of external breast prostheses in mainland China. This study sought to examine medical professionals' knowledge of the use of external breast prostheses among breast cancer patients in China. Self-designed questionnaires were administered to 635 medical professionals specializing in breast cancer in China to examine their knowledge. Medical professionals who were older in age, those who had higher levels of education and those who had senior professional titles had a broader professional knowledge of external breast prostheses. Medical professionals who were younger in age and those who had junior professional titles thought that the patients were willing to choose direct-adhesive breast prostheses. Medical professionals who were older in age, those who had higher levels of education, those who had senior professional titles and those who had been working for many (but less than 30) years were more likely to think that patients could wear external breast prostheses shortly after surgery, and at all times except when sleeping. More highly educated doctors, head nurses and medical staffs from the East were more likely to think that patients would accept the use of high-priced external breast prostheses. Medical professionals' knowledge about the wearing of external breast prostheses is lacking. A number of factors, including age, education level, professional title, number of years working years and geographical region have different effects on medical professionals' knowledge. Medical professionals with a good knowledge of external breast prostheses, especially specialist breast nurses, can provide patients with comprehensive information about breast prostheses, assist patients in selecting the appropriate prostheses, understand patients' wearing experiences, and help to reduce patients' physical and mental distress.

This paper provides a comprehensive scoping review of external breast prostheses, an essential component of post-operative care for breast cancer patients, the most common cancer globally. Mastectomy, a frequent treatment, often leads to physical and psychological issues. External breast prostheses help improve body image and psychosocial well-being after surgery. We included studies on the views, evaluations, opinions, and experiences of women who had had a mastectomy and medical personnel regarding external breast prostheses, as well as the assessment, design, and simulation of these prostheses. A scoping review was conducted using Web of Science Core Collection, PubMed, Medline, Scopus, and Google Scholar. We reviewed relevant English research articles published in peer-reviewed journals up to December 2023, focusing on “breast cancer,” “mastectomy,” “post-mastectomy recovery,” “breast prosthesis satisfaction/dissatisfaction,” and “external breast prosthesis/prostheses.” Thirty-four studies were analyzed, covering various prosthesis types, user feedback, effects on daily activities, and new technologies and designs. This review reveals the prosthesis’ significantly positive effect on women’s lives after mastectomy, but also such persistent issues as weight, price, and body movement compatibility. Moreover, the paper suggests the potential for advances to improve comfort, aesthetics, and affordability.

: In 2012, the breast cancer estimate worldwide stood at 1.67 million new cases, these accounting for 25% of all types of cancer diagnosed in women. For 2014, 57,120 new cases are expected, with a risk estimated at 56.1 cases for every 100,000 women. The objective of this study was to analyze the satisfaction regarding the use of external breast prostheses by women undergoing mastectomy. This cross-sectional study was conducted with 76 women who used an external breast prosthesis (EBP), registered in the services of the Cuiaba Center for Comprehensive Rehabilitation, Mato Grosso, Brazil, from 2009 to 2012. Data were collected from the records of women who had requested the opening of a process of external breast prosthesis concession. Satisfaction with the EBP was identified in 56.6% of the women. Those satisfied with the EBP reported that its weight was not annoying (p<0.01). Although the women felt body sensations of stitches, pains, pulling, dormancy and phantom limb, they are satisfied with the EBP. The variable related to the displacement of the breast prosthesis during activity of everyday life has demonstrated that even though the women have reported the possibility of displacements, they are satisfied with the EBP. The satisfaction with the use of external breast prosthesis did not affect the sexuality of the women with mastectomy. Learning the specificities of the EBP, taking into consideration the satisfaction of its use, allows the rehabilitation team, by listening to their clientele more attentively, following up this woman throughout her life journey, supporting and guiding the best way of use, with an eye to her personal, emotional and social life, as well as to her self-esteem.

A good-quality external breast prosthesis and prosthesis-fitting service is an integral part of the recovery process post-mastectomy. However, this is an area of care that has minimal information or research available. The aim of this research was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. To ascertain women's own personal and subjective experiences, five focus groups with 47 women recruited through national cancer advocacy/support organizations and four Follow-up Breast Clinics throughout Ireland were conducted. As a result, five main themes emerged: (1) The fitting experience--Fitting? (2) Post-mastectomy products--Having? (3) Cost--Affording? (4) Information--Knowing? and (5) Adaptation--Accepting? The emerging themes pinpointed the impact of the fitting experience, fitting environment and the qualities of a prosthesis fitter on a woman's experience in obtaining a first or replacement breast prosthesis; the importance of the physical characteristics of the prosthesis and mastectomy bras; cost, affordability and entitlements; a lack of and perceived difficulty in getting information; and the myriad of personal and social impacts of a breast prosthesis for the woman. These findings are integral for the development of standards of practice in the fitting and supply of external breast prostheses in post-mastectomy care.

