Exploring prosthetics, reconstruction and other options after breast removal

When a woman loses one or both breasts, it is rarely by choice. Most often, it is the result of illness, medical necessity or trauma, moments where survival takes precedence over everything else.

Globally, breast cancer is the most commonly diagnosed cancer among women, according to the World Health Organisation (WHO) and the International Agency for Research on Cancer (IARC).

Data from IARC’s GLOBOCAN project shows that more than 2.3 million women are diagnosed with breast cancer worldwide every year. For many, treatment involves a mastectomy, the surgical removal of part or all of the breast tissue, either to eliminate existing cancer or reduce the risk of its spread.

Some women undergo bilateral mastectomies, losing both breasts, while others lose one and must navigate the physical imbalance that follows. Beyond cancer, breasts may also be lost or significantly altered due to severe trauma from road accidents and burns, aggressive infections, or congenital conditions that affect breast development.

Medically, the removal of breast tissue is only one part of the treatment journey. What follows often shapes a woman’s long-term quality of life. Anne Waithaka, a plastic and reconstructive surgeon, notes that survival-focused care frequently overshadows what comes next.

“We save a woman’s life, which is the priority,” she says. “But we must also ask ourselves how she lives after that. The body does not exist in isolation from the mind. When you remove a breast, you are not just removing tissue. You are altering how a woman experiences herself,” said Dr Waithaka.

International oncology bodies such as the National Comprehensive Cancer Network increasingly emphasise post-treatment quality of life as a core component of breast cancer care. Reconstructive options, including oncoplastic surgery and reconstructive or reduction mammoplasty, offer one pathway.

These procedures aim to restore breast shape and symmetry using implants or a patient’s own tissue and, in some cases, relieve physical strain caused by imbalance or excessive breast weight.

However, reconstruction is not always possible or accessible. Cost, medical contraindications, late-stage diagnosis, ongoing cancer treatment and limited specialised surgical services mean many women either delay reconstruction or opt out of it entirely.

For these women, external breast prostheses become the primary option. Breast prosthetics are artificial forms designed to replicate the size, shape, weight and contour of a natural breast. Worn inside specially designed prosthetic or mastectomy bras, they help restore balance to the body, reduce strain on the neck and shoulders, and allow clothing to fit more naturally.

“When a woman loses one breast, the body compensates in ways that can cause chronic pain,” Waithaka explains.

“Prostheses help redistribute weight. They are functional devices, not luxuries.”

In this sense, breast prostheses function much like other medical prosthetics. Just as artificial limbs restore mobility after amputation or dental prostheses restore speech and chewing, breast prosthetics address both functional and psychological needs. The National Cancer Institute notes that post-mastectomy rehabilitation tools play a significant role in long-term recovery.

Studies cited by the institute show that many women experience changes in body image, self-esteem and social confidence after mastectomy. Returning to work or public spaces can become emotionally fraught. External prostheses, while not replacing what was lost, offer women a way to reclaim control over how they present themselves and move through the world.

Historically, breast prosthetics became more widespread in the mid-20th century as cancer survival rates improved. Early prostheses were rudimentary and uncomfortable.

Over time, materials evolved. Silicone gel prostheses became common in high-income settings, closely mimicking the weight and movement of natural breast tissue. Foam and lightweight options were developed for use during healing.

More recently, fabric-based and knitted prostheses have gained attention, particularly in low-resource settings where cost and access remain major barriers.

In Kenya and across much of sub-Saharan Africa, access to post-mastectomy options remains uneven. Reconstructive surgery is often concentrated in specialised centres and dependent on insurance or personal finances.

The WHO has repeatedly highlighted the heavy reliance on out-of-pocket payments for cancer care in low- and middle-income countries, leaving many women financially strained long after treatment ends.

It was this gap that Dorcas Kunusia encountered personally. In 2011, her late sister underwent a double mastectomy after battling breast cancer. Unable to afford silicone prosthetics, she relied on improvised cloth inserts.

“She would tell me she felt like everyone could see what was missing,” Dorcas recalls. “Even when no one said anything, she felt exposed.”

That experience later inspired One Boob at a Time: Knitting 1,000 Reasons to Smile, a colleague-led initiative supported by Absa Bank Kenya. Through volunteer-driven knitting, fundraising and partnerships with cancer support organisations, the initiative produces soft, breathable knitted breast prostheses as an affordable alternative.

“It wasn’t about vanity,” Dorcas says. “It was about dignity. It was about being able to stand in front of people and feel like yourself again.”

“Colleagues across the organisation rallied behind the initiative, turning offices into crafting hubs and raising Sh222,507, which was matched under the bank’s shilling-for-shilling model,” Dorcas says.

“So far, 700 knitted prostheses have been produced, alongside the procurement of 1,000 balls of yarn to support continued production.”

“Some women hug me and cry,” Dorcas adds. “They say, ‘I finally feel whole again.’ Others tell us they’ve been using rags for years and never thought there was another option.”

Medical professionals say such alternatives matter. “Not every woman wants reconstruction, and not every woman can have it,” Waithaka notes. “What matters is informed choice. Prosthetics, whether surgical or external, are part of holistic care.”

Globally, cancer care is increasingly moving toward patient-centred models that prioritise quality of life alongside survival. Breast prosthetics, whether silicone, foam or knitted, sit firmly within that vision. They acknowledge that recovery does not end when treatment stops.

For many women, it continues in dressing rooms, workplaces, family spaces and private moments of reckoning with changed bodies.