Post-Mastectomy Care: Aiding Cancer Survivors

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Patricia Metcalf, Orthotist/CMF, A Fitting Image, demonstrates placement of a breast form in a swimsuit to Mildred Holtz, mastectomy patient.
Patricia Metcalf, Orthotist/CMF, A Fitting Image, demonstrates placement of a breast form in a swimsuit to Mildred Holtz, mastectomy patient.

Every three minutes a case of breast cancer is diagnosed; every 13 minutes a woman dies from the   disease.

The good news is that breast cancer—if diagnosed early—is highly treatable. Over two million breast cancer survivors are alive in the US, and many of them are receiving post-mastectomy fitting of forms and prostheses from O&P facilities. Here are just a few of the O&P companies involved in post-mastectomy care.

A Fitting Image is a small, separate boutique under the aegis of Calumet Orthopedic and Prosthetic Co., Hobart, Indiana. "Since these survivors have gone through a very traumatic situation, we want to make them feel as comfortable as possible," said Micki Pawlowski, Calumet vice president.

An attractively decorated separate room for fitting post-mastectomy patients and women patients requiring corset and spinal bracing features a soothing feminine ambience. Patty Metcalf, a certified mastectomy fitter and orthotist, educates clients by showing a video of breast forms and how they are created, and by answering questions. Patty's warmth and concern for her clients gives them a big psychological boost.

"Since we are an O&P facility, I have the luxury of offering breast cancer survivors a wide selection of prostheses and bras instead of ‘whatever is in stock,' said Alison Kimura, CO, CMF, Total Care, Clifton Heights, Pennsylvania. "Our office offers mastectomy products ranging from prostheses and bras to camisoles and swimwear. I feel that having these choices is an important and necessary service for these women." Due to space restrictions, the facility uses a regular patient care room rather than a separate area. The company is included in the local chapter of the American Cancer Society's provider list, Kimura added.

Boland Prosthetic and Orthotic Center, Warner Robins, Georgia, offers post-mastectomy services ranging from compression sleeves to a full breast prosthesis line, according to Stephanie Molnar, CMF. "Our services not only include fitting, but also consultation and reassurance after the fitting has been completed, because we understand that this is a new experience for many of these women. They need to know that someone is there for them."

Stephanie Molnar, Boland O&P
Stephanie Molnar, Boland O&P

She added, "I extend not only my expertise in being a certified post-mastectomy fitter, but also the patience to sit and listen, when this may be all these ladies need."

The facility has a special room set aside to provide a secluded, warm environment for fitting. All the products are kept in the room during the fitting process to minimize traffic in and out of the room. "This helps show the patient that we are setting aside this time for them, and that we are focused on providing the best services and products available," Molnar said. 

In 1996 Britt M.G. Aguilar, CPO, helped create the Breast Care Center in Loma Linda, California, with the support of the Loma Linda University Cancer Institute, Loma Linda University Medical Center. The Institute also established its Breast Cancer Division in 1996, under director Carlos Garberoglio, MD, who also is one of the surgeons. The comprehensive services include pre-surgery consultation, follow-up, and provision of post-surgery custom prostheses. A private room is specially decorated to help patients feel comfortable during consultations and fittings. Bras and prostheses are designed for patients who have undergone mastectomies, lumpectomies, or edema, scar, and burn management.

The centers' brochure notes that most insurance plans follow Medicare guidelines, which include allowing two post-mastectomy bras every year and one prosthesis every two years. However, the center recommends that patients contact their insurance companies or third-party payers to determine coverage and needed authorization before scheduling an appointment.

Aguilar strongly feels that improvement in breast care services is needed throughout the country. A large need is for increased patient education, both pre- and post-surgery, she said. Better fitting of breast prostheses and bras and achievement of longer term patient satisfaction both physically and psychologically is another vital area, she added.

Artisan Orthotic Prosthetic Technologies, Tualatin, Oregon, has been in business for just over a year. The facility currently provides only off-the-shelf forms and prostheses. "We are not sure there is a huge call for custom breast prostheses," said Terri Wells, CMF. "At least, at this point we are not ready to incur the additional costs needed to provide custom forms."

Although she has not had time to do much marketing, Wells notes that she has been successful with previous patients following her to the new facility and with word-of-mouth advertising. She also receives quite a few referrals from a physical therapist who specializes in lymphedema, a mastectomy complication in which lymph fluid flow is obstructed, resulting in pain, swelling, and increased susceptibility to infection. "My goal is to have the mastectomy portion of our business more profitable within the next three years," Wells added.

Mahnke's Orthotics & Prosthetics, Fort Lauderdale, Florida, provides both custom and off-the-shelf breast forms and prostheses, fitted by certified mastectomy fitters, according to Jim Newberry, LPO. However, he has found that third-party insurers often consider these services non-reimbursable.

Riverside Prosthetics, Evansville, Indiana, provides post-mastectomy services with two certified fitters, Cindy Whitehurst and Stephanie Willis. "We do not see much need to provide custom-made forms, since custom-fit is suitable," noted Whitehurst.

J.J. Hill Brace and Limb Company, Gulfport, Mississippi, not only provides breast forms and bras, but also custom and off-the-shelf lymphedema sleeves and vests, turbans, bathing suits, sports bras, and nightgowns, according to Dawn Hill, BOCO, CPed, CMF. Three certified mastectomy fitters care for clients, who are fitted in a separate fitting room. Two of the fitters are also orthotists.

The company also holds open houses with bathing suit sales and information for pre-mastectomy patients. "We pride ourselves on being able to give the biggest selection of mastectomy products on the Mississippi gulf coast to ensure the patient's happiness with the products they receive," Hill said. J.J. Hill Brace and Limb is included in the American Cancer Society's post-mastectomy product provider list.

Obtaining and maintaining certification is very important, Hill noted. "We think certification helps assure our patients…that we are professionals."

Breast Cancer: A Statistical Snapshot

A total of 203,500 new cases of breast cancer are expected to be diagnosed in 2002, and 39,600 women are expected to die, according to the National Alliance of Breast Cancer Organizations (NABCO). Based on current life expectancy, one in every nine women will develop the disease; in 1960 the ratio was one in 14. Men too can develop breast cancer, although it is relatively rare. In 2002, 1,500 male cases are projected to be diagnosed; 400 men are expected to die.

October is Breast Cancer Awareness Month. For more information about breast cancer and Awareness Month activities, visit the NABCO website: www.nabco.org, and the National Breast Cancer Awareness Month site: www.nbcam.org

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