Breast prostheses are extensively employed for either aesthetic augmentation or medical aims. Clinical or subjective reasons may sometimes induce early removal; however, it is not uncommon for them to remain implanted for extended periods, often exceeding 20 years. Understanding the expected materials changes over time is crucial for deciding on their potential removal or replacement. This study examines the aging of silicone prosthesis materials, measuring the changes in the mechanical properties of the elastomeric shell and the viscosity of the inner gel after accelerated aging tests at various temperatures over a period exceeding two years. Predictive models based on the time‐temperature superposition principle enable the estimation of mechanical performance over extended timeframes, providing valuable insights into the expected durability and lifespan of implants.

Letter From the Editor: Body Image

Women experiences of using external breast prosthesis after mastectomy

As many as 90% of women who have undergone mastectomy or lumpectomy for breast cancer surgery will choose to wear a breast prosthesis. To date, there has been little systematic exploration of experiences and preferences related to wearing external breast prostheses, especially with new products. For this qualitative descriptive study, 24 women were interviewed regarding their perspectives about the conventional breast prosthesis and 19 about their perspectives regarding a newly available custom-designed breast prosthesis. Women spoke about difficulties obtaining information regarding available breast prostheses options; the awkwardness of being measured and fitted for a prosthesis, especially with seemingly untrained staff; challenges in wearing an external prosthesis; and how a prosthesis can foster increased confidence, enhanced body image and self-esteem, and a sense of normalcy. All recommended that women must make an individual decision about wearing a breast prosthesis and emphasized how important it is to have information about options early in the cancer journey. The study findings can guide oncology nurses in educating women about breast prostheses.

Background: Women after mastectomy may decide to either have a breast reconstruction or use an external breast prosthesis. Aim: The aim of the presented research was to evaluate the influence of external breast prosthesis on postural stability in women after mastectomy. Methods and Procedures: In the study 52 women after unilateral mastectomy took part. The study consisted of 4 parts: 1) anthropometric measurements; 2) measurements of upper limb circumference; 3) assessment of weight-bearing (WB); and 4) posturographic tests (PT). Outcomes and Results: Differences in the arm circumferences on the amputated (A) and non-amputated (NA) sides did not confirm the occurrence of lymphedema in limb on amputated side. The results of the WB between the A and NA body sides in both tested conditions, i.e., with open and closed eyes, showed no significant differences between the test with and without an external prosthesis. No statistically differences have been observed between posturometric parameters with and without breast prosthesis during both PT. In comparing the posturometric parameters between the PT with open and closed eyes, the sway path of the center of pressure was statistically significantly longer when eyes were closed in both conditions, i.e., with and without breast prosthesis. Conclusion and Implications: The finding show that 1) external breast prosthesis does not have a significant influence on the symmetry of loading on the A and NA body sides and on the postural stability of women after unilateral mastectomy and 2) exclusion visual control during PT increases postural instability in women after unilateral mastectomy.

The purpose of the study to assess the effectiveness of video- assisted teaching regarding impact on external breast prosthesis among post mastectomy women in a selected hospital at Kanyakumari District The purpose of the study was to assess the knowledge and attitude of post mastectomy women on external breast prosthesis before and after video assisted teaching. The study was conducted in International cancer center at Kanyakumari medical mission, Neyyoor. Purposive sampling technique was adopted. Samples were selected on the basis of inclusion criteria. Samples used were 30 post mastectomy women who were admitted at the International cancer center. The data collection tools developed for gathering the data, were a structured knowledge questionnaire to assess the knowledge of post mastectomy women regarding external breast prosthesis, five point likert scales to assess the attitude of post mastectomy women regarding external breast prosthesis. The study was based on the J.W Kenny” open system model. The research design adapted for this study was pre experimental one group pretest and posttest design. The feasibility of the study and the refinement of tools were assessed through pilot study. Findings of the study as follows in the pretest knowledge majority of the post mastectomy women that is 30(100.0%) had inadequate knowledge. In attitude the pretest of the post mastectomy women, 14(46.7%) were disagree, 12(40.0%) were uncertain, 3(10.0%) were strongly disagree, 1(3.3%) was agree and none of them had strongly agree. In the post-test, majority of the post mastectomy women that is 17(56.7%) had moderate knowledge, 11(36.6%) had adequate knowledge, and 2(6.7%) had inadequate knowledge. In the post-test, 16(53.3%) of the post mastectomy women were agree, 11(36.7) were uncertain, 2(6.7%) were strongly agree, 1(3.3%) were disagree and no one had strongly disagree. This study revealed that the video assisted teaching was effective in improving the knowledge and attitude on external breast prosthesis among post mastectomy women. Though knowledge and attitude of post mastectomy women were significantly improved with highest mean improvement, there was some lagging noted because of unavailability of adequate resources in the oncology unit. So we strongly recommend to conduct the in service education programme to upgrade the knowledge.

