Subjective Sensation and Objective Body Physiology Responses of

Breast Prosthesis in Dry and Wet States among Korean Women

without a History of Breast Cancer

Hee-Sun Oh

, Hee-Kyoung Oh

Seoul National University Research Institute of Nursing Science,

Soongsil University Research and Business Development Foundation,

Keywords: Breast Prosthesis, Breast Cancer in Women, Objective Human Physiological Responses, Subjective Sensory,

Dry and Wet Condition

Abstract: In order to contribute to the development of breast prosthesis products for breast cancer patients in Korea,

this experiment was conducted with 9 participants from June to July 2018, in Seoul, Korea. The breast

prosthesis consisted of three kinds of material: silicone breast prosthesis 1, silicon breast prosthesis 2 and

silk fabric breast prosthesis 3. Subjects were evaluated by touch in a dry state without water and a wet state

with 30~35degree hot water. Evaluation was performed using Schuhfried's biofeedback 2000x-pert wireless

multi-module for measuring skin conduction level, skin temperature, and blood flow. Subjective sensory

evaluation including thermal sensation, humid sensation, and feeling of comfortable was implemented with

the scale test. Results showed that there was no significant difference in an objective human physiological

response according to the state of dry and wet. However, there was a significant difference with subject

sensory perception in dry and wet. Furthermore, the breast prosthesis made with silk fabric, the humid

sensation was significantly higher in the wet state whereas a thermal sensation and feeling of

comfortableness were not significantly difference between dry and wet. Therefore, this study suggests that

researchers develop and apply other materials like silk for breast cancer patients.

1 INTRODUCTION

Today, breast cancer is the second most common

cancer for woman in Korea. In 2014, the number of

Korean women experiencing breast cancer was

16,521 people, which is more than four times higher

than the 3,801 people in 1996, 15 years ago.

However, breast cancer is relatively well treated and

overall has a high survival rate of over 90.0% when

detected early (National Cancer Information Center,

2013). In the case of breast cancer in the West, the

incidence is high in women after menopause.

In Korea, it highly occurs in women in their 40s

who are most active in family and society (Breast

cancer white paper, 2013). Thus, the increase of the

breast cancer’s incidence in a relatively younger age

group means that these women live longer as breast

cancer survivors. When breast cancer progresses,

more than half of breast cancer patients still need

complete mastectomy (Glaus & Carlson, 2009).

While this is a life-saving procedure for the breast

cancer patient, the loss of one or both breasts may

cause mental shock due to physical changes and

cosmetic damage (Kim et al., 2006). In other words,

it is not merely a re-sectioning of a part of the

biological body, but impacts the breast, with its

symbolic meaning of femininity, hence the

experience of stress as the appearance of the body

and the identity of femininity are both impacted

(Kwon & Yi, 2012). Therefore, in order to improve

physical image and quality of life, emotional stress

should be reduced for the patients (Roberts et al.,

2003). The use of breast reconstruction or using of

breast prostheses after mastectomy is helpful in the

recovery process of breast cancer survivors

(Gallagher et al., 2010). Due to the problem of

multiple operations for breast reconstruction and the

burden of cost, some breast cancer survivors have

chosen breast prosthesis over cosmetic surgery

(Baron, 2007).

Breast prostheses are produced in a variety of

sizes, shapes, and nipple types, so that women of all

ages can choose a breast that is almost identical to

Oh, H. and Oh, H.

Subjective Sensation and Objective Body Physiology Responses of Breast Prosthesis in Dry and Wet States among Korean Women without a History of Breast Cancer.

DOI: 10.5220/0008394100002442

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 21-29

ISBN: 978-989-758-413-8

their own (Glaus & Carlson, 2009). However, in the

case of Korea, most Korean woman who have had a

mastectomy use silicone breast prosthesis imported

from western countries. The wearing of silicone

breast prostheses in summer, with its high humidity,

is uncomfortable due to the creation of sweat inside

the device, making some breast cancer patients

avoid breast prosthesis (Oh, 2016a; Oh, 2016b).

