The Fight for Custom Breast Prosthesis Rages On

  Susan O. Cassidy, MD, JD
  Susan O. Cassidy

Susan O. Cassidy, MD, JD, is just one woman fighting for
a cause. She is a physician and a lawyer, but also serves as an advocate. She
speaks on behalf of those who have breast cancer.

Cassidy is just one woman, marching up and down Capitol
Hill with a bag filled with breast prostheses for meetings with senators and
representatives, to show them the options available to women who have had
mastectomies after breast cancer. Most have agreed that the prefabricated
selections are not acceptable as an only alternative to surgery.

Perhaps the ability to define the line between medically
necessary and unnecessary lies in the coverage provided by CMS and the
Department of Veterans Affairs (VA). The VA offers patients a choice between
reconstructive surgery or a custom-fitted breast prosthesis. Medicare, however,
provides coverage for a custom-fitted prosthesis for every missing body part
with the exception of a woman’s breast.

Many private third-party payers, too, have begun to
limit their patients’ access to this option, Cassidy, who serves as acting
president and chief executive officer at ContourMed in Little Rock, Ark., when
she’s not in the Capitol, said. One large third-party payer in particular
recently ceased coverage for custom breast prostheses. The company found that
to be a way to cut costs in a fledging economy, and justified it because
“Medicare set a discriminatory standard,” Cassidy said.

In Cassidy’s medical opinion, breast reconstruction
that involves the patient’s own body tissue is the best surgical option.
Surveys have shown that the women who are the happiest with their
post-mastectomy choices are those who opted for the body
tissue reconstruction instead of implant reconstruction, she said. Although the
body tissue procedure requires a more prolonged recovery time, it is a
once-and-done option; implant reconstruction, on the other hand, comes with the
risk of rupture during routine mammograms and requires replacing the silicone
and saline implants, possibly more than once.

“What are we going to do with these women when
they’re 70 and 80 years old? Are we going to put them on the [operating]
table to replace these implants? Are we out of our minds?” she asked.

In addition, the FDA recently released a warning in
light of 50 or more cases of anaplastic lymphoma that developed around the scar
tissue and the inflammatory reaction of the capsule of implants, she told
O&P Business News.

“We’ve never really established the safety of
silicone implants in cancer patients, yet we are putting them in women every
single day,” she said.

Congressional legislation is set to be introduced within
the next few weeks that will provide the option of a custom fabricated breast
prosthesis for women post-mastectomy. Similar to the type of language in the
Women’s Health and Cancer Rights Act, which designated a woman’s
right to reconstruction after mastectomy, the proposed legislation will provide
women with a third option for replacing a breast after mastectomy: the custom
breast prosthesis. The update would apply only to Medicare standards, but the
expectation is that private third-party payers will follow suit.

This legislation would potentially create jobs in the
O&P profession, she said, as more patients chose custom prostheses instead
of surgery or prefabricated items. The threat to both post-mastectomy fitters
and to breast care manufacturers is the increasing number of surgical patients
who never need prosthetic intervention. One breast surgeon who spoke with
Cassidy said that 90% of post-mastectomy patients at a major East Coast
hospital undergo reconstructive surgery despite the fact that most women facing
mastectomy at that institution start out not wanting reconstruction. Their
change in decision is due to their refusal to wear the prefabricated forms and
required pocketed bras.

The proposed custom prostheses would last approximately
5 years. In a 10-year period, the patient would be allowed two.

“Post-mastectomy fitters might not appreciate that
women using custom breast prostheses will still need bras that fit well and
provide support for the prostheses. Most patients undergoing reconstructive
surgery never receive a referral for post-mastectomy bra fitting,” she

Cassidy has the support of numerous organizations —
including the American Society of Breast Surgeons, the AugMe Foundation, and
veterans’ and seniors’ groups — but said she hopes for
additional support from O&P professionals and the industry’s major

“It’s their members who are going to be well served by
this,” she said. — by Stephanie Z. Pavlou

Leave a Reply

Your email address will not be published.