Nipple prosthesis
Nipple/Areola prostheses (prostheses is the plural of prosthesis) are made of silicone by breast prosthesis manufacturers and anaplastologists for breast cancer survivors who were treated for breast cancer with a mastectomy. Prostheses can be worn weeks after a mastectomy, breast reconstruction, or even nipple reconstruction. As an inexpensive and convenient alternative to surgery, patients may choose to wear them anytime during treatment. Patients who ultimately find nipple prostheses thought that they should be informed of them during the consultation prior to mastectomy (Janes S 2005). Fabrication. Nipple prosthetics are made of silicone and are adhered to the  skin. There are several different types of prostheses with different benefits and costs. Benefits. The physical and emotional scars of breast cancer remain with survivors every day. Women worry less about their appearance and more about cancer recurrence and mortality (Schover L 1994). Such emotional distress can have a profound impact on living. The emotional devastation of breast cancer and a life sparring mastectomy for women can affect self-appearance, self-confidence, and most certainly intimacy. Approximately 30% of women that had a mastectomy have a decreased desire for sex (Schover L 1994), which is related to self-appearance and  self-confidence, and may or may not be related to her partner’s attraction. A healthy intimate relationship with a spouse resonates with posterity and creates a happy and loving environment for the family. Although NAC prosthetics have been around for decades, few patients are informed of the option since surgeons recommend surgery for reconstruction instead of prosthetics. Many breast surgeons and plastic surgeons have yet to even see mass-produced nipple prostheses, let alone custom nipple prostheses. Reconstruction of the breast mound is very common after surgical treatment for advanced breast cancer and significantly contributes to the psychosocial well -being and rehabilitation of the breast cancer survivor. Following a mastectomy, body image is more positive with reconstruction (Noone RB 1989). Breast reconstruction alone falls short of its restorative potential. The nipple-areolar complex (NAC) is extremely important to women, which is why so many women would like a nipple-sparing mastectomy even though the nipple renders insensate after surgery. Nipple prostheses can provide this benefit even in situations that nipple reconstruction and tattooing cannot. Generally speaking, women with only breast mound reconstruction do not have a difference in self-appearance with clothing compared to women with breast mound  and nipple reconstruction. However, women with a reconstructed NAC are more content with their nude appearance than women with only breast mound reconstruction. These women also were happier with erotic breast sensation and tissue softness than women with only breast mounds (Wellish 1985). There is also a psychological benefit of creating the NAC after the surgical reconstruction of the breast. Women with breast mound surgery and nipple reconstruction report an overall greater satisfaction with breast reconstruction, regarding the size, softness, and sexual sensitivity of the breast (Wellish 1987). Similar benefits are achievable with nipple prosthetics. Challenges. Mass-produced nipple prostheses  have been around and readily available for many years. Accessibility, for custom nipple prosthetics, remains a challenge although some manufacturers are beginning to provide services remotely using impression kits, color samples, and photographs. In the past, the greatest complaint with prosthetics is not having secure adherence. When prostheses are not adhered securely, satisfaction of prostheses is significantly decreased. In a survey conducted approximately two years after receiving the prostheses, only 67% of respondents “benefited” and only 39% still used them (Janes S 2005). Adhesion of prostheses depends greatly on the materials and fabrication techniques. Presently common are self-adhering prostheses  (mass-produced) which adhere well initially, but the adhesion weakens over a few months. Another common method of adhesion is to apply an organic based pressure sensitive adhesive to the prosthesis for each use. However, removing the adhesive is difficult and can easily tear the thin edges of the prosthesis. Most promising though is a fabrication technique where the silicone prostheses are bonded to a thin layer of polyurethane. A water-based acrylic rubber adhesive is applied to the polyurethane, and the prostheses could be adhered to the skin for up to two weeks at a time. Removing the adhesive  from the prostheses is fairly simple and is done with an alcohol swab. The edges of the prostheses remain thin and durable due to the polyurethane layer. Additionally, the water-based adhesive is gentle on the skin and is indicated for irradiated skin.