Therefore, it is necessary to develop a functional

breast prosthesis that is comfortable even in the high

humidity of a Korean summer.

In order to improve the quality of breast

prosthesis for breast cancer patients, this study

showed the reality of physical and physiological

discomfort to discern the differences in materials for

breast prosthesis.

2 METHODS

This experiment was exempted from IRB and it was

conducted in the clothing laboratory (26 ± 1 %, 50 ±

10% RH) of the university from June to July 2018,

Seoul, Korea. A total of 9 female Korean

participants in their 40s without a history of breast

cancer and no experience with breast prosthesis

participated. The subjects could participate in the

experiment 2 hours after eating and the 3 kinds of

breast prostheses were touched with the left hand.

Breast prosthesis 1 is a silicone prosthetic by T

company, Breast prosthesis 2 is a silicone prosthetic

by S company, and Breast prosthesis 3 is handmade

product of silk fabric (Table 1). Subjects were

evaluated by touching the prostheses under 2 kinds

of conditions: First, they were touched in a dry state

without water and secondly, in a wet state with 30 ~

35 degree hot water to replicate sweat.

The contents of the experiment are an objective

human physiological responses evaluation and

subjective sensory evaluation. The former was

performed using Schuhfried's biofeedback 2000x-

pert wireless multi-module for measure skin

conductance level (SCL), skin temperature (TEMP),

blood volume pulse (BVP), and pulse (Puls). The

measurement was performed automatically at

intervals of 0.038 sec., or 1578 times per minute.

The sensor was attached to the right hand of the end

of the third finger using a Velcro band. The

measured data output used Biofeedback 2000xpert

Tele-BFB ver. 2.0 software. Meanwhile the latter as

thermal sensation (7 scale), humid sensation (4

scale), and feeling of comfortableness (4 scale) was

implemented via survey method (Table 2). As the

number increases, thermal sensation and humid

sensation refers to heat or humidity, and the feeling

of comfortableness means greater or less comfort.

Prior to questioning, the definitions of thermal

sensation, humid sensation, and feeling of

comfortableness were defined

Table 1: Three kinds of breast prosthesis for experiment.

AINC 2018 - Aceh International Nursing Conference

Table 2: Subjective sensory evaluation.

All quantitative data for objective human

physiological responses evaluation and subjective

sensory evaluation were expressed as mean and

standard deviations (Mean, ±S.D.). In order to

analyze the touch evaluation for dry and wet breast

prostheses, a Kruskal-Wallis Test was performed for

the 3 conditions--dry, wet, and no touching status

with three kinds of breast prosthetics. Once a

significant main effect was found, a post hoc

analysis using the Mann-Whitney U-test was

undertaken. All statistical analysis of experimental

data was carried out using SPSS (Version 24.0,

SPSS Inc., USA).

3 FINDINGS

3.1 Dry, Wet, and No Touching

The experimental results showed that there was no

significant difference in an objective human

physiological experiment between the state of dry

and wet. However, table 3 shows the mean and

standard deviation of objective human physiological

response as skin conduction level, skin temperature,

blood flow and pulse for breast prosthesis, as well as

and p-values in dry, wet, and no touch conditions

by a Kruskal-Wallis Test. It reveals a statistically

significant difference. Skin temperature was higher

for the no touch breast prosthesis than dry and wet

conditions χ

=10.900, p< .01; in other words, when

subjects touched a breast prosthesis under dry and

wet conditions, it made a lower skin temperature

than no touch (Fig. 1). In order to ascertain which of

the breast prostheses is statistically significantly

different from the other in conditions of dry, wet and

no touching, a Post hoc analysis was conducted. The

result of the Mann-Whitney U-test revealed

statistically significant differences for all three kinds

of breast prosthesis with no touch under dry

conditions χ

=15.998, p< .01, <Fig 2>. But in wet

conditions, breast prosthesis 1 was only significantly

different with no touching χ

=14.222, p< .01. Breast

prosthesis 2 and breast prosthesis 3 were not

significantly different with no touch (Fig 3).

Table 3: Result of measurement for objective human physiological responses from touching abreast prosthesis in dry

conditions and wet, and no touch.

** P<.01

Thermal sensation very hot (3) hot (2) warm (1) normal (0) little cold (-1) cold (-2) very cold (-3)

Humid sensation very humid (3) little humid (2) little humid (1) normal (0)

Feeling of comfortable comfortable (3) little uncomfortable (2) little uncomfortable (1) uncomfortable (0)

M ean (SD) M ean (SD) M ean (SD)

SCL(us) 0.424 (0.201) 0.418 (0.184) 0.292 (0.189) 3.877

Temp(

℃

) 31.442 (2.936) 31.991 (3.054) 34.409 (0.905) 10.900 **

BVP(ml/m/n/100g) 49.286 (0.147) 49.347 (0.196) 49.205 (0.288) 1.384

Puls(bbm) 72.250 (8.352) 73.649 (8.521) 78.035 (9.256) 2.725

breast prosthesis

condition

objective human

phy siological resp onses

dry wet No touching

Subjective Sensation and Objective Body Physiology Responses of Breast Prosthesis in Dry and Wet States among Korean Women without

a History of Breast Cancer

P<.05, ** P<.01

Figure 1: Result of measurement for skin temperature with touching a breast prosthesis in dry and wet conditions, as well

as no touching.

Meanwhile, Table 4 shows the mean and standard

deviation of objective human physiological response

for three kinds of breast prosthesis χ

and p-values

in touching under dry and wet conditions and no

touching by the Kruskal-Wallis Test. It reveals a

statistically significant difference in skin

temperature between touch conditions and no touch

for breast prostheses. Skin temperature was higher in

no touch breast prostheses than in touching for all of

the three breast prostheses. In order to ascertain

which of the breast prostheses were statistically

significantly different from one another in the

condition of touch/ no touch, a Post hoc analysis was

conducted. The result of the Mann-Whitney U-test

revealed statistically significant differences for

silicone breast prostheses than no touch under dry

conditions χ

=12.673, p< .01. The silk breast

prosthesis did not show any significant difference.

Table 4: Result of measurement for objective human physiological responses from touching breast prosthesis 1~3, and no

touching

** P<.01*

M ean (SD) M ean (SD) M ean (SD) M ean (SD)

SCL(us) 0.38 (0.199) 0.49 (0.221) 0.39 (0.135) 0.29 (0.189) 5.912

Temp(

℃

) 30.91 (2.731) 31.88 (3.299) 32.35 (2.864) 34.41 (0.905) 15.998 **

BVP(ml/m/n/100g) 49.33 (0.240) 49.34 (0.174) 49.29 (0.075) 49.21 (0.288) 0.704

Puls(bbm) 73.17 (8.965) 73.20 (8.895) 72.48 (7.952) 78.04 (9.256) 2.717

Breast prosthesis 3 No touching

breast prosthesis

condition

objective human

phy siological resp onses

Breast p rosthesis 1 Breast prosthesis 2

31.44

31.99

34.41

dry wet no touching

(℃)

AINC 2018 - Aceh International Nursing Conference

** P<.01

Figure 2: Result of measurement for skin Temperature with touching breast prosthesis 1 ~ 3, and no touching it.

3.2 Subject Sensory Perception under

Dry and Wet Conditions

Table 5 presents the average values and standard

deviations for the subject sensory evaluation as

thermal sensation, humid sensation, and feeling of

comfortableness along with χ

and p-values of dry

and wet conditions by Paired-samples t-tests. They

revealed a statistically significant difference in all

three values. Thermal sensation is significantly

higher in wet conditions than dry t =-4.108, p< .001,

and humid sensation is significantly higher in wet

conditions than dry t =-5.851, p< .001. However,

feeling of comfortableness is significantly higher in

dry conditions than dry t =6.248, p< .001. This

shows that, in the wet condition, the touching of the

breast prosthesis regarding thermal sensation and

humid sensation is higher than under dry conditions,

but the feeling of comfortableness is lower than

under dry conditions.

Furthermore, in order to know which of the

breast prostheses are statistically significantly

different from the others, a Post hoc analysis was

conducted. The result of the Mann-Whitney U-test

revealed a statistically significant difference with

each of the three kinds of breast prostheses in

subject sensory evaluation. Breast prosthesis 1 had

significantly higher thermal sensation in wet

conditions than dry χ

=5.913, p< .001, but the

feeling of comfortableness was significantly higher

in dry conditions than wet χ

=14.069, p< .001.

Breast prosthesis 2 had significantly higher thermal

sensation in wet conditions than dry χ

=10.971,

p< .001, and also the humid sensation was

significantly higher in wet conditions than dry χ

=9.946, p< .01 but a feeling of comfortableness was

significantly higher in dry conditions than wet χ

=11.306, p< .01. Breast prosthesis 3 had only a

significantly higher humid sensation in wet

conditions than dry χ

=7.344, p< .01, Breast

prosthesis 1 and breast prosthesis 2 had significantly

higher thermal sensation in wet conditions than dry t

=-2.921, p< .05, t =-5.289, p< .001, and humid

sensations higher in wet condition than dry t=-2.292,

p< .05, t =-5.096, p< .001, but the feeling of comfort

was higher in the dry condition than wet t=7.019,

p< .001, t =5.541, p< .001. However, in the case of

the breast prosthesis made with silk fabric, the

sensation of humidity was significantly higher under

wet conditions than dry t=-3.377, p< .01. There was

no significant difference between the thermal

sensation and feeling of comfort between dry and

wet states.

30.91

31.88

32.35

34.41

Breast prosthesis 1 Breast prosthesis 2 Breast prosthesis 3 No touching

(℃)

Subjective Sensation and Objective Body Physiology Responses of Breast Prosthesis in Dry and Wet States among Korean Women without

a History of Breast Cancer

Table 5: Result of survey for subjective sensation evaluation from touching breast prostheses in dry and wet conditions.

* P<.05

Figure 3: Result of survey for subjective sensation evaluation from silicone breast prosthesis 1.

** P<.01

Figure 4: Result of survey for subjective sensation evaluation from silicone breast prosthesis 2.

‐1

thermal sensation humid sensation feeling of comfortable

Silicone breast prosthesis1

dry wet

‐1

thermal sensation humid sensation feeling of comfortable

Silicone breast prosthesis2

dry wet

Mean (SD) Mean (SD)

thermal sensation -0.26 (1.163) 0.92 (0.830) -4.108 ***

humid sensation 0.52 (0.643) 1.96 (1.083) -5.851 ***

feeling of comfortable 2.30 (0.609) 1.08 (0.776) 6.248 ***

dry wet

condition

Subjective sensation

AINC 2018 - Aceh International Nursing Conference

** P<.01

Figure 5: Result of survey for subjective sensation evaluation from silicone breast prosthesis 3.

4 DISCUSSION

It is important to maintain lower humidity for

breasts prosthetics as this affects the quality of life

of breast cancer patients. Tamura (2008) and Yatagai

et al. (2012) showed that the temperature and

humidity of a brassiere were the same in the right

and left breast in healthy women. But in case of

breast cancer survivors, the surgery part of breast

side was higher in these than the healthy breast side.

A mastectomy patient particularly is clearly different

with a partial resection. The reason for the high

temperature and humidity in brassieres of breast

cancer patients is that they wear silicone breast

prostheses, which does not have hygroscopicity and

moisture permeability. The other reason is that

radiation therapy for breast cancer creates a loss

sweating functions in the skin, increasing dryness

around the breast, and therefore, in the side of the

brassiere with a silicone breast prosthesis,

temperature is higher.

Most Korean breast cancer patients wear

imported silicone breast prostheses. The purchase of

the breast prosthetics is often directly introduced in

hospital in Korea, but there are many cases where it

is necessary to find products personally, creating

hassle in the purchasing procedure and the

inconvenience caused by this, which is not taken

under consideration (Choi & lee, 2001; Kim, 2004).

In Korea, wearing breast prosthetics in summer, with

its high humidity, is highly uncomfortable due to

heat, sweat, and moisture. Experimental results

showed no significant difference in objective human

physiological responses evaluation as skin

conductance level (SCL), skin temperature (TEMP),

blood volume pulse (BVP), and Pulse (Puls) under a

dry or wet status. However, the result of comparing

with touch under dry conditions and wet breast

prosthesis and no touching, the no touching

temperature average was 34.409 (SD = ±0.905),

significantly higher than the touching of breast

prosthesis. It is considered that the body skin

temperature without breast prosthesis is significantly

higher than the touching of breast prosthesis. For

this study, the breast prostheses materials were at a

temperature of 27  in the laboratory, and, in order

to replicate a breast prosthesis with sweat, the breast

prosthesis was soaked in hot water at 30 to 33 .

The breast prosthesis with silicone material was

lower in temperature than the silk fabric breast

prosthesis. According to the Morooka (2015)

experiment, the humidity of the silicone breast

prosthesis was almost zero in hygroscopicity and

moisture permeability, while cotton material was

higher than silicone. Meanwhile, there was a

significant difference between silicone breast

prosthesis 1, silicone breast prosthesis 2 and no

touching in objective human physiological responses

evaluation. There was no significant difference in

touching the silk fabric breast prosthesis and no

touch.

The results of this survey for subjective sensory

perception of silicone breast prostheses found that

they were less comfortable in wet conditions than in

‐1

thermal sensation humid sensation feeling of comfortable

Silk fabric breas t prosthesis3

dry wet

Subjective Sensation and Objective Body Physiology Responses of Breast Prosthesis in Dry and Wet States among Korean Women without

a History of Breast Cancer

dry conditions. However, the silk fabric breast

prosthesis was found to have no difference in

dryness and wetness in terms of comfort. Mooroka

(2015) showed that a breast prosthesis should be

characterized by high moisture, and that such

materials are good for breast prosthetics for women

who have undergone a mastectomy.

Silk is very skin-friendly. Silk is composed of

fibroin (70 ~ 75%) in the middle and is surrounded

with sericin (25 ~ 30%). These are 85% or more

protein. Fabric is made from the fibroin remaining

after dissolving sericin by hot water extraction. It is

composed of more than 90% of amino acids such as

glycine, alanine, serine and tyrosine, etc. It is known

that when attached to the skin surface with an extra-

humidifying ability, it maintains the moisture

required by the skin and activates collagenase in the

cells to help skin fibrosis. It also has the function of

holding or releasing moisture by temperature and

humidity. Recently, due to the rapid development of

the applied biomedical industry, silk has also been

studied for various bio applications as a very

friendly component to the human body as a protein

resource material. As such, breast prostheses should

not be limited to silicon as they are now, but can be

produced in various forms such as with human-

friendly materials.

5 CONCLUSION

In order to contribute to the development of products

for breast cancer patients in Korea, this experiment

was performed with nine female Korean participants

in their 40s who did not have a history of breast

cancer using three kinds breast prostheses. In Korea,

the most common age group for breast cancer is

women in their forties. Experimental materials were

composed of silicone breast prostheses and one

made of silk fabric. According to objective human

physiological responses, only temperature was

significantly different between touching and no

touching of the breast prostheses. Skin temperature

without breast prosthesis showed a higher skin

temperature than touching. However, comparing

three kinds of breast prostheses and no touching,

only silk was not significantly different to no

touching of the breast prosthesis. According to

subjective sensation in touching dry and wet breast

prosthesis, the thermal and humid sensation was

significantly higher in wet conditions, but the feeling

of comfort was significantly higher in dry conditions.

Furthermore, an analysis of three kinds breast

prosthesis respectively found that the breast

prostheses of silicone and silk fabric had high humid

sensations in wet states but that the silk fabric beast

prosthesis still felt as comfortable as in the dry state.

Therefore, it is necessary to change the direction of

making breast prostheses from only concentrating on

verisimilitude in shape and touch to considering

biometric reactions such as body temperature and

moisture. This study suggests silk as an alternative

to silicone. In the future, it will be necessary to study

the application of silk as a breast prosthetic to breast

cancer patients and to study the suitability of other

natural fibers such as cotton and wool.

ACKNOWLEDGEMENT

This work was supported by the Ministry of

Education of the Republic of Korea and the National

Research Foundation of Korea (NRF-

2018S1A5A8027072)

REFERENCES

Baron, R. H. (2007). Surgical management of breast

cancer. Seminars in Oncology Nursing, 23, 10-19.

Vasconcelos, A., Freddi, G., and Cavaco-Paulo, A. (2008).

Biodegradable Materials Based on Silk Fibroin and

Keratin. Biomacromolecules, 9 (4), 1299-1305.

Breast cancer white paper. 2017. Korean Breast Cancer

Society. Retrieved from

http://www.kbcs.or.kr/journal/file/

2017_Breast_Cancer_Facts_and_Figures.pdf

Choi, H. S. & Lee, K. M. 2001. A study on the

development of mastectomy bras and breast prosthesis.

Journal of the Korean Society of Costume, 51, 5-18.

Morooka, H. Sano, K., & Yatagai, M. 2015. Water

Properties of Breast Pad Materials for Females Post

Breast Cancer Surgery from the Viewpoint of Thermal

Comfort. Journal of the Japan research association

for textiles end-uses, 56(1), 54-60.

Gallagher, P., Buckmaster, A., O’Carroll, S., Kieman, G.,

& Geraphty, J. 2010. External breast prostheses in

post-masterctom care: Women’s qualitative accounts.

European journal of Cancer Care, 19, 61-71.

Glaus, W.W., & Carlson, G.W. 2009. Long-term role of

external breast prosthesis after total mastectomy.

Breast Journal, 15, 385-393.

Kim, J. G. 2004. Body as others, the body of the

community. Seoul: Konkuk University Press.

Kim, S.H., Jun, E. Y., & Lee, W. H. (2006). The factors

influencing depression in patients with breast cancer.

Journal of Korean Oncology Nursing, 6(2), 133-142.

Kwon, E. J. & Yi, M. S. (2012). Distress and Quality of

life in breast cancer survivor in Korea. Asian

Oncology Nursing, 12(4), 289-296.

AINC 2018 - Aceh International Nursing Conference

Oh, H. K. (2016)a. Survey of clothing behavior for breast

cancer women after surgery: Comparison between a

breast conserving surgery group and a mastectomy

group. Science of Emotion & Sensibility, 19(1), 49-60.

Oh, H. K. (2016)b. Survey of Suitable Clothes for Breast

Cancer Patients-Changes in Clothing Habits Before

and After Surgery-. Journal of the Korean Society of

Clothing and Textiles, 40(3), 526-538.

Roberts, S., Livingston, P., White, V., & Gobbs. A. (2003).

External breast prosthesis use: Experiences and views

of women with breast cancer, breast care nurses, and

prosthesis fitters. Cancer Nursing, 26, 179-186.

National Cancer Information Center. 2013. Statistics for

cancer. Retrieved from

https://www.cancer.go.kr/lay1/program/S1T211C217/

cancer/view.do?cancer_seq=4757

Tamura, T. (1998). Measuring Techniques for Thermal

Comfort of Clothing. Sen'i Gakkaishi, 54(9), 313- 317.

Yatagai, M., Okabe, K., & Sato, A. (2012). A field

experimental investigation on clothing microclimate of

the women who underwent breast cancer

surgery. Journal of the Japan Research Association for

textile end-uses, 53(3), 215-220.

Subjective Sensation and Objective Body Physiology Responses of Breast Prosthesis in Dry and Wet States among Korean Women without

a History of Breast Cancer