When You Need a Breast Prosthesis

Yesterday was my annual pick out your new breast prosthesis day at the Underneath It All boutique. In my case, it was pick out breast prostheses as I had a bilateral mastectomy.

I met with Kate Rubien, a Certified Mastectomy Fitter in the privacy of a comfortable, attractive fitting room in Underneath It All, a custom boutique specializing in products for women who have had breast surgery. Underneath It All is located in the NYU Clinical Cancer Center, NYC, where I continue to be followed since my surgery in 2009. Underneath It All is accredited  by the American Board for Certification for Orthotics and Prosthetics and recognized by Medicare.

While many women are opting for reconstruction following a mastectomy or bilateral mastectomy, there are still a substantial number of us who chose and continue to choose not to have reconstruction. This post is not about reconstruction vs no reconstruction but it is about how and where to shop for a breast prosthesis(es) and how to pay for it.

It may not seem that information about breast prosthesis would need to be posted, but having met with 100′s of women who were stuffing their bras with  tissues or socks or cotton pads, I know it still needs to be said.

Sadly, many of the women I met with were not told, following a mastectomy, that they could get a prescription from their surgeon for a breast prosthesis (es), which most private insurance companies, Medicaid and Medicare would cover with little or no cost to them. No one explained the process to them.

To begin the process:

• Contact your insurance company and confirm that your policy covers a breast prosthesis(es), Medicaid and Medicare recipients are covered.
• If your cancer center/hospital  does not have a shop where you can get fitted for a breast prosthesis(es), ask you doctor’s nurse for a list of accredited shops.
• Call to make an appointment for a fitting. Be sure to ask if they accept your insurance plan and if there is any cost to you, such as a co-payment for a breast prosthesis
  

Getting a breast prosthesis(es) that is a good fit depends on having a certified fitter and being fitted in an accredited shop.

Once at the shop, your fitter will be able to tell you what your insurance covers initially and what you are entitled to annually thereafter. Ask your fitter about what materials the breast prosthesis(es) come in and try all to see what is the most comfortable, stays in place and is a good balance with your own remaining breast.  The hollow breasts are great for a swimsuit and for every day use in the warm months. A full breast can feel better in the some clothing and balance better with your natural breast.

Breast prosthesis come in a variety of skin colors. The bras that you use with a prosthesis also come in a variety of colors and can be plain or lacy…your choice. If you have had a bi-lateral mastectomy you can also go up or down in cup size from what you were prior to your surgery.

If you had a lumpectomy or a partial mastectomy and need a little something to balance you because your breasts are no longer a matched set, most shops  stock a partial prosthesis or what is sometimes referred to as an enhancer. You will need to check with your insurance company to see if they cover this item.

If you do not have insurance or your insurance company doesn’t cover breast prosthesis(es) and you are not eligible for Medicaid or Medicare, there are ways to get what you need at no cost, or little cost to you. Contact a shop or boutique that sells breast prostheses and ask about what they do with discontinued models that they have in stock. Ask your doctor’s nurse if she knows of organizations that have donated breast prostheses for distribution. Call the American Cancer Society or Cancer Care or breast cancer organizations and ask if they know of any organizations that distribute new or slightly used, clean, breast prostheses.

I am happy to say I now have four new, well-fitting bras and a new set of prostheses all covered by my Blue Cross, Blue Shield Medicare Advantage Plan. No, I’m not special. If, like me, you have private insurance that covers a breast prosthesis, and most do, or Medicaid or Medicare, you can get what you need to feel good about how you look!