Breast cancer is one of the most common types of cancer affecting women. Despite advancements in early diagnosis, neoadjuvant therapy, and various treatment modalities, mastectomy remains a common procedure for many women. Although some women opt for reconstructive surgery (BR), many do not have the indication, desire, or opportunity to undergo this procedure. An easily manufactured, washable, lightweight, and inexpensive external breast prosthesis (EBP) model was developed specifically for the study. Participants were presented with five EBP models-one commercially available, three manufactured options, and one created for the study-and were asked to choose a prosthesis. We also evaluated the factors associated with non-adherence to EBP among women who had undergone mastectomy without BR. The chi-square test was used to assess adherence or non-adherence to EBP, while logistic regression was used to identify factors associated with non-adherence. We introduced a low-cost, lightweight, washable EBP model. When participants were asked to choose between two prostheses, the silicone prosthesis was the first choice for 33.9% of the participants, while the prosthesis created for the study emerged as the second choice for 70.5%. Out of the 72 women assessed, 45.8% (33) opted not to use any of the EBP models. Our analysis revealed that age and BMI were significantly associated with non-use of EBP. Multiple barriers contribute to non-adherence to EBP, underscoring the need for interventions aimed at improving patient knowledge and adherence. This study introduces a lightweight, easily reproducible, and low-cost EBP model.

The major impact of mastectomy is on the self-image and the mental status of patients, which may negatively affect their quality of life. External breast prosthesis (EBP) gives the woman a better shape as it takes the shape of the lost breast. This improves her confidence, looks and general disposition. We assessed EBP awareness among mastectomy patients, its availability and affordability in the Eastern region of Nigeria. The survey was conducted among mastectomy patients attending clinics at University of Nigeria Teaching Hospital Enugu, Federal Medical Centre Owerri and Federal Medical Centre Umuahia, all in South East Nigeria. A total of 32 mastectomy patients filled out questionnaires designed to obtain relevant data on knowledge of existence, availability and affordability of EBP in three big cities in South Eastern Nigeria. Data were analysed using the Statistical Analysis Software Version 8.2. Result showed only half (50%) of the participants were aware of the existence of EBP. Out of 32 patients, 23 (71.9%) were not using EBP and only 9 (28.1%) were currently using EBP. The majority of the participants (85.7%) do not know where and how to get EBP and therefore do not have access to EBP, while 4.8% cannot afford EBP.Contribution: There is poor awareness of the existence of EBP among breast cancer survivors. Consequently, there is poor usage of this device which otherwise, would help to restore self esteem in this population. The study exposed the need for awareness creation on the existence of EBP.

Resources that help people with some disability to perform their daily tasks are named as assistive technology. The devices under this denomination are listed in an ISO standard (ISO 9999:2016), and this organization is due, in part, to the efforts of the industry and governments to know exactly what can be called so. Breast forms (external breast prostheses) are included in that normative. There is also a part in that standard dedicated to undergarments, where bras can be found. Even healthy women with no disability at all may benefit of better built bras, as some of them are more carefully developed that the regular off-the-shelf offered by fashion brands or commercial shops. In order to improve the quality of such aids or supports, this manuscript registers the process of verifying the possibility of using low-cost sensors to acquire 3D images of the breasts. The technology itself is studied by doctors, interested in evaluate the volume and the shape of that region in order to perform more precise breast reconstruction surgeries (after a mastectomy), or to check the results of the work already done. The Golden standard that they use are 3D scanners that cost thousands of dollars, not affordable by all countries or hospitals. This is the reason why this study tested the reliability of three low-cost equipment: to check the feasibility of using them broadly to manufacture better external breast prostheses and bras, respecting the human anatomy as any product that claims to be ergonomic should do. Using the plaster replica of a patient’s breast as reference, researchers gauged the 3D images and checked their index error. A geometric solid was also put in the scene with the same goal. Asus Xtion Pro™, connected to a notebook using Skanect™ software, Structure Sensor™, in the same condition, and the same Structure Sensor™, then connected to an iPad™ 2 were the gadgets used to evaluate the possibility of using low-cost systems (less than US$ 2000,00) to acquire 3D images of the breast region. The most important advantage to science, besides the quality of assistive technology to be offered, is the popularization of technology and the portability of said low-cost equipment. The main downgrade of all three equipment – when compared to high end ones – is the lower quality of the tridimensional mesh they generate, but still reliable, although needing some post processing manipulation. KeywordsAssistive technology3D scanExternal breast prosthesisErgonomic designBreast volumeLow-cost 3D imagingBra fittingPopularization of technologyHollow breast prosthesis