For patients who have recently undergone a mastectomy, reconstructive
options can seem overwhelming and confusing. While
breast prostheses provide a pain-free alternative to reconstructive surgery
and a more personal option than generic breasts forms, the long and tedious
casting process is daunting to many women. Recognizing this, Wendy Carter,
CFoM, LPN, pioneered the use of digital 3-D scanning to simplify the process.
Carter is the director of clinical operations at Symmetry, a division of
Ability Prosthetics and Orthotics, Inc. specializing in post-mastectomy care.
The traditional method of creating custom breast prostheses occurs in
two phases. First, plaster is applied to the bare chest wall to create a mold.
Then, a second plaster mold is created while the patient is wearing a bra with
breast forms. In total, the process can take up to 2½ hours to complete.
“If you have a patient going through chemotherapy or radiation,
wanting her to stand with her hands on her hips for that long is asking a lot.
It’s very challenging for the patient,” Carter told O&P
After working with 3-D scanning to create cranial remolding helmets,
Carter realized that the same technique could be applied to creating breast
prostheses. With the 3-D scanner, the entire casting process takes about 30
seconds to complete, and the scanner, which fits inside a rolling suitcase, can
be easily transported between Ability’s 11 offices.
First, a set of digital photos and scans are taken while the patient is
wearing a bra with breast forms in order to create the slope, protrusion and
overall shape desired for the end product. A second set of photos and scans are
taken of the patient’s bare chest wall to capture the shape, invaginations
and any scar tissue or markings that may occur on the chest. The scans are
transferred to a computer file and sent to a carver who forms a mold. The
carving is then sent to an artisan who creates the prostheses.
Many women are unaware of the benefits that custom prostheses offer when
compared with reconstructive surgery and generic forms.
“Many of my patients share that they are happy they don’t have
to go through another surgery. They won’t have to deal with the pain, and
they don’t have something foreign in their bodies,” she said.
“They can take them off whenever they want, and as the years go on, they
can change the size or shape. There is a lot of flexibility.”
The custom prostheses are made out of a silicon material and are
designed to look like a normal breast. They can be worn by attaching them
directly against the chest wall with a medical-grade adhesive, placing them in
a pocketed, post-mastectomy bra or laying them inside the patient’s
favorite store-bought bra.
“One of the biggest benefits of a custom prosthesis is that the
interface of the prosthesis fits against the chest wall like a puzzle. A lot of
women have lymph nodes removed during the mastectomy, which leaves a concave
area under the arm, and a lot of time, a basic, off-the-shelf breast form stops
before it can fill in those areas,” Carter said. “A custom breast
prosthesis doesn’t just sit in the hole—it fills in and fills out the
areas to create a natural balance.”
Symmetry has more than 32 skin tones to choose from, and patients can
even add freckles, moles, veins or other markings to their prostheses. The
prostheses are designed for women who enjoy an active lifestyle, so they are
extremely durable and easy to maintain. They can even be worn while swimming or
exercising, eliminating the need to buy several different breast forms for
According to Carter, the prostheses are covered under most health care
providers, with the exception of Medicare. If a Medicare patient wants custom
prostheses, out of pocket payment is necessary. However, the O&P industry
continues to lobby CMS to support the provision of custom breast prostheses for
Currently, Ability is one of the only O&P practices who utilize 3-D
scanning, but Carter urges others to explore the options available for creating
custom breast prostheses.
“Practices should experiment and research exactly what’s
offered. As with any O&P device, new advances are coming out every day. And
because of early detection, new patients are being diagnosed with breast cancer
every day,” she said. “The difference that I have seen in my
patients’ lives is unbelievable. Women certainly deserve what works for
them, so they can put feel comfortable with themselves. It’s doing your
patients justice to give them the best products available.” — by
Disclosure:Carter has no relevant