Custom Breast Prostheses: Expanding the Domain of O&P
September 2008 Issue
As a physician involved in expanding the options available to women post-mastectomy, I have the pleasure of working closely with O&P professionals. Advances in CAD/CAM scanning technology have expanded options for women undergoing mastectomy surgery and for the field of O&P. However, these options are currently being limited by the lack of equitable Medicare coverage for custom-fabricated breast prostheses.
There is an initiative under way to expand Medicare coverage to offer the option of a custom-fabricated breast prosthesis to women who do not undergo surgical breast reconstruction. For many women, prefabricated silicone forms are not a medically appropriate option. Currently, Medicare pays for a custom-fabricated external prosthesis for every body part except the breast.
Passage of the 2007 amendment to the Women's Health and Cancer Rights Act, mandating payment for surgical breast reconstruction, resulted in a surgical option for women undergoing a mastectomy for breast cancer. The concept of using individually fabricated breast prostheses as an alternative to surgery is not only consistent with the legislation's intent to restore women as closely as possible to their pre-surgical condition, it is also medically appropriate. For women who are unable to have surgical reconstruction, it is inequitable not to provide the option of a custom-colored, matched, and fabricated breast prosthesis with a nipple.
Not only is it equitable to expand post-mastectomy options to include Medicare payment of custom external breast prostheses, it is also cost-effective. Given the durability of custom-fabricated prostheses and the fact that women can wear them with normal bras, the amount of money Medicare currently spends for prefabricated forms and mastectomy bras is the same as or more than the overall cost of a custom prosthesis.
Because the training and expertise required to properly evaluate and fit other prostheses is comparable to that required for custom breast scanning and fitting, such work is most appropriately done by O&P professionals.
Now is the time to ensure that this important procedure is available to Medicare recipients on the same basis as those privately insured, and that the evaluation, scanning, and fabrication of custom breast prostheses is done by certified O&P professionals.
Please join the efforts to persuade the Centers for Medicare & Medicaid Services (CMS) to expand the options available to women with breast cancer and ensure patients' needs are best met by O&P professionals.
Susan Cassidy, MD, is the president and CEO of ContourMed, Little Rock, Arkansas. For more information about this issue, e-mail: