External Breast Prosthesis Survey
This survey is open to individuals who currently wear an external breast prosthesis or have worn an external breast prosthesis in the past.
For any further comments, please use the section at the end.
All participants will remain anonymous.
1. How often do you wear your breast prosthesis? *
2. How long have you been wearing a breast prosthesis? *
3. How often do you buy a new breast prosthesis? *
4. Which company/companies did you buy your breast prosthesis from? *
5. Why did you choose to buy your breast prosthesis from this company/companies? *
6. If you no longer wear a breast prosthesis, what is the reason for the abandonment of your breast prosthesis?
If you do wear a breast prosthesis please do not answer this question. If you no longer wear your breast prosthesis please move to question 27 once answering this question.
7. Do you change the types of clothes you wear because of your breast prosthesis?
8. Do you have a selection of breast prostheses for different clothing?
9. Do you wear non mastectomy bras?
10. Do you own different types of breast prostheses? If yes, please state how they differ in the comment section at the end of the survey.
11. Do you wear a breast prosthesis that adheres to your skin or sits in a bra?
12. Would you wear a breast prosthesis that was not skin coloured? (Eg. blue)
13. How important is it that your breast prosthesis is not visible through your clothing?
Not important at all
Very important
Clear selection
14. How important is it that your breast prosthesis is lightweight?
Not important at all
Very important
Clear selection
15. How important is it that the colour of your breast prosthesis matches your skin tone?
Not important at all
Very important
Clear selection
16. How important is it that your breast prosthesis has a nipple?
Not important at all
Very important
Clear selection
17. How important is it that your breast prosthesis feels like a natural breast?
Not important at all
Very important
Clear selection
18. How important is it that your breast prosthesis matches your natural breast? (single mastectomy only)
Please do not answer this question if you have had a double mastectomy.
Not important at all
Very important
Clear selection
19. How important is it that your breast prosthesis matches your natural breast/s pre surgery?
Not important at all
Very important
Clear selection
20. How important is the comfort of your breast prosthesis?
Not important at all
Very important
Clear selection
21. How important is it that the temperature of your breast prosthesis is similar to your body temperature?
Not important at all
Very important
Clear selection
22. How important is it to be able to wear your breast prosthesis while exercising?
Not important at all
Very important
Clear selection
23. How important is it that your breast prosthesis does not cause you to sweat?
Not important at all
Very important
Clear selection
24. How important is it to be able to wear a non mastectomy bra?
Very important
Not important at all
Clear selection
25. What do you like about your breast prosthesis?
26. What do you dislike about your breast prosthesis?
27. What would you like to see improved in breast prostheses? *
28. Please make any further comments